SUPERFICIAL MYCOSIS

Pepy Dwi Endraswari, dr., M.Si., Sp.MK

Juli 2019
 1. Superfisial mycosis

Fungal infection on superficial of the skin or

hair shaft (stratum corneum)
No living tissue is invaded
No inflamation or cellular response
Patients are often unaware of their condition
 Pityriasis versicolor
• Chronic mild superficial infection of the
stratum corneum
• Caused by: Malassezia furfur
• Host responses (scaling, inflammation, and
irritation) are minimal.
• Discrete, serpentine, hyper- or
hypopigmented maculae occur on the skin,
usually on the chest, upper back, arms, or
abdomen.
• Species of Malassezia are considered part of
the microbial flora  can be isolated from
normal skin and scalp.
• They have been implicated as a cause of or
contributor to seborrheic dermatitis, or
dandruff.
 LABORATORY DIAGNOSIS
• 1. Clinical material: Skin scrapings from
patients with superficial lesions, blood from
patients with suspected fungaemia.
• 2. Direct Microscopy:
• Skin scrapings  10% KOH, glycerol and
Parker ink solution  spagety and meat ball
(yeat and pseudohyphae)
• Culture preparations are usually not
necessary.
M. furfur on skin scrapping specimen with GMS staining
(left) and KOH staining (right):
spagety and meatballs appearance
Culture
• only necessary in suspected fungaemia
• M. furfur is a lipophilic yeastin vitro growth must
be stimulated by natural oils or other fatty
substances.
• Medium:
– Sabouraud's dextrose agar with olive oil
– or Dixon's agar (contains glycerol mono-oleate)
• Rapid growth
(best growth 37 C, 3 days)
 Tinea Nigra (Tinea Nigra Palmaris)
• A superficial chronic and asymptomatic infection
of the stratum corneum
• caused by: the dematiaceous fungus Hortaea
(Exophiala) werneckii.
• More prevalent in warm coastal regions and
among young women.
• The lesions appear as a
dark (brown to black)
discoloration, often on
the palm.
 Hortaea (Exophiala) werneckii
• a common saprophytic fungus
• believed to occur in soil, compost, humus and
on wood in humid tropical and sub-tropical
regions.
 LABORATORY DIAGNOSIS
• Diagnosis:
– Specimen: Skin scrapings
– Staining KOH
Branched, septate hyphae and budding yeast cells
(2-celled yeast cells) with melaninized cell walls.
– Cultur: not necessary
 Black piedra
• Nodular infection of the hair shaft
• Caused by Piedraia hortai
• Axillary, pubic, beard, and scalp hair may be
infected.
• Treatment :
– removal of hair
– topical antifungal
agent
 LABORATORY DIAGNOSIS
• Specimen: hair with hard black nodule
• Staining with 10%KOH
• Culture: hair shaftSabouraud’s dextrose
agar  2-3 weeks black to brown colony
microscopic : septate hyphae with
chlamydoconidia appearance.
 White piedra
• larger, softer, yellowish nodules on the hairs
• Caused by: Trichosporon species
 LABORATORY DIAGNOSIS
• Specimen: hair with soft white nodule
• Staining with 10%KOH
• Culture: hair shaftSabouraud’s dextrose
agar  2-3 weeks yellowish to deep cream
colored, smooth coloniesmikros: hifa,
pseudohifa, arthroconidia, blastoconidia
 RANGKUMAN
Disease Causative organisms Incidence Clinical Manifestation
Pityriasis
Malassezia furfur
versicolor Common Hipopigmented macule

Tinea nigra Exophiala werneckii Rare black macules

Cream colored nodule on
White piedra Trichosporon beigelii Rare
hair shaft
Black piedra Piedraia hortae Rare Black nodules on hair shaft