Dermatophyto

sis
( Ring worm )
BY
Riyadh Saleh
Hamoud
 Dermatophytes
• Dermatophytes : are keratinophilic fungi –
they possess keratinase allowing them
to utilize keratin as a nutrient & energy
source
• They infect the keratinized (horny) outer
layer of the scalp, glabrous skin, and
nails causing tinea or ringworm
• Although no living tissue is invaded (keratinized
stratum only colonized) the infection induces
an allergic and inflammatory eczematous
response in the host
• Lesions on skin and sometimes nails have
a characteristic circular pattern that was
mistaken by ancient physicians as being
a worm down in the tissue
• These lesions are still today called
ringworm infections even though the
etiology is known to be a fungus rather
Classical “Ringworm”
Lesion
Tinea/Ringworm
Infection
 Possible Causes for
These Lesions
• Direct contact with a person who has
a fungal infection
• Direct contact with fungi
contaminated items (bedding
clothes, towels, brushes, etc.)
• Direct contact with soil containing
fungi
• Contact with pets that have a fugal
infection

Possible Etiologic Agents
• Microsporum audouinii (scalp and
body)
• Microsporum gypseum (feet,
hands, body, scalp, rarely nails)
• Micropsorum canis (body in adults,
scalp in children,rarely nails)
• Trichophyton mentagrophytes
(feet, body, nails, scalp, hands,
groin, does not infect hair)
• Epidermophyton floccosum (groin,
body, epidemic athlete’s foot,
occasionally nails, does not infect
 Ecology of
Dermatophytes
To determine the source of infection
Anthropophilic : associated with

humans only. Person -to-person

transmission through contaminated
objects (comb, hat, etc.)
Zoophilic : associated with animals.

Direct transmission to humans by close

contact with animals.
Geophilic : usually found in soil.

Transmitted to humans by direct

exposure



 Clinical manifestations of
ringworm infections are
called different names on
basis of location of
• infection
Tinea capitis sites of the head,
: ringworm infection
scalp, eyebrows, eyelashes
• Tinea favosa : ringworm infection of the scalp
(crusty hair)
• Tinea corporis : ringworm infection of the
body (smooth skin)
• Tinea cruris : ringworm infection of the groin
(jock itch)
• Tinea unguium : ringworm infection of the
nails
• Tinea barbae : ringworm infection of the
beard
• Tinea manuum: ringworm infection of the
hand
• Tinea pedis : ringworm infection of the foot
Tinea Capitis
Tinea Capitis
• Children most common cases.
• Most Common Organisms:
• T. Tonsurans - acounts for 90% in
U.S.
• M. Canis - seen in children with
infected animals.
• Adults not infected.
• M. Audouinii - grey, broken shaft
tinea

Tinea Capitis


• Presentations of Tinea Capitis

1.Non-inflammatory ‘black dot’ type
2.Seborrheic type
3.Pustular
4.Inflammatory (Kerion)
5.Favus is a distinctive infection with
grey, crusting lesions


1.

Tinea Capitis
l Black Dot Type :
l Large Areas of Alopecia without
inflammation
l Mild scaling
l Occipital adenopathy
l Black dot hairs.
l At first glance may look like Alopecia
areata

Hair infected by Microsporum gyseum showing
large - spored ecothrix invasion .
Tinea Capitis
 Seborrheic type :
lCommon– resembles dandruff
lClose exam for broken hairs, black
dots
lAdenopathy
lFrequently negative KOH (70%)
lCulture often necessary for DX

Tinea Capitis
 Kerion :
lInflamed, Boggy and tender.
lM. Canis common etiology
lSystemic symptoms: Fever,
Adenopathy.
lScaring alopecia may occur
lKOH often negative
lMay look bacterial

Tinea Capitis - Kerion
Tinea Capitis
 Pustular :
•Discrete pustules and crusted areas
•No significant hair loss or scale
•Often KOH negative
•Frequently treated as bacterial at first

 Tinea barbae

Tin e a b a rb a e affects
Tinea barbae
 (also known as "Barber's itch,Ringworm of
the beard,and "Tinea sycosis ) is a
fungal infection of the hair. Tinea barbae is
due to a dermatophytic infection around the
bearded area of men. Generally, the
infection occurs as a follicular inflammation,
or as a cutaneous granulomatous lesion, i.e.
a chronic inflammatory reaction. It is one of
the causes of Folliculitis. It is most common
among agricultural workers, as the
transmission is more common from animal-
to-human than human-to-human. The most
common causes are T. mentagrophytes
and T. verrucosum.
 Tinea Pedis
Athlete’s Foot Infection
Tinea Pedis
• T. Rubrum most common etiology
• Dull erythema with pronounced scale.
• Leading edge of scale not as
common.
• Two feet one hand involvement.
• T. Mentagrophytes causes
inflammatory tinea pedis
• Vesicles and bullae.

Tinea Pedis
• Groups: M > F. Young and middle aged.
• Patient is susceptible to reoccurrence
• Onychomycosis and tinea pedis associated.
• Differential:
• Eczema, contact dermatitis
• Psoriasis.
• Erythrasma and Candida (esp in web
spaces.)
• Pitted keratolysis
•
Tinea manuum
Tinea manuum
is a fungal infection of the


hand. It is typically more

aggressive than tinea pedis
but similar in look. Itching,
burning, cracking, and scaling
are observable and may be
transmitted sexually or
otherwise, whether or not
symptoms are present
Tinea Unguium – Nail
Infection
((Onychomycosis



Onychomycosis
• 15-20% of those between 40-60 yrs.
infected.
• No Spontaneous remissions
• General Appearance:
– Typically begins at distal nail corner
– Thickening and opacification of the nail
plate
– Nail bed hyperkeratosis
– Onycholysis
– Discoloration: white, yellow, brown
– Edge of the nail itself becomes
severely eroded.
• Some or all nails may be infected
• Often accompanying tinea pedis
Onychomycosis
4 Types:


1.Distal Subungal
2.White superficial
l T. Mentagrophytes and molds
l Chalky white patches
3.Proximal Subungal
l May indicate HIV infection
4.Candidaonychomycosis
l Normally hands with accompanying paronychia

Candidaisis of nail
Onychomycosis
• Differential Diagnosis: (50% of ‘thick nails’ not
classic fungus.)
• Allergic contact (nail polish, food
items)
• Psoriasis
• Lichen Planus
• Molds
• Nail dystrophies (ex – nephrogenic)
• Drugs

Tinea Corporis - body
ringworm
 General Morphology
Tinea Corporis
•
• Generally restricted to stratum corneum of the smooth
skin.
• Symptoms result form fungi metabolites such as
toxin/allergens.
• Disease found throughout the world.
• Produces concentric or ring-like lesions on skin, and in
severe cases these are raised and may become
inflamed.
• All forms of tinea corporis caused by T. rubrum, T.
mentagrophytes, T. tonsurans, M. canis, and 
M. audouinii are treatable with topical agent
containing tolnaftate, ketoconazole, miconazole,
etc...
• Disease transmitted through infected scales hyphae or
arthroconidia on the skin.
• Also transmitted through direct contact between
infected humans or animals, by fomites (any agent
such a bedding or clothing capable of retaining a
pathogen and transmitting to a new host).


• Transfer form on area to the body to another (from

Tinea faciei ) ) Tinea
Faciales
Tinea faciei
Tinea faciei : is a fungal infection of


the face
• It generally appears as a red rash on
the face, followed by patches of
small, raised bumps. The skin may
peel while it is being treated.
• Tinea faciei : is contagious just by
touch and can spread easily to all
regions of skin

 tinea cruris - ringworm of
the groin and surrounding
region
•
• More common in men than women.
• Infection seen on scrotum and
inner thigh, the penis is usually
not infected.
• Epidemics associated with grouping of
people into tight quarters - athletic
teams, troops, ship crews, inmates of
institutions.
• Several causes of tinea cruris include T.
rubrum (does not normally survive
long periods outside of host), E.
flocossum (usually associate with
epidemics because resistant
arthroconidia in skin scales can
survive for years on rugs, shower
stalls, locker room floors),
Tinea Cruris – Jock Itch
T. mentagrophytes (usually of
animal origin, such as rodents), and
Microsporum gallinae (rarely seen -
usually found on gallinaceous birds
like turkeys and chickens).
Predisposing factors include persistent

perspiration, high humidity, irritation

of skin from clothes, such as tight
fitting underwear or athletic
supporters, pre-existing disease,
such as diabetes and obesity
 Tinea
(Pityriasis)Versicolor
 Tinea
(Pityriasis)Versicolor
• Etiologic agent;
Malassezia furfur.
• Common in tropical area,
part of skin flora.
• Predisposing factors are
warmth, humidity and
immunosuppression
• Yeast grows in stratum
corneum, sebum reached
Tinea Versicolor
Clinical Manifestions
• Skin rash: oval lesions white,
brown, pink or tan, discrete and
coalescent with fine faint scale.
• Distribution : most common area
is trunk, sometimes face
forehead, and temple. Rarely
arms, neck and axila.
• Common in healthy adolescence
Tinea Versicolar
Differential Diagnosis
• Pityriasis alba.
• Vitiligo.
• Pityriasis rosea.
• Seborrheic dermatitis.
•
