Superficial fungal infection

• Mycoses

  The disease caused by fungi
• Classifications of fungal infections

  • Superficial mycoses
  • Cutaneous mycoses
  • Subcutaneous mycoses
  • Systemic endemic mycoses
  • Opportunistic mycoses
• Superficial mycoses

  • Superficial fungal infections of the skin, hair shaft and nails
  • Usually of cosmetic concern only
  • Easy to diagnose and treat
  • No living tissue is invaded
  • No cellular response from the host
• Types of superficial mycoses

  • Malassezia infections
  • Tinea nigra
  • White piedra
  • Black piedra
• Malassezia infections


  • Common conditions that do not cause serious infections
  • Characterized by frequent recurrences
  • Caused by commensal yeast of the Malassezia genus
• Factors that influence Malassezia infections

  • Oily skin
  • Heat, humidity, sweating
  • Pregnancy
  • Immunosuppression
  • Genetic predisposition
• Clinical manifestations of Malassezia infections

  • Pityriasis versicolor
  • Seborrheic dermatitis
  • Pityriasis capitis (Dandruff)
  • Malassezia folliculitis
• Pityriasis versicolor


  • Chronic, superficial fungal disease of the skin
  • Characterized by hypopigmented or hyperpigmented lesions
  • Often covered with thin furfuraceous scales
• Pityriasis versicolor is a disease of healthy persons that occurs worldwide
• Furfuraceous scale


  Fine and loose scales that are not conspicuous and made visible by scratching
• Pityriasis versicolor is caused by the lipophilic yeast species of the Malassezia furfur complex
• Pityriasis versicolor lesions


  • Vary in color depending on the patient's normal pigmentation, exposure to sunlight, and severity of the disease
  • Irregular, well-demarcated patches of discoloration
  • May be raised and covered by a fine scale
• Lab diagnosis of pityriasis versicolor

  • Microscopy (KOH, H&E, PAS stains)
  • Wood lamp examination
  • Culture
• Pityriasis versicolor is generally chronic and persistent, but spontaneous cure has been reported
• Treatment of pityriasis versicolor

  • Topical azoles
  • Selenium sulfide shampoo
  • Oral ketoconazole or itraconazole (for more widespread infection)
• Seborrheic dermatitis


  • Common, harmless, itchy, red skin and scaling rash affecting the face, scalp and other areas
  • Particularly affects the gland-rich areas of skin (sebaceous glands)
• Seborrheic dermatitis is a non-infectious skin disease, significantly affecting the scalp
• Factors that cause seborrheic dermatitis

  • Sebaceous secretions
  • Fungal colonization on skin surface
  • Genetic factors
  • Unhygienic environmental conditions
• Lipophilic yeasts of the Malassezia genus contribute to seborrheic dermatitis
• Diagnosis of seborrheic dermatitis


  Based on clinical appearance and location of lesions
• Treatment of seborrheic dermatitis

  • Antifungal shampoos (e.g. ketoconazole)
  • Keratolytic shampoos (zinc pyrithione, selenium sulfide, sulfur and salicylic acid)
  • Topical corticosteroid solutions
• Pityriasis capitis (Dandruff)


  • Dandruff of the scalp
  • Often favored by stress and seborrhea
  • Itching is common and can cause hair loss
  • An uninflamed form of seborrheic dermatitis
• Diagnosis of pityriasis capitis (Dandruff)


  • Mainly based on clinical appearance
  • Direct microscopy or culture are not usually done
• Treatment of pityriasis capitis (Dandruff)

  • Hair wash with medicated shampoos (Ketoconazole, Zinc Pyrithione)
  • Avoid application of oil
  • Severe cases may require oral medicines and medicated lotions
  • Alternative therapies: Vinegar, Tea Tree Oil
• Malassezia folliculitis


  • Infection of the pilosebaceous unit caused by lipophilic Malassezia yeasts
  • Malassezia are normal skin inhabitants that only cause disease under specific conditions
• Clinical presentation of Malassezia folliculitis

  • Small, uniform, itchy papules and pustules particularly on the upper back and chest
  • Other sites can be involved: forehead/hairline, chin, neck, upper limbs
  • Monomorphic eruption without comedones, distinguishing it from acne vulgaris
• Diagnostic methods for Malassezia folliculitis

  • Wood lamp examination
  • Dermoscopy features
  • Direct microscopic examination (KOH, skin scraping, tape stripping, swab, biopsy)
  • Culture (not routinely performed)
• Treatment of Malassezia folliculitis

  • Topical treatments: Selenium sulfide shampoo, econazole solution, topical ketoconazole
  • Weekly application may be particularly useful
• Malassezia folliculitis


  Diagnosis: Wood lamp examination may demonstrate a yellow-green fluorescence. Dermoscopy features include papules and pustules based on hair follicles, perifollicular erythema, perilesional scale, hypopigmented and coiled/looped hairs.
• Malassezia folliculitis diagnosis


  Direct microscopic examination: Skin scraping, tape stripping, swab, or skin biopsy confirm the presence of yeasts. Potassium hydroxide preparation of skin scrapings may reveal budding yeasts, hyphae are rarely seen.
• Malassezia folliculitis diagnosis


  Culture: Culture of Malassezia species typically requires special media for growth, so is not routinely performed.
• Superficial Mycoses


  • Malassezia infections
  • Tinea nigra
  • White piedra
  • Black piedra
• Tinea nigra


  A superficial phaeohyphomycosis caused by the black fungus Hortaea werneckii (formerly Exophiala werneckii). It is likely contracted by traumatic inoculation of the fungus into the superficial layers of the epidermis. Children and young adults are most often affected, with a higher incidence in females.
• White piedra


  A superficial infection of hair caused by yeastlike fungi of the genus Trichosporon: T. ovoides (causes scalp hair white piedra), T. inkin (causes most cases of pubic white piedra), and T. asahii. White piedra is found worldwide, but is most common in tropical or subtropical regions. Is related to poor hygiene. Infections are usually localised to the axilla or scalp but may also be seen on facial hairs and sometimes pubic hair. White piedra is common in young adults.
• Black Piedra

  Another condition affecting the hair, primarily the scalp. The causative agent of black piedra is Piedraia hortae. Black piedra is uncommon and has been reported from tropical areas in Latin America and Central Africa. It is thought to be a condition of poor hygiene. Infections are usually localised to the scalp but may also be seen on hairs of the beard, moustache and pubic hair. Black piedra mostly affects young adults and epidemics in families have been reported following the sharing of combs and hairbrushes. Infected hairs generally have a number of hard black nodules on the shaft.