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MYCOSES
Superfici
al
Involving
stratum
corneum,
hair, nails.
Subcutaneo Deep/syste
us
mic
HematoInvolving
genous
dermis
spread of
and/ or
pathogeni
subc or
cutaneous
opportunic
tissue
organism
Superficial Fungal
Infection
Superficial mycoses
1. Non-dermatophytes fungal infection:
Pytiriasis versicolor
Black/white piedra
Tinea nigra palmaris
2. Dermatophyte fungal infection:
Tinea capitis
Tinea corporis, etc.
3. Candida infection.
Introduction
Superficial mycoses involving skin (stratum
corneum), nails, and hair.
Tropical country : high prevalence
Influenced by predisposing factors
Prevalence at RSHS:
10.5 -11 % patient of dermatology-
venereology clinic
58.94 %
dermatofitosis
33.55 %
pitiriasis versikolor
Tinea (Pityriasis)
versicolor
Def: * superficial fungal infection of the skin
* E/: Ragi/yeast: Malassezia sp. (M.furfur,
M.pachydermatis, M.sympodialis,
M.obtusa, M.globosa, M.restricta,
M.slooffiae, M nana, M.dermatis,
M.yamatoensis, M.caprae)
* Fungi : saprophyte
* predisposing factors:
endogenous: genetic
Exogenous : weather (warm),
Pathogenesis
Saprophytic yeast
Converts to
Predominantly
parasitic mycelial
form associated
with clinical
diseases
Transition
influenced
by:
Exogen: warm
humidity
Endogen:
heredity
Cushings
disease
Immunosupressi
on
Clinical manifestation
Mild, chronic, asymptomatic(-)
Predilection: all part of the body, >>
trunk, axilla, face, neck
Fine scale patch: vary in color
Laboratory Findings
1. Woods lamp : orange-yellowish
fluorencent
2. 10% KOH preparation (20% KOH+ Parker
Ink):
Short cigar-butt hyphae (spaghetti and
meatballs)
Differential diagnosis
Most likely:
Pityriasis alba
Pityriasis rosea
Seborrheic dermatitis
Dermatophyte infections
Consider
Erythrasma
Vitiligo
Psoriasis
Pityriasis rubra
pilaris
TREATMENT
Topical: - 25%Na tiosulfat solution
- 1%-2% Azole derivative cream,
- Terbinafine cream
- Selenium sulfide (1.8-2.5%)
shampoo
- 2% ketokonazole shampoo
Systemic: (with extensive, reccurent disease),
- Ketokonazole 200 mg 7-10 days p.o
- Ketokonazole 400 mg single dose
- Itrakonazole 200-400 mg 3-7 days
Pityriasis
versicolor
Pityriasis versicolor
Woods Lamp
Laboratory examination
Skin Scrapping
Laboratory examination
KOH preparation
Malassezia sp.
Malassezia sp.
DERMATOPHYTOSIS
- Skin, nail, hair >>> Kronik
-Fungal infection cause by dermatophytes
fungi:
E/ Dermatophytes : Microsporum sp.
Habitat:
Geophilic
Trichophyton sp.
: Zoophilic
Epidermophyton
:
Terminology
based onsp.anatomical
Antropophilic
site
t.kapiti
s
t.fasialis
*
t.barba
e
- t.
korporis/glabrosa
- t. kruris
- t. manus
- t. pedis
- t. unguium
Patogenesis
Stratum
corneum
microlesion
,
hydration,
maseration
Fungi
eukariotic
Antigenic
substance
arthroconidia attachment with
keratinocyte ( 4-6 hours)
germination
7 days
Hyphae penetration tissue damage
1-3 weeks
Skin lesion
Geophilic/zoophilic : acute, severe:
erythema, edema, vesicles.
Antropophilic : chronic, scales,
hyperpigmentation
Initial lesion as erythematous papules
extend to periphery
x
central
healing
konfluen
- Well-defined
- raised - anular
Active border
- erythema, papules
Sometimes
polycyclic
shape
TINEA CAPITIS
> > children , there are 3 clinical
manifestation:
1. Grey patch ringworm (> M.canis)
woods light
- Scaly, gray patches
f+
- hairs broken off several mm from scalp
2. Black dot ringworm
f- black dot patches
- hairs broken off at the level of scalp
TINEA KORPORIS
TINEA KRURIS
Affected
inguinalm,
buttocks,
perineum, and perianal.
TINEA MANUS
Affected palm and hands
pubis,
TINEA PEDIS
1. Interdigital type scaling, erythema, and
maceration of the interdigital and subdigital skin
of the feet, and in particular between the lateral
3rd and 4th and 5th toes
2. Dyshydrotic type: vesicles , pustules
3. papulo-squamous hyperkeratotic
- soles and lateral and medial aspect of the
feet. - patchy or diffuse scaling
ONIKOMIKOSIS
1. Onikomikosis sub ungual distalis
(OSD/OSDL)
2. Onikomikosis sub ungual proksimal (OSP)
3. Onikomikosis superfisial putih (OSPT)
4. Onikomikosis kandida (OK)
# 1 s/d 4 ODT
total)
(Onikomikosis distrofik
# Endoniks
T. unguium -e/dermatophytes
ONIKOMIKOSIS
hifa
artrospora
Sample
- Skin
- Nails
- Hairs
Skin clean up with 70%alcohol cotton
swab
- scrape the lesion from the center to
the edge.
- Choose active lesion
- Micr : Long branched, septated
hyphae,
arthrospores
DOUBLE
CONTOU
R
Dermatophytosis treatment
a. General : reducing predisposing factors,
increased personal hygiene.
Avoid :
Using tight, layered cloths, over
sweating, and prevent obesity
Contact with sick person or animal
Shared combs, towel.
Treat sick person/animal
2% ketokonazole shampoo could
prevent reccurent t. capitis
Use the shampoo with all household
reduce transmission.
b. Topical antifungal
Azol
(krim ketokonazol
2%, krim mikonazol
2%, krim bifonazol,
sertakonazol dll)
Unguentum
Whitfield:
Ac. salicylicum 36
%
Ac. benzoikum 6
12 %
Alilamin: krim
terbinafin 1%
Benzilamin:
butenafin &
tolnaftat
* Asam undesilenat
rare (recovery rate
27% )
c. Systemic antifungal
S.E : hepatotoxic
Indication:
- T. kapitis,widespread or recalcitran
t.korporis/kruris luas
- T. kruris with e/ Trychophyton rubrum
- T. pedis, T.manus, onikomikosis
1. Griseofulvin
500mg/hari
2. Gol. azol : ketokonazol, itrakonazol &
flukonazol
3. Gol. alil-amin: terbinafin: 250mg/hari
Onikomikosis:
Treatment depend on infected nail (3-18 month)
Systemic: griseofulvin 500 mg/h . 1 tab 500/ 4
tab 125
ketokonazol 200 mg/h . . . . . . . 1
tab
itrakonazol 100 mg/h . . . . . . . 1
kaps
itrakonazol 2x200 mg/h - 7 days in 1
months
(pulse dose)
Restricted lesion: superfisial/ 1/3 nail
* Cyclopiroxolamine (nail laquer)
Tinea kapitis
Otomikosis
Tinea korporis
Tinea imbrikata
Tinea imbrikata
Tinea kruris
Tinea kruris
Tinea manus
Tinea pedis
T. pedis + T. unguium
Tinea pedis
Onikomikosis Endoniks
D. Leroy
(Caen)
Psoriasis kuku
Dermatofita
Kultur SBA
A.
Hifa panjang
Artrospora (40x)
B.
C. Artrospora (100x)
Hasil kultur
A. Mikrokonidia
B. Makrokonidia
Hasil kultur
A. Makrokonidia
Hasil kultur
A. Mikrokonidia
B. Makrokonidia
Hasil kultur
A. Chlamydospora
Hasil kultur
A. Mikrokonidia
3. Candidiasis/Candidosis
-The Disease : acute, subacute, chronic
-E/ Candida > C.albicans
Endoge
n
Predisposing
Eksoge
n
Klasifikasi
Physiologic:
pregnancy,
hormonal
Malnutritio
contraception
n
Drugs: antibiotic,
steroid
Iritatio
n
Weather, Warm,
humidity
1. Skin, nail
2. Mucous membran
3. Systemic
INTERTRIGINOUS CANDIDOSIS
- Affected skin folds : axilla, inguinal, etc.
- erythematous patch, well difined, vesicles,
erosion, satelite lesion.
- Chronic: lichenification,
hyperpigmentation(rare)
- symptomps : itchy
ONIKIA PARONIKIA
- > people who habitually immerse their
hands in water.
- Paronychia: redness, swelling and
terderness of the proximal and lateral
nailfolds, retaction of cuticle, pain.
- Nail :
- Thick , hard, dull
- Brown, debris ( - )
TRUSH
> Infant
mouth : ulcer wich is covered by membrane
PERLECHE Fissures at the corner of the
mouth
LAB EXAMINATION
- Microscopic: yeast cell, budding cell
- Culture
PENATALAKSANAAN
- >< predisposing factor
- Wet lesion: wet dressing
- Topical: - Azole derivatives cream, gentian
violet solution.
- Systemic: extensive nail disorder
- ketokonazol, itrakonazol, flukonazol
Candida
Candida
C.albicans
KANDIDOSIS KUTIS
INTERTRIGINOSA
VULVITIS KANDIDA
BALANITIS KANDIDA
KANDIDIASIS INTERDIGITALIS
Angular Cheilitis
Kandidiasis Pseudomembran
Kandidiasis
Pseudomembran
Kandidiasis Hipertrofik
Kandidiasis
mukokutan
kronik
MIKOSIS
SUBKUTAN
getting bigger
wart, exudate
DD/ TVC : Tuberkulosis verukosa kutis
Kromomikosis
Kromomikosis
Sporotrikosis
Kromomikosis vs TVC
Kromomikosis
vs.
TVC
Parakoksidioidomikosis
Parakoksidioido
mikosis
Lobomikosis
Misetoma
Misetoma
Misetoma
Misetoma
Misetoma
Skrofuloderma
Tuberkulosis
verukosa
kutis
SYSTEMIC MYCOSIS
SYSTEMIC MYCOSIS
Insidence - ~ Immunity state
for example : AIDS
Primary: systemic infection
skin: secondary
Skin manifestation: unspecific
Tx/ - amfoterisin B
- Itrakonazol
- Flukonazol
Histoplasmosis
Kriptokokosis
Penisiliosis
Penisiliosis
Penisiliosis
Anti mikotik
D
E
S R
E- M
DI A
A T
A O
N FI
T
A
C
A
N
T.
D
V
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A
GRISEO
FULVIN
MIKON
AZOL
2%
KLOTRI
MAZOL
KETOK
ONAZO
TS
STRUKTUR
JAMUR
Ds
Thank you V
m
K
Ms
re
U
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Y
K
N
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