Dermatology Fungal Infection Test

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Questions and Answers

Which layer of the skin contains the stratum corneum?

  • Dermis
  • Subcutaneous Tissue
  • Epidermis (correct)
  • Skin Appendages

Which layer of the skin accounts for skin tone and the strength of the skin?

  • Epidermis
  • Skin Appendages
  • Dermis (correct)
  • Subcutaneous Tissue

Which skin layer holds hair follicles and sebaceous glands?

  • Dermis (correct)
  • Epidermis
  • Subcutaneous Tissue
  • Skin Appendages

Where is the subcutaneous tissue located?

<p>Below the dermis (A)</p> Signup and view all the answers

What structures are included in skin appendages?

<p>Hairs, glands, nails (B)</p> Signup and view all the answers

Which skin layer contains specialized structures such as sweat glands and erector muscles?

<p>Dermis (B)</p> Signup and view all the answers

Where is the tough horny superficial layer of the skin located?

<p>Epidermis (D)</p> Signup and view all the answers

What does the subcutaneous tissue mainly consist of?

<p>Loose connective tissue and stored fat (B)</p> Signup and view all the answers

What is the primary risk factor associated with pityriasis versicolor?

<p>Heavy sweating (D)</p> Signup and view all the answers

Which region shows a lower incidence of pityriasis versicolor?

<p>USA and Europe (C)</p> Signup and view all the answers

What is the characteristic color of the macular lesions in pityriasis versicolor for dark-skinned people?

<p>Hypopigmented (C)</p> Signup and view all the answers

What is the primary method for diagnosing pityriasis versicolor?

<p>Microscopic examination of skin scrapings with 10% KOH (B)</p> Signup and view all the answers

What is the first-line treatment for pityriasis versicolor?

<p>(Topical) Shampoos (pyrithione zinc or selenium sulfide) (D)</p> Signup and view all the answers

What is the characteristic appearance of mature nodules of Malassezia on the hair shaft?

<p>Attached and more adherent to hair (A)</p> Signup and view all the answers

What is the characteristic morphology of Malassezia when observed under a microscope?

<p>Branched hyphae in the hair shaft (C)</p> Signup and view all the answers

Which environmental factor favors the growth of Malassezia?

<p>Warm and humid climate (A)</p> Signup and view all the answers

What is the primary site for infection by Malassezia?

<p>Neck, chest, back, upper arms, scalp, abdomen, groin area (A)</p> Signup and view all the answers

Which test is used for diagnosing Tinea nigra?

<p>Wood Lamp Examination (D)</p> Signup and view all the answers

What is the primary method for diagnosing Tinea nigra?

<p>Culture on SDA with cycloheximide and chloramphenicol (B)</p> Signup and view all the answers

What is the superficial layer of the skin consisting of dead skin cells?

<p>Stratum corneum (B)</p> Signup and view all the answers

Which layer of the skin contains a lot of specialized structures such as hair follicles, sweat glands, arteries, and afferent nerve endings?

<p>Dermis (A)</p> Signup and view all the answers

What is the function of sweat glands in the skin?

<p>Thermoregulation (D)</p> Signup and view all the answers

Where is subcutaneous tissue located?

<p>Between dermis and deep fascia (C)</p> Signup and view all the answers

What is the causative agent of tinea nigra?

<p>Hortaea werneckii (B)</p> Signup and view all the answers

What leads to the transition of Malassezia to its mycelial form and invasion of stratum corneum?

<p>&quot;Human host’s hydrolysis of sebum triglyceride&quot; (B)</p> Signup and view all the answers

What triggers inhibition of melanin synthesis in tinea versicolor causing hypopigmentation?

<p>Azelaic acid (A)</p> Signup and view all the answers

Where is Malassezia furfur found in nature?

<p>Soil, sewage, decaying vegetation (B)</p> Signup and view all the answers

What does Malassezia furfur rely on for its survival?

<p>Human host’s hydrolysis of sebum triglyceride (D)</p> Signup and view all the answers

What is the characteristic feature of tinea versicolor?

<p>Brown to black macular lesions (B)</p> Signup and view all the answers

What causes infection after trauma to the skin by Malassezia furfur?

<p>2-7 weeks after trauma due to early colonization in infants (D)</p> Signup and view all the answers

What triggers inflammation resulting in erythematous skin in tinea versicolor?

<p>Free fatty acid from hydrolysis of triglyceride (D)</p> Signup and view all the answers

Pityriasis versicolor is characterized by patches of which of the following?

<p>Hypopigmentation or hyperpigmentation (B)</p> Signup and view all the answers

What is the causative agent of pityriasis versicolor?

<p>Malassezia furfur (A)</p> Signup and view all the answers

What are the risk factors for pityriasis versicolor?

<p>Tropical climate, heavy sweating, and immunosuppression (A)</p> Signup and view all the answers

How is diagnosis of pityriasis versicolor typically made?

<p>Distinctive morphology of the lesions or dermoscopy (A)</p> Signup and view all the answers

What is the color of lesions under Wood lamp examination for pityriasis versicolor?

<p>Pale yellow-green (A)</p> Signup and view all the answers

Which statement about pityriasis versicolor treatment is accurate?

<p>Easily treatable with antifungal agents but relapse is common (D)</p> Signup and view all the answers

Which is the causative agent of Tinea Nigra?

<p>Hortaea werneckii (B)</p> Signup and view all the answers

What is the incubation period for Tinea Nigra after skin trauma?

<p>2-7 weeks (C)</p> Signup and view all the answers

Where does Tinea Nigra infection occur?

<p>Stratum corneum (B)</p> Signup and view all the answers

Which area does Piedra (Trichomycosis nodularis) affect?

<p>Scalp hair (C)</p> Signup and view all the answers

What is the causative agent of White Piedra?

<p>Trichosporon asahii (C)</p> Signup and view all the answers

What is the appearance of White Piedra on hair shaft?

<p>White compressions (D)</p> Signup and view all the answers

Which agar is used for culture in Tinea Nigra diagnosis?

<p>Sabouraud dextrose agar (SDA) (B)</p> Signup and view all the answers

What type of fungal infection is Piedra (Trichomycosis nodularis)?

<p>Superficial infection of the hair shaft (A)</p> Signup and view all the answers

What is the appearance of Black Piedra on hair shaft?

<p>Black compressions (A)</p> Signup and view all the answers

What does Tinea nigra look like under a Wood Lamp Examination with 10-15% KOH?

<p>Spaghetti-and-meatballs appearance (C)</p> Signup and view all the answers

What type of transmission is rare in Tinea Nigra?

<p>Person-to-person transmission (D)</p> Signup and view all the answers

Which topical treatment can be used for Tinea Nigra?

<p>Pyrithione zinc shampoo (B)</p> Signup and view all the answers

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Study Notes

  • Wood Lamp Examination (Direct Examination): 10-15% KOH - Presence of hyphal and yeast forms, resemble a "spaghetti-and-meatballs" appearance.
  • Tinea Nigra:
    • Caused by Hortaea werneckii, a dematiaceous fungus.
    • Infection occurs after trauma to the skin, with an incubation period of 2-7 weeks.
    • Infection is confined in the stratum corneum with no disfiguration, and can be asymptomatic and non-pruritic.
    • Occurs in tropical or subtropical areas, with a low incidence in the USA and Europe but associated with tropical travel.
    • Person-to-person transmission is rare, and there is a female-to-male predilection.
  • Macular Lesion caused by Tinea nigra: Figure 5.
  • Diagnosis of Tinea nigra:
    • Microscopic examination of skin scrapings with KOH - brown or black septate hyphae, oval-to-spindle-shaped yeast cells.
    • Culture on Sabouraud dextrose agar (SDA) - definitive diagnosis, growth visible within one week.
  • Tinea nigra is not caused by Malassezia.
  • Treatment for Tinea nigra:
    • Topical treatments: shampoos (pyrithione zinc or selenium sulfide), propylene glycol in aqueous solution, keratolytic (Whitfield ointment), topical imidazoles (ketoconazole).
    • Second line (oral) treatments: topical antifungal, oral fluconazole, systemic antifungals (rarely indicated).
  • Piedra (Trichomycosis nodularis) is an asymptomatic superficial fungal infection of the hair shaft with characteristic white or black nodules attached to the hair shaft.
  • Piedra occurs in temperate and semitropical climates and affects scalp hair.
  • Piedra is caused by various dematiaceous etiologic agents, which are found in soil, stagnant water, and crabs.
  • White Piedra:
    • Softer, less adherent to hair shaft.
    • Causative agent is Trichosporon asahii, other body surfaces.
    • Appears as white or brown compressions on hair shaft.
    • Growth occurs in a hyphal form, which can fragment into component buds, or as branched hyphae.
  • Black Piedra:
    • Firmer, more adherent to hair shaft.
    • Causative agent is T. ovoides, scalp.
    • Appears as black compressions on hair shaft.
    • Growth occurs in a hyphal form, which fragments into closely aligned fungal arthrospores or as ascus.
  • Culture: Sabouraud dextrose agar, does not require cycloheximide for growth (Sabouraud Dextrose Agar), takes long to culture (Sabouraud Dextrose Agar), resembles colonies of Tinea nigra.
  • Shaving infected hair or curative treatment + topical azole + systemic antifungal agent (i.e. oral itraconazole) due to high relapse rates.
  • Review Questions:
    • The layer of the skin that contains the sweat glands is: d. Skin appendages.
    • The type of primary skin lesions that can be erythematous, pruritus is: b. Wheal.
    • TRUE OR FALSE: Scales are accumulations of thickened stratum corneum - True.
    • In Tinea nigra, infection can spread to other parts of the body - False.
    • The male-to-female predilection in Tinea nigra is 3:1 - False.
    • Microscopic examination of skin scrapings in Tinea nigra is with __% KOH - 10%.
    • White piedra occurs in the frontal area of scalp - False.
    • The definitive diagnosis of Tinea nigra is: a. Culture on SDA with cycloheximide and chloramphenicol additive - False.
    • Malassezia lacks: a. Tyrosinase - False.
    • Pityriasis veriscolor is caused by an undergrowth of Malassezia furfur - False.

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