1. عضو هيات علمي دانشگاه علوم پزشكي لرستان
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کلیات قارچ شناسی پزشکی2
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عضو هيات علمي دانشگاه علوم پزشكي لرستان
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3. دو نوع كلی غدد عرق
1- غدد عرق <اكرین> که به طور منتشر در تمام بدن و مخصوصاً كف دست‌ها و پاها یافت می‌شود.
2- غدد عرق "آپوكرین" که به طور عمده در زیر بغل‌ها و نواحی تناسلی یافت می‌شود و ترشحات حاصل از آنها در ایجاد بوی بدن دخالت دارند.
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4. غدد سباسه
موها با روغنی طبیعی به نام سبوم(Sebum)  که توسط غدد سباسه (Sebaceous Glands) فولیکول ها  ساخته می شود لغزنده(Lubricate) میگردد.
مقدار تولید سبوم ) حاوی اسیدهای چرب،کلسترول و ...) هر فرد وابسطه به عوامل ژنتیکی می باشد.
علاوه بر این غدد جنسی مردانه و زنانه نیزسبب افزایش ترشح سبوم میگردند. در بسیاری ازنوجوانان افزایش ناگهانی مقدار هورمون های فوق  در زمان بلوغ سبب افزایش ساخت چربی و سبوم شده و در نتیجه موهای چرب شکل می گیرند.
غدد سباسه تحت کنترل هورمونی قرار داشته و با هورمون تستسترون تحریک و با  هورمون استروژن سرکوب می گردد.
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5. ساختمان مو سه قسمت اصلی مو: 1- ریشه حاوی سلولهای زنده
2- ساقه حاوی سلولهای کراتینیزه
3- مغز مو
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6. ساختمان ناخن
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7. بهروز عزت پور - دانشگاه علوم پزشكي لرستان

8. بهروز عزت پور - دانشگاه علوم پزشكي لرستان

9. The Superficial Mycoses
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10. Pityriasis versicolor
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11. Pityriasis versicolor
Synonyms
tinea versicolor
Definition
Pityriasis versicolor is a mild to chronic colonization of the stratum corneum by the lipophilic fungi Malassezia furfur. It causes characteristic discolored or depigmented lesions of the skin.
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12. Epidemiology
Pityriasis versicolor is classically a disease affecting young people around the pubertal time probably related with hormonal changes and increase in sebum secretion. However, children are not excluded from suffering this fungal infection . Both males and females can be equally affected. High temperatures and humidity favor the occurrence of pityriasis versicolor. Accordingly, tropical areas can have a prevalence as high as 40% and the frequency is higher during summer months in temperate climates.
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13. Clinical manifestations
Multiple macules and/or patches of variable appearance (hypopigmented, hyperpigmented, dark brown or erythematous) surrounded by normal skin are the typical lesions of pityriasis versicolor. The extension and severity of the lesions tend to be worse in tropical climates . Affected areas include the back, chest, abdomen, neck, and upper limbs. However, classically the back carries more lesions. The face is an area commonly affected in children and it is the forehead showing mostly hypopigmented macules that is found . Uncommon but possible locations include axilla, popliteal fossa, forearms, lower limbs, radiotherapy field and penis/genitalia .
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14. Diagnosis
1-The diagnosis is usually based on clinical grounds. Nevertheless a useful, rapid and easy way to confirm the diagnosis is by using a Wood's lamp. Yellow to yellow-green fluorescence is characteristic of fine scales taken from actvie lesions. Although the sensitivity of this procedure is reduced when patients have taken a recent shower .
2- Direct microscopic detection of etiologic agent in the specimen ( …& Scotch tape )
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15. Malassezia furfur is not usually cultured since it is lipophilic
Malassezia furfur is not usually cultured since it is lipophilic.  It can be cultured by adding olive oil to the isolation medium.  The yeast will grow in 3-7 days at 30°C. The yeast has also been isolated from blood cultures of neonates undergoing parenteral nutrition and from persons with IV catheters.
Natural habitat:
Humans
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16. Prognosis and therapy
Therapeutic options include the use of topical agents and oral medication. Topical therapy is cheaper and probably safer, however compliance is sometimes low because of odor, difficulties in applying the solution to the back and/or the length of time the solution must be kept on. Topical agents include selenium sulfide shampoo, zinc pyrithione shampoo, ciclopirox olamine, propylene glycol lotions, topical terbinafine, and benzoyl peroxide .
Lotions are left on for about 10 minutes and then washed off. This treatment is repeated daily for 7 days and then once a month for 6 months. Systemic therapy with either ketoconazole, fluconazole, and itraconazole are alternatives for patients not responding to topical therapy, frequent relapses or severe disease .
Oral terbinafine is not effective, probably because required fungicidal levels for Malassezia furfur are too high to be reached on the stratum corneum .
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17. PAS stained skin sample with Malassezia furfur خوشه هایی از سلولهای مخمری گرد با جدار ضخیم همراه هیف های کوتاه خمیده
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18. تشخیص افتراقی 1- برص(vitiligo) 2- ماسک حاملگی(chloasma) 3-اریتراسما
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19. Tinea nigra Synonyms کچلی سیاه کف دست Pityriasis nigra
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20. Tinea nigra is a superficial fungal infection of the stratum corneum.
Definition
Tinea nigra is a superficial fungal infection of the stratum corneum.
Hortaea werneckii
Synonyms: Exophiala werneckii
Natural habitat
Plants, soil and foods with a high salt content
Epidemiology
Tinea nigra is a rare condition overall. One hundred ten cases had been reported up to 1989 and only 19 more cases were recovered from a Medline search up to March Tinea nigra occurs most frequently in tropical climates within Central and South America, Africa, Asia, and North America .
Direct inoculation onto the skin from contact with decaying vegetation, wood, or soil seems to be the form of acquisition. Incubation periods may be as long as 20 years .
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21. Clinical manifestations
Clinically, the disease is asymptomatic in most cases, but it may be associated with pruritus. Patients usually consult for the new appearance of brown to black nonscaly macules with well-defined borders that resemble silver nitrate stains. Macules may be unique or multiple, rounded or have irregular shapes. Their size varies between 1 mm to 1.5 cm .
The palmar surfaces are most often affected ("Tinea nigra palmaris"), but lesions may occur on the soles ("Tinea nigra plantaris") and other surfaces of the skin .
Macules showing an uneven rate of spread and/or coalescence raise the suspicion of melanocytic nevi, junctional nevi, or melanoma . Other differential diagnoses include Addison's disease, pinta, stains from chemicals or dyes and syphilis .
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22. Prognosis and therapy
Spontaneous resolution is rare. However historical reports of therapies as simple as shaving or striping have reported to be successful . This is in perfect correlation with the superficial location of the fungus in the stratum corneum . A more conservative approach using the combination of keratolytic preparations with topical antifungals are equally effective . Interestingly, the topical use of the antiparasitic drug, thiabendazol, has also been reported as useful . Systemic antifungal agents like itraconazole and terbinafine can also be curative but may not be required .
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23. Histopathology
Abnormal thickening of the cornified epidermis (hyperkeratosis) and separation of its layers by branched hyphae that do not reach the stratum lucidum are characteristic findings. Inflammation is usually absent.
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24. Laboratory Direct examination
Superficial scraping mounted in 10% KOH shows abundant branched septate fragmented hyphae measuring from 1.5 to 5 µm in diameter. As it is characteristic of dimorphic dematiaceous fungi, elongated budding cells, 3 X 10 µm, in clusters or along the length of dark hyphae are also seen .
Skin scrapings mounted in 10% KOH showing pigmented brown to dark olivaceous (dematiaceous) septate hyphal elements and 2-celled yeast cells producing annelloconidia typical of Hortaea werneckii.
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25. Isolation
Inoculate the clinical specimens onto Sabouraud glucose agar, incubate at 30°C and discard negative cultures in 4 weeks. After a week the culture yields slow growing mucoid colonies that become progressively olive to greenish-black in color and eventually develops aerial mycelium.
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26. Piedra
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27. Synonyms کچلی گره ای ، بیماری بژل عارضه قارچی ساقه مو بر حسب رنگ گره:
1- پیدرای سفید
2- پیدرای سیاه
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28. Definition
Piedra refers to colonization of the hair shaft that results in firm, irregular nodules. If the nodule is dark, the infection is Black Piedra and is due to Piedra iahortae. The nodule is the ascomycete fruiting body of the fungus, know as an ascostroma. If the nodule is white, the infection is White Piedra and is due to Trichosporon beigelii. These nodules are a loose aggregate of hyphae and arthroconidia. Multiple colonization of the same strand are common. The infection may affect hairs of the scalp, body and genital areas . The source of infection is unknown and even though person to person transmission has been suggested, it rarely occurs
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29. Clinical manifestations
Both clinical varieties are mostly asymptomatic. However, according to the severity of the infection, progressive weakness of the hair shaft will occur causing breaks. In black piedra, brown to black nodules will be firmly adherent to the shaft and cannot be readily detached. The area most frequently involved is the scalp. Indeed, a metallic sound may be heard when the hair is combed. In white piedra, the nodules are easily detached from the hair shaft by rubbing along its length. Their color varies from white to light brown. Pubic hair, beard and mustache are the most commonly infected areas . Disseminated infections due to T. beigelli, another Trichosporon species, have been described among immunosuppressed hosts . Differential diagnosis for both conditions includes pediculosis capitis, pubis louse infestations, trichorrhexis nodosa, trichomycosis axillaris and monilothrix
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30. Ubiquitous ( tropical)
Prognosis and therapy
Therapy includes shaving of affected areas or topical application of salycylic acid, 2% formaldehyde or azole creams. Oral therapy with either ketoconazole or terbinafine has also been used. However, relapse rates are high even after adequate therapy .
Mycology
Black piedra: Piedraia hortae
White piedra: Trichosporon beigelii(رشد سریعی دارد)
Natural habitat
Ubiquitous ( tropical)
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31. تشخیص افتراقی
1- تریکو میکوز زیر بغل(از نظر رنگ،محل گره و فقدان فلورسانس)
2- رشک و شپش (پدیکولوز)
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32. Trichomycosis Axillaris
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33. Trichomycosis Axillaris
Trichomycosis axillaris is a relatively common superficial bacterial colonization of the axillary hair shafts. Granular concretions, which are yellow, black, or red, adhere to the hair shaft and clinically characterize trichomycosis axillaris.
Trichomycosis axillaris is a superficial bacterial colonization of the hair shafts in sweat gland–bearing areas, such as the armpits and the . It is a trivial disease of worldwide occurrence that is believed to be caused by the genus Corynebacteria (mostly.
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34. Presentation
It is characterised by yellow, orange, black or red granular nodules or concretions that stick to the hair shaft. Usually the condition is symptomless and all that is noticed are sweaty, smelly armpits. Hair shafts may also expand appearing more noticeable after bathing.
Treatment
Daily cleansing with soap and water and application of benzoyl peroxide generally cures the infection. Regular use of antiperspirants aids in prevention. Topical erythromycin is occasionally required to eliminate the infection.
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35. Erythrasma
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36. Erythrasma
Erythrasma is a chronic superficial infection of the intertriginous areas of the skin. The incriminated organism is Corynebacterium minutissimum, which usually is present as a normal human skin inhabitant.
Erythrasma is a skin disease that causes brown, scaly skin patches. It is caused by the gram positive bacterium Corynebacterium minutissimum.
It is prevalent among diabetics, the obese, and in warm climates and is worsened by wearing occlusive clothing.
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37. Pathophysiology
Corynebacteria invade the upper third of the stratum corneum; under favorable conditions such as heat and humidity, these organisms proliferate. The stratum corneum is thickened. The organisms that cause erythrasma are seen in the intercellular spaces as well as within cells, dissolving keratin fibrils. The coral-red fluorescence of scales seen under Wood light is secondary to the production of porphyrin by these diphtheroids
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38. The patient is commonly otherwise asymptomatic..
The patches of erythrasma are initially pink, but progress quickly to become brown and scaly (as skin starts to shed
Signs and Symptoms
Erythrasma presents with fine, brown scaling patches which are classically sharply demarcated. Erythrasmic patches are typically found in intertriginous areas (skin fold areas - e.g. armpit, groin, under breast) - with the toe being most commonly involved.
The patient is commonly otherwise asymptomatic..
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39. Diagnosis The diagnosis can be made on the clinical picture alone.
However, a simple side-room investigation with a Wood's lamp is additionally useful in diagnosing erythrasma. The ultraviolet light of a Wood's lamp causes the organism to fluoresce a coral red color, differentiating it from fungal infections and other skin conditions.
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40. Predisposing factors for erythrasma include the following:
Excessive sweating/hyperhidrosis
Delicate cutaneous barrier
Obesity
Diabetes mellitus
Warm climate
Poor hygiene
Advanced age
Other immunocompromised states
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41. Similar to Pityriasis versicolor but:
Treatment
Similar to Pityriasis versicolor
but:
Extensive infection can be treated with oral antibiotics, including erythromycin or tetracycline and usually responds promptly. Antibacterial soap can be used to prevent recurrence.
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