Abstract
Superficial mycoses are fungal infections of the skin, hairs, and nails that invade only the stratum corneum and the most superficial layers of the skin, and include dermatophytoses, tinea versicolor, candidiasis, tinea nigra, and Piedras (white and black). Dermatophytosis, also known as tinea, is a superficial fungal infection of the stratum corneum, nails, and hair, caused by dermatophytes, and includes three genera: Trichophyton sp., Microsporum sp., and Epidermophyton sp. Pityriasis versicolor, or tinea versicolor, is a common superficial fungal infection of the skin caused by Malassezia yeasts that presents as flaky round or oval macular elements, usually located in the upper aspects of the trunk, neck, and arms. Candidiasis is a fungal infection caused by any of the species from the genera Candida, which includes about 150 different species of yeast, among which C. albicans is the most common causative species, accounting for up to 80% of cases. Subcutaneous mycoses include a heterogeneous group of infections that often result from direct penetration of the fungus into the skin through trauma. Systemic mycosis is characterized by infections caused by truly pathogenic fungi as well as those produced by fungi with small intrinsic pathogenicity, enhanced by immunocompromised hosts. In the majority of cases, the respiratory tract may be the first site of entry; fungi then usually spread hematogenously to other organs.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- AIDS:
-
Acquired immune deficiency
- AmB:
-
Deoxycholate amphotericin B
- BHI:
-
Brain heart infusion
- CBM:
-
Chromoblastomycosis
- CNS:
-
Central nervous system
- CrAg:
-
Cryptococcal antigen
- DSO:
-
Distal and lateral subungual onychomycosis
- ELISA:
-
Enzyme-linked immunosorbent assay
- HE:
-
Hematoxylin and eosin
- HIV:
-
Human immunodeficiency virus
- IL:
-
Interleukin
- LA:
-
Latex agglutination
- LFA CrAg:
-
Lateral flow immunoassay for the detection of CrAg
- PAS:
-
Periodic acid-schiff
- PCM:
-
Paracoccidioidomycosis
- PV:
-
Pityriasis versicolor
- SDA:
-
Sabouraud dextrose agar
- SOT:
-
Solid organ transplant
- SSKI:
-
Saturated solution of potassium iodide
- TMP-SMX:
-
Trimethoprim-Sulfamethoxazole
- VVC:
-
Vulvovaginal candidiasis
References
Kaushik N, Pujalte GG, Reese ST. Superficial fungal infections. Prim Care. 2015;42(4):501–16.
Nenoff P, Krüger C, Ginter-Hanselmayer G, Tietz HJ. Mycology—an update. Part 1: dermatomycoses: causative agents, epidemiology and pathogenesis. J Dtsch Dermatol Ges. 2014;12(3):188–209. quiz 210, 188–211; quiz 212.
Moriarty B, Hay R, Morris-Jones R. The diagnosis and management of tinea. BMJ. 2012;345:e4380.
Weitzman I, Summerbell RC. The dermatophytes. Clin Microbiol Rev. 1995;8(2):240–59.
Ilkit M, Durdu M. Tinea pedis: the etiology and global epidemiology of a common fungal infection. Crit Rev Microbiol. 2015;41(3):374–88.
Nenoff P, Krüger C, Schaller J, Ginter-Hanselmayer G, Schulte-Beerbühl R, Tietz HJ. Mycology—an update part 2: dermatomycoses: clinical picture and diagnostics. J Dtsch Dermatol Ges. 2014;12(9):749–77.
Eisman S, Sinclair R. Fungal nail infection: diagnosis and management. BMJ. 2014;348:g1800.
Khanna D, Bharti S. Luliconazole for the treatment of fungal infections: an evidence-based review. Core Evid. 2014;9:113–24.
Saunders J, Maki K, Koski R, Nybo SE. Tavaborole, Efinaconazole, and Luliconazole: three new antimycotic agents for the treatment of dermatophytic fungi. J Pharm Pract. 2017;30(6):621–30.
Kelly BP. Superficial fungal infections. Pediatr Rev. 2012;33(4):e22–37.
González U, Seaton T, Bergus G, Jacobson J, Martínez-Monzón C. Systemic antifungal therapy for tinea capitis in children. Cochrane Database Syst Rev. 2007;4:CD004685.
Bonifaz A, Gómez-Daza F, Paredes V, Ponce RM. Tinea versicolor, tinea nigra, white piedra, and black piedra. Clin Dermatol. 2010;28(2):140–5.
Hald M, Arendrup MC, Svejgaard EL, Lindskov R, Foged EK, Saunte DM, Danish Society of Dermatology. Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases. Acta Derm Venereol. 2015;95(1):12–9.
Pedrosa AF, Lisboa C, Gonçalves RA. Malassezia infections: a medical conundrum. J Am Acad Dermatol. 2014;71(1):170–6.
Gupta AK, Lyons DC. Pityriasis versicolor: an update on pharmacological treatment options. Expert Opin Pharmacother. 2014;15(12):1707–13.
Khatu SS, Poojary SA, Nagpur NG. Nodules on the hair: a rare case of mixed piedra. Int J Trichol. 2013;5:220–3.
Kiken DA, Sekaran A, Antaya RJ, Davis A, Imaeda S, Silverberg NB. White piedra in children. J Am Acad Dermatol. 2006;55(6):956–61.
Criado PR, Delgado L, Pereira GA. Dermoscopy revealing a case of Tinea Nigra. An Bras Dermatol. 2013;88(1):128–9.
Hani U, Shivakumar HG, Vaghela R, Osmani RAM, Shrivastava A. Candidiasis: a fungal infection—current challenges and progress in prevention and treatment. Infect Disord Drug Targets. 2015;15(1):42–52.
Peixoto JV, Rocha MG, Nascimento RTL, Moreira VV, Kashiwabara TGB. Candidiasis—a literature review. BJSCR. 2014;8(2):75–82.
Sardi JC, Scorzoni L, Bernardi T, Fusco-Almeida AM, Mendes Giannini MJ. Candida species: current epidemiology, pathogenicity, biofilm formation, natural antifungal products and new therapeutic options. J Med Microbiol. 2013;62(Pt 1):10–24.
Fidel PLJ. Immunity to Candida. Oral Dis. 2002;8(Suppl. 2):69–75.
Gonçalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S. Vulvovaginal candidiasis: epidemiology, microbiology and risk factors. Crit Rev Microbiol. 2015;21:1–23.
Waugh MA. Balanitis. Dermatol Clin. 1998;16(4):757–62.
Jayatilake JAMS, Tulakaratne WM, Panagoda GJ. Candidal onychomycosis: a mini-review. Mycopathologia. 2009;168:165–73.
Farah CS, Lynch N, McCullough MJ. Oral fungal infections: an update for the general practitioner. Aust Dent J. 2010;55(1 Suppl):48–54.
Colombo AL, Guimarães T, Camargo LFA, et al. Brazilian guidelines for the management of candidiasis—a joint meeting report of three medical societies: Sociedade Brasileira de Infectologia, Sociedade Paulistana de Infectologia and Sociedade Brasileira de Medicina Tropical. Braz J Infect Dis. 2013;17(3):283–312.
Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists guidelines for onychomycosis 2014. Br J Dermatol. 2014;171:937–58.
Peter G, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by infectious diseases society of America. Clin Infect Dis. 2016;62(4):409–17.
Mahajan VK. Sporotrichosis: an overview and therapeutic options. Dermatol Res Pract. 2014;2014:272376.
Rosa AC, Scroferneker ML, Vettorato R, et al. Epidemiology of sporotrichosis: a study of 304 cases in Brazil. J Am Acad Dermatol. 2005;52:451–9.
Vásquez-del-Mercado E, Arenas R, Padilla-Desgarenes C. Sporotrichosis. Clin Dermatol. 2012;30:437–43.
Ramos-e-Silva M, Vasconcelos C, Carneiro S, Cestari T. Sporotrichosis. Clin Dermatol. 2007;25:181–7.
Queiroz-Telles F, McGinnis MR, Saljin I, Graybill JR. Subcutaneous mycoses. Infect Dis Clin North Am. 2013;17:59–85.
Kauffman CA, Bustamante B, Chapman SW, Pappas PG, Infectious Diseases Society of America. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45(10):1255–65.
Chapman SW, Pappas P, Kauffmann C, et al. Comparative evaluation of the efficacy and safety of two doses of terbinafine (500 and 1000 mg day(−1)) in the treatment of cutaneous or lymphocutaneous sporotrichosis. Mycoses. 2004;47(1–2):62–8.
Correia RTM, Valente NYS, Criado PR, Martins JEC. Chromoblastomycosis: study of 27 cases and review of medical literature. An Bras Dermatol. 2010;85(4):448–54.
Krzyściak PM, Piaszczyńska MP, Piaszczyński M. Chromoblastomycosis. Postep Derm Alergol. 2014;5:310–21.
Torres-Guerrero E, Isa-Isa R, Isa M, Arenas R. Chromoblastomycosis. Clin Dermatol. 2012;30:403–8.
Spiker A, Ferringe T. Chromoblastomycosis. Cutis. 2015;96(4):224. 267–268.
Queiroz-Telles F, de Hoog S, Santos DW, et al. Chromoblastomycosis. Clin Microbiol Rev. 2017;30(1):233–76.
Minotto R, Bernardi CDV, Mallmann LF, Edelweiss MIA, Scroferneker ML. Chromoblastomycosis: a review of 100 cases in the state of Rio Grande do Sul, Brazil. J Am Acad Dermatol. 2001;44:585–92.
Severo CB, Oliveira FM, Pilar EFS, Severo LC. Phaeohyphomycosis: a clinical-epidemiological and diagnostic study of eighteen cases in Rio Grande do Sul, Brazil. Mem Inst Oswaldo Cruz. 2012;107(7):854–8.
Isa-Isa R, García C, Isa M, Arenas R. Subcutaneous phaeohyphomycosis (mycotic cyst). Clin Dermatol. 2012;30:425–31.
Revankar SG, Patterson JE, Sutton DA, Pullen R, Rinaldi MG. Disseminated phaeohyphomycosis: review of an emerging mycosis. Clin Infect Dis. 2002;34:467–76.
Seyedmousav S, Netea MG, Mouton JW, Melchers WJG, Verweij PE, de Hoog GS. Black yeasts and their filamentous relatives: principles of pathogenesis and host defense. Clin Microbiol Rev. 2014;27(3):527–42.
Revankar SG. Phaeohyphomycosis. Infect Dis Clin North Am. 2006;20:609–20.
Revankar SG. Dematiaceous fungi. Mycoses. 2007;50:91–101.
Naggie S, Perfect JR. Molds: hyalohyphomycosis, phaeohyphomycosis and zygomycosis. Clin Chest Med. 2009;30:337–53.
Varkey JB, Perfect JR. Rare and emerging fungal pulmonary infections. Semin Respir Crit Care Med. 2008;29(2):121–31.
Tortorano AM, et al. ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: fusarium spp., Scedosporium spp. and others. Clin Microbiol Infect. 2014;20(Suppl. 3):27–46.
Enoch DA, Ludlam HA, Brown NM. Invasive fungal infections: a review of epidemiology and management options. Microbiology. 2006;55:809–18.
Cornely OA. Aspergillus to zygomycetes: causes, risk factors, prevention, and treatment of invasive fungal infections. Infection. 2008;36:296–313.
Ramos-E-Silva M, Aguiar-Santos-Vilela F, Cardoso-de-Brito A, Coelho-Carneiro S. Lobomycosis. Literature review and future perspectives. Actas Dermosifiliogr. 2009;100(Suppl 1):92–100.
Francesconi VA, Klein AP, Santos AP, Ramasawmy R, Francesconi F. Lobomycosis: epidemiology, clinical presentation, and management options. Ther Clin Risk Manag. 2014;10:851–60.
Talhari S, Talhari C. Lobomycosis. Clin Dermatol. 2012;30(4):420–4.
Nenoff P, Van de Sande WWJ, Fahal AH, Reinel D. Eumycetoma and actinomycetoma—an update on causative agents, epidemiology, pathogenesis, diagnostics and therapy. JEADV. 2015;29:1873–83.
Welsh O, Vera-Cabrera L, Salinas-Carmona MC. Mycetoma. Clin Dermatol. 2007;25:195–202.
Estrada R, Chávez-López G, Estrada-Chávez G, López-Martínez R, Welsh O. Eumycetoma. Clin Dermatol. 2012;30:389–96.
Barnetson RS, Milne LJ. Mycetoma. Br J Dermatol. 1978;99(2):227–31.
Barry SM. Mycetoma. Rev Argent Dermatol. 2009;90:50–62.
Ameen M, Arenas R. Developments in the management of mycetomas. Clin Exp Dermatol. 2008;34:1–7.
Welsh O, Al-Abdely HM, Salinas-Carmona MC, Fahal AH. Mycetoma medical therapy. PLoS Negl Trop Dis. 2014;8(10):e3218.
Muszewska A, Pawłowska J, Krzyściak P. Biology, systematics, and clinical manifestations of Zygomycota infections. Eur J Clin Microbiol Infect Dis. 2014;33(8):1273–87.
Farmakiotis D, Kontoyiannis DP. Mucormycoses. Infect Dis Clin North Am. 2016;30(1):143–63.
El-Shabrawi MH, Arnaout H, Madkour L, Kamal NM. Entomophthoromycosis: a challenging emerging disease. Mycoses. 2014;57(Suppl 3):132–7.
Boelaert JR, Van Cutsem J, de Locht M, Schneider YJ, Crichton RR. Deferoxamine augments growth and pathogenicity of Rhizopus, while hydroxypyridinone chelators have no effect. Kidney Int. 1994;45(3):667–71.
Lackner M, Caramalho R, Lass-Flörl C. Laboratory diagnosis of mucormycosis: current status and future perspectives. Future Microbiol. 2014;9(5):683–95.
Fortes MRP, Miot HA, Kurokawa CS, Marques MEA, Marques SA. Immunology of paracoccidioidomycosis. An Bras Dermatol. 2011;86(3):516–25.
Martinez R. Epidemiology of paracoccidioidomycosis. Rev Inst Med Trop Sao Paulo. 2015;57(Suppl 19):11–20.
Shikanai-Yasuda MA, Mendes RP, Colombo AL, et al. Brazilian guidelines for the clinical management of paracoccidioidomycosis. Rev Soc Bras Med Trop. 2017;50:715.
de Oliveira HC, Assato PA, Marcos CM, Scorzoni L, de Paula ESAC, De Fátima Da Silva J, et al. Paracoccidioides-host interaction: an overview on recent advances in the paracoccidioidomycosis. Front Microbiol. 2015;6:1319.
Bocca AL, Amaral AC, Marcus Melo Teixeira MM, Sato P, Shikanai-Yasuda MA, Sueli Soares Felipe M. Paracoccidioidomycosis: eco-epidemiology, taxonomy and clinical and therapeutic issues. Future Microbiol. 2013;8(9):1177–91.
Marques SA. Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating. An Bras Dermatol. 2013;88(5):700–11.
Ramos-e-Silva M, Saraiva LES. Paracoccidioidomycosis. Dermatol Clin. 2008;26(2):257–69.
de Fátima da Silva J, de Oliveira HC, Marcos CM, Assato PA, Fusco-Almeida AM, Mendes-Giannini MJ. Advances and challenges in paracoccidioidomycosis serology caused by Paracoccidioides species complex: an update. Diagn Microbiol Infect Dis. 2016;84(1):87–94.
Garcia-Garcia SC, Salas-Alanis JC, Gomez-Flores M, Gonzalez-Gonzalez SE, Vera-Cabrera L, Ocampo-Candiani J. Coccidioidomycosis and the skin: a comprehensive review. An Bras Dermatol. 2015;90(5):610–21.
Duarte-Escalante E, Frías-De-León MG, Zúñiga G, Martínez-Herrera E, Acosta-Altamirano G, Reyes-Montes MR. Molecular markers in the epidemiology and diagnosis of coccidioidomycosis. Rev Iberoam Micol. 2014;31(1):49–53.
Ampel NM. The treatment of coccidioidomycosis. Rev Inst Med Trop Sao Paulo. 2015;57(Suppl 19):51–6.
Colombo AL, Tobón A, Restrepo A, Queiroz-Telles F, Nucci M. Epidemiology of endemic systemic fungal infections in Latin America. Med Mycol. 2011;49(8):785–98.
Adenis AA, Aznar C, Couppié P. Histoplasmosis in HIV-infected patients: a review of new developments and remaining gaps. Curr Trop Med Rep. 2014;1:119–28.
Benedict K, Mody RK. Epidemiology of histoplasmosis outbreaks, United States, 1938-2013. Emerg Infect Dis. 2016;22(3):370–8.
Fernandez-Flores A, Saeb-Lima M, Arenas-Guzman R. Morphological findings of deep cutaneous fungal infections. Am J Dermatopathol. 2014;36(7):531–53. quiz 554–6.
Gullo FP, Rossi SA, Sardi Jde C, Teodoro VL, Mendes-Giannini MJ, Fusco-Almeida AM. Cryptococcosis: epidemiology, fungal resistance, and new alternatives for treatment. Eur J Clin Microbiol Infect Dis. 2013;32(11):1377–91.
La Hoz RM, Pappas PG. Cryptococcal infections: changing epidemiology and implications for therapy. Drugs. 2013;73(6):495–504.
Wang Y, Aisen P, Casadevall A. Cryptococcus neoformans melanin and virulence: mechanism of action. Infect Immun. 1995;63(8):3131–6.
Nin CS, de Souza VV, do Amaral RH, et al. Thoracic lymphadenopathy in benign diseases: A state of the art review. Respir Med. 2016;112:10–7.
Kothiwala SK, Prajapat M, Kuldeep CM, Jindal A. Cryptococcal panniculitis in a renal transplant recipient: case report and review of literature. J Dermatol Case Rep. 2015;9(3):76–80.
Perfect JR, Bicanic T. Cryptococcosis diagnosis and treatment: what do we know now. Fungal Genet Biol. 2015;78:49–54.
Further Readings
Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists’ guidelines for the management of onychomycosis 2014. Br J Dermatol. 2014;171(5):937–58.
de Souza Framil VM, Melhem MSC, Szeszs MW, Zaitz C. Novos aspectos na evolução clínica da pitiríase versicolor. An Bras Dermatol. 2011;86(6):1135–40.
Guarner J, Brandt ME. Clin Microbiol Rev. 2011;24(2):247–80.
Khurana A, Sardana K, Chowdhary A. Antifungal resistance in dermatophytes: recent trends and therapeutic implications. Fungal Genet Biol. 2019;132:103255.
Marques SA. Paracoccidioidomicose: atualização epidemiológica, clínica, diagnóstica e terapêutica. An Bras Dermatol. 2013;88(5):701–12.
May PJ, Tong SYC, Steer AC, Currie BJ, Andrews RM, Carapetis JR, Bowen AC. Treatment, prevention and public health management of impetigo, scabies, crusted scabies and fungal skin infections in endemic populations: a systematic review. Trop Med Int Health. 2019;24(3):280–93.
Richardson MD, Warnock DW. Fungal infection: diagnosis and management. 4th ed. Chichester: Wiley Blackwell; 2012.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Glossary
- Anthropophilic (dermatophytes)
-
Restricted to human hosts, produce a mild, chronic inflammation.
- Cytokine
-
Any of a class of immunoregulatory proteins such as interleukin or interferon that are secreted by cells, especially of the immune system.
- Ectothrix
-
A fungus that grows inside the shaft of a hair but produces a conspicuous external sheath of spores.
- Endothrix
-
Dermatophyte infections of the hair that invade the hair shaft and internalize in the hair cell.
- Folliculitis
-
Common skin condition whereby hair follicles become inflamed, usually caused by a bacterial or fungal infection.
- Geophilic (dermatophytes)
-
Usually recovered from the soil, occasionally infect humans and animals; they cause a marked inflammatory reaction.
- Hyperkeratosis
-
Hypertrophy of the corneous layer of the skin.
- Hypha (plural form hyphae)
-
Name of the long, individual pieces that comprise a mycelium, overall a fungus; often described as strings and thread-like filaments.
- Keratinocyte
-
The predominant cell type in the epidermis.
- Kerion
-
The most severe form of tinea capitis, characterized by an abscess-like deep infection of the scalp. Clinically, it is seen a boggy, indurated, tumor-like mass that exudes pus.
- Leukonychia
-
White spotting, streaking, or discoloration of the fingernails.
- Mycelium
-
Mass of hyphae that forms the body of a multicellular fungus; it enables either sexual or asexual reproduction of fungi.
- Onycholysis
-
Spontaneous separation of the nail plate, usually starting at the distal free margin and progressing proximally; the nail plate is separated from the underlying and/or lateral supporting structures.
- Onychodystrophy
-
Widely used, yet rarely defined term; it describes any kind of irregular difference in the nail, apart from modifications in color (called nail dyschromia).
- Spore
-
Specialized cell of the fungus that can function as resting or dispersal propagules; each spore has the capacity to generate another individual of the species.
- Zoophilic (dermatophyte)
-
Found primarily in animals, it causes marked inflammatory reactions in humans who have contact with infected cats, dogs, cattle, horses, birds, or other animals.
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Chemello, R.L., Castagna, R.D., Cappelletti, T., Stramari, J.M., da Silva, C.B., Comazzetto, L.R. (2023). Fungal Infections. In: Rangel Bonamigo, R. (eds) Dermatology in Public Health Environments. Springer, Cham. https://doi.org/10.1007/978-3-031-13505-7_11
Download citation
DOI: https://doi.org/10.1007/978-3-031-13505-7_11
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-13504-0
Online ISBN: 978-3-031-13505-7
eBook Packages: MedicineMedicine (R0)