Tinea nigra

Last updated
Tinea nigra
Other namesSuperficial phaeohyphomycosis, tinea nigra plantaris, [1] tinea nigra palmaris et plantaris [2]
Hortaea-werneckii-fungus--causes-tinea-nigra.jpg
Micrograph of the fungus Hortaea werneckii , the causative agent of tinea nigra
Specialty Dermatology
Symptoms One or more dark brown/black, painless spots on palms or soles [3]
Causes Hortaea werneckii [3]
Diagnostic method Visualisation, dermoscopy, microscopy and culture [3]
Treatment Antifungals, scraping the lesion [3]
Medication Topical Whitfield's ointment or salicylic acid ointment, or oral itraconazole [1]
Tinea nigra new image.jpg

Tinea nigra, also known as superficial phaeohyphomycosis and Tinea nigra palmaris et plantaris, [2] is a superficial fungal infection, a type of phaeohyphomycosis rather than a tinea, that causes usually a single 1–5  cm dark brown-black, non-scaly, flat, painless patch on the palms of the hands and the soles of the feet of healthy people. [1] There may be multiple spots. [1] The macules occasionally extend to the fingers, toes, and nails, and may be reported on the chest, neck, or genital area. [4] :311 Tinea nigra infections can present with multiple macules that can be mottled or velvety in appearance, and may be oval or irregular in shape. The macules can be anywhere from a few mm to several cm in size. [5]

Contents

Most cases are caused by Hortaea werneckii , a pigmented fungus, which is a dark yeast found in sewage, soil, rotting vegetation and wood and in places with a high salt content such as moldy salted fish and on beaches, where contact with sand may result in transmission. [1] Infection is by direct contact and the fungus enters and remains in the outer dead layer of skin with little or no skin inflammation. [1] The infection does not invade deeper tissues. [1]

Diagnosis is by visualisation, dermoscopy, and microscopy and culture of skin scrapings. [3] Differential diagnosis includes Addison's disease, syphilis, pinta, yaws, melanoma, lentigines, lichen planus of the palms, and junctional melanocytes nevus. [1] Treatment is with topical Whitfield's ointment or salicylic acid ointment. [1] Topical antifungals or oral itraconazole are other options. [1] Scraping the lesion can be curative. [3] Prevention is by general hygiene measures. [1]

It is uncommon. [1] It generally occurs in tropical and subtropical countries of Central and South America, the Caribbean, Europe, South East Asia, Australia and the Far East. [1] The disease was first described by Alexandre Cerqueira from Brazil in 1891. [1] No cases in animals have been reported. [1]

Signs and symptoms

Causes

This infection is caused by the fungus formerly classified as Cladosporium werneckii, but more recently classified as Hortaea werneckii . [6] The causative organism has also been described as Phaeoannellomyces werneckii. [7] Tinea nigra is extremely superficial and can be removed from the skin by forceful scraping. It tends to appear in areas where eccrine sweat glands are highly concentrated. Infections generally start to appear on the skin around 2–7 weeks post inoculation. The ability of H. werneckii to tolerate high salt concentrations and acidic conditions allows it to flourish inside the stratum corneum. H. wernickii tends remain localized in one spot or region, and produces darkly-colored, brown macules on the skin due to the production of a melanin-like substance. [5]

Diagnosis

Diagnosis of tinea nigra is made based on microscopic examination of stratum corneum skin scrapings obtained by using a scalpel. The scrapings are mixed with potassium hydroxide (KOH). [8] The KOH lyses the nonfungal debris. [8] The skin scrapings are cultured on Sabouraud's agar at 25°C and allowed to grow for about a week. H. werneckii can generally be distinguished due to its two-celled yeast form and the presence of septate hyphae with thick, darkly pigmented walls. [5]

Treatment

Treatment consists of topical application of dandruff shampoo, which contains selenium sulfide, over the skin. Topical antifungal azoles such as ketoconazole, itraconazole, and miconazole may also be used. Azoles are generally used twice daily for a two-week period. This is the same treatment plan for tinea or pityriasis versicolor. Other treatment methods include the use of epidermal tape stripping, undecylenic acid, and other topical agents such as ciclopirox. Once a tinea nigra infection has been eradicated from the host, it is not likely to reoccur. [5]

Epidemiology

Tinea nigra is commonly found in Africa, Asia, Central America, and South America. It is typically not found in the United States or Europe, although cases have been documented in the Southeastern United States. People of all ages can be infected; however, it is generally more apparent in children and younger adults. Females are three times more likely than males to become infected. [5]

See also

Related Research Articles

<span class="mw-page-title-main">Tinea cruris</span> Medical condition

Tinea cruris, also known as jock itch, is a common type of contagious, superficial fungal infection of the groin and buttocks region, which occurs predominantly but not exclusively in men and in hot-humid climates.

<span class="mw-page-title-main">Tinea versicolor</span> Skin disease

Tinea versicolor is a condition characterized by a skin eruption on the trunk and proximal extremities. The majority of tinea versicolor is caused by the fungus Malassezia globosa, although Malassezia furfur is responsible for a small number of cases. These yeasts are normally found on the human skin and become troublesome only under certain circumstances, such as a warm and humid environment, although the exact conditions that cause initiation of the disease process are poorly understood.

<span class="mw-page-title-main">Athlete's foot</span> Skin infection caused by fungus

Athlete's foot, known medically as tinea pedis, is a common skin infection of the feet caused by a fungus. Signs and symptoms often include itching, scaling, cracking and redness. In rare cases the skin may blister. Athlete's foot fungus may infect any part of the foot, but most often grows between the toes. The next most common area is the bottom of the foot. The same fungus may also affect the nails or the hands. It is a member of the group of diseases known as tinea.

Dermatophyte is a common label for a group of fungus of Arthrodermataceae that commonly causes skin disease in animals and humans. Traditionally, these anamorphic mold genera are: Microsporum, Epidermophyton and Trichophyton. There are about 40 species in these three genera. Species capable of reproducing sexually belong in the teleomorphic genus Arthroderma, of the Ascomycota. As of 2019 a total of nine genera are identified and new phylogenetic taxonomy has been proposed.

<span class="mw-page-title-main">Tinea corporis</span> Medical condition

Tinea corporis is a fungal infection of the body, similar to other forms of tinea. Specifically, it is a type of dermatophytosis that appears on the arms and legs, especially on glabrous skin; however, it may occur on any superficial part of the body.

<span class="mw-page-title-main">Tinea capitis</span> Cutaneous fungal infection of the scalp

Tinea capitis is a cutaneous fungal infection (dermatophytosis) of the scalp. The disease is primarily caused by dermatophytes in the genera Trichophyton and Microsporum that invade the hair shaft. The clinical presentation is typically single or multiple patches of hair loss, sometimes with a 'black dot' pattern, that may be accompanied by inflammation, scaling, pustules, and itching. Uncommon in adults, tinea capitis is predominantly seen in pre-pubertal children, more often boys than girls.

<span class="mw-page-title-main">Tinea barbae</span> Medical condition

Tinea barbae is a fungal infection of the hair. Tinea barbae is due to a dermatophytic infection around the bearded area of men. Generally, the infection occurs as a follicular inflammation, or as a cutaneous granulomatous lesion, i.e. a chronic inflammatory reaction. It is one of the causes of folliculitis. It is most common among agricultural workers, as the transmission is more common from animal-to-human than human-to-human. The most common causes are Trichophyton mentagrophytes and T. verrucosum.

<span class="mw-page-title-main">Fungal infection</span> Disease caused by fungi to animals or humans

Fungal infection, also known as mycosis, is a disease caused by fungi. Different types are traditionally divided according to the part of the body affected; superficial, subcutaneous, and systemic. Superficial fungal infections include common tinea of the skin, such as tinea of the body, groin, hands, feet and beard, and yeast infections such as pityriasis versicolor. Subcutaneous types include eumycetoma and chromoblastomycosis, which generally affect tissues in and beneath the skin. Systemic fungal infections are more serious and include cryptococcosis, histoplasmosis, pneumocystis pneumonia, aspergillosis and mucormycosis. Signs and symptoms range widely. There is usually a rash with superficial infection. Fungal infection within the skin or under the skin may present with a lump and skin changes. Pneumonia-like symptoms or meningitis may occur with a deeper or systemic infection.

<span class="mw-page-title-main">Dermatophytosis</span> Fungal infection of the skin

Dermatophytosis, also known as ringworm, is a fungal infection of the skin. Typically it results in a red, itchy, scaly, circular rash. Hair loss may occur in the area affected. Symptoms begin four to fourteen days after exposure. Multiple areas can be affected at a given time.

<span class="mw-page-title-main">Onychomycosis</span> Medical condition

Onychomycosis, also known as tinea unguium, is a fungal infection of the nail. Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. Toenails or fingernails may be affected, but it is more common for toenails. Complications may include cellulitis of the lower leg. A number of different types of fungus can cause onychomycosis, including dermatophytes and Fusarium. Risk factors include athlete's foot, other nail diseases, exposure to someone with the condition, peripheral vascular disease, and poor immune function. The diagnosis is generally suspected based on the appearance and confirmed by laboratory testing.

<i>Malassezia furfur</i> Species of fungus

Malassezia furfur is a species of yeast that is naturally found on the skin surfaces of humans and some other mammals. It is associated with a variety of dermatological conditions caused by fungal infections, notably seborrhoeic dermatitis and tinea versicolor. As an opportunistic pathogen, it has further been associated with dandruff, malassezia folliculitis, pityriasis versicolor (alba), and malassezia intertrigo, as well as catheter-related fungemia and pneumonia in patients receiving hematopoietic transplants. The fungus can also affect other animals, including dogs.

<span class="mw-page-title-main">Clotrimazole</span> Chemical compound

Clotrimazole, sold under the brand name Lotrimin, among others, is an antifungal medication. It is used to treat vaginal yeast infections, oral thrush, diaper rash, tinea versicolor, and types of ringworm including athlete's foot and jock itch. It can be taken by mouth or applied as a cream to the skin or in the vagina.

<i>Piedraia hortae</i> Species of fungus

Piedraia hortae is a superficial fungus that exists in the soils of tropical and subtropical environments and affects both sexes of all ages. The fungus grows very slowly, forming dark hyphae, which contain chlamydoconidia cells and black colonies when grown on agar. Piedraia hortae is a dermatophyte and causes a superficial fungal infection known as black piedra, which causes the formation of black nodules on the hair shaft and leads to progressive weakening of the hair. The infection usually infects hairs on the scalp and beard, but other varieties tend to grow on pubic hairs. The infection is usually treated with cutting or shaving of the hair and followed by the application of anti-fungal and topical agents. The fungus is used for cosmetic purposes to darken hair in some societies as a symbol of attractiveness.

<span class="mw-page-title-main">Tinea incognita</span> Fungal skin infection caused by the presence of a topical immunosuppressive agent

Tinea incognita, also spelled tinea incognito, is a fungal infection of the skin that generally looks odd for a typical tinea infection. The border of the skin lesion is usually blurred and it appears to have florid growth.

<i>Microsporum audouinii</i> Species of fungus

Microsporum audouinii is an anthropophilic fungus in the genus Microsporum. It is a type of dermatophyte that colonizes keratinized tissues causing infection. The fungus is characterized by its spindle-shaped macroconidia, clavate microconidia as well as its pitted or spiny external walls.

<span class="mw-page-title-main">Fungal folliculitis</span> Inflammation of hair follicles due to fungal infection

Majocchi's granuloma is a skin condition characterized by deep, pustular plaques, and is a form of tinea corporis. It is a localized form of fungal folliculitis. Lesions often have a pink and scaly central component with pustules or folliculocentric papules at the periphery. The name comes from Domenico Majocchi, who discovered the disorder in 1883. Majocchi was a professor of dermatology at the University of Parma and later the University of Bologna. The most common dermatophyte is called Trichophyton rubrum.

<i>Epidermophyton floccosum</i> Species of fungus

Epidermophyton floccosum is a filamentous fungus that causes skin and nail infections in humans. This anthropophilic dermatophyte can lead to diseases such as tinea pedis, tinea cruris, tinea corporis and onychomycosis. Diagnostic approaches of the fungal infection include physical examination, culture testing, and molecular detection. Topical antifungal treatment, such as the use of terbinafine, itraconazole, voriconazole, and ketoconazole, is often effective.

Two feet-one hand syndrome(TFOHS), is a long-term fungal condition where athlete's foot or fungal toe nail infections in both feet is associated with tinea manuum in one hand. Often the feet are affected for several years before symptoms of a diffuse scaling rash on the palm of one hand appear, which is when most affected people then seek medical help.

Topical antifungaldrugs are used to treat fungal infections on the skin, scalp, nails, vagina or inside the mouth. These medications come as creams, gels, lotions, ointments, powders, shampoos, tinctures and sprays. Most antifungal drugs induce fungal cell death by destroying the cell wall of the fungus. These drugs inhibit the production of ergosterol, which is a fundamental component of the fungal cell membrane and wall.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Chander, Jagdish (2018). "8. Tinea Nigra". Textbook of Medical Mycology (4th ed.). New Delhi: Jaypee Brothers Medical Publishers Ltd. pp. 145–153. ISBN   978-93-86261-83-0.
  2. 1 2 Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. Chapter 76. ISBN   978-1-4160-2999-1.
  3. 1 2 3 4 5 6 James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "15. Diseases resulting from fungi and yeasts". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Elsevier. p. 299. ISBN   978-0-323-54753-6.
  4. James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN   0-7216-2921-0.
  5. 1 2 3 4 5 Schwartz, Robert A (September 2004). "Superficial fungal infections". The Lancet. 364 (9440): 1173–1182. doi:10.1016/S0140-6736(04)17107-9. PMID   15451228. S2CID   28932880.
  6. Murray, Patrick R.; Rosenthal, Ken S.; Pfaller, Michael A. (2005). Medical Microbiology (5th ed.). Elsevier Mosby.
  7. Pegas JR, Criado PR, Lucena SK, de Oliveira MA (2003). "Tinea nigra: report of two cases in infants". Pediatric Dermatology. 20 (4): 315–7. doi:10.1046/j.1525-1470.2003.20408.x. PMID   12869152. S2CID   28484339.
  8. 1 2 Gladwin, Mark; Trattler, Bill. Clinical Microbiology (4th ed.). p. 196.