Common Skin infections S .SH .MOHSENI. MD. dermatologist Associate professor . Tehran medical sciences branch . Islamic Azad university. s.sh.mohseni.MD.dermatologist. Structure of the Skin

• Functions of the Skin – Prevents excessive water loss – Regulates temperature – Involved in sensory phenomena – Barrier against microbial invaders • Composed of three main layers – Epidermis –Dermis – hypodermis

© 2012 Pearson Education Inc. Normal Microbiota of the Skin

• Skin micro biota are normally harmless microbes present on the skin – Cannot be completely removed through cleansing – Made up of various microbes – YtYeast – Malassezia – Bacteria – Staphylococcus, Micrococcus, and the diphtheroids – May produce disease – If penetrate epidermis or if immune system is suppressed

. The skin-overview Skin Infections

y The skin always has some amount of bacteria, fungus and viruses living on it. y Skin Infections Occur when there are breaks in the skin and the organisms have uncontrolled growth y Colonisation: Bacteria are present, but causing no harm y Infection: Bacteria are present and causing harm. Causative Organisms y Bacterial y Fungal y Viral y Parasitic Bacterial Skin infection y Two gram-pp,pyositive cocci ,staphylococcus aureus and group A beta –hemolytic streptococci. y S.aureus cause impetigo, folliculitis, cellu lit is, furunc les. y Streppy , secondary invader , cause imp pgetigo ,erysipelas, cellulitis, and lymphangitis. Staphylococcus impetigo

Ecthyma

Erysipelas

Cellulitis

Panniculitis

Necroti z ing fasciiti s Impetigo Definition and Etiology

Impetigo is a superficial skin infection usually caused by S. aureus and occasionally by S. pyogenes Diagnos is Diagnosis is by clinical presentation ,gram –stained smear of vesicles and confirmation by culture. impetigo y Common, contaggpfious, superficial skin infection, by staph or strep or combination of both y Bullous and non bullous. y Staph .aureus is primary pathogen. y Children more than adults. y Poststreptococcal glomerulonephritis. Impeti go

• Superficial bacterial infection of the skin • Most commonly Staph or Strep • Thin vesicles with honey colored crusting • Usually on face, hands, neck & extremities • Spread occurs via contact from fingers, towels, clothing • Tx: Topical antibiotics, severe infections need oral

Impetigo (Bullous form) RECURRENT IMPETIGO& TREATMENT OF IMPETIGO ¾PiPatients wihith recurrent impet igo shldhould be evaluated for carriage of S. aureus. ¾The nares are the most common sites of carriage, but the perineu m, aaaexillae, and toe webs may also be colonized. ¾ MiMupiroc inoitintment or cream (BtbBactroban) applied to the nares twice each day for 5 days significantly reduces S. aureus carriage in the nose and hands at 3 dayygs and in the nasal carriage for as long as 1 year. Impetigo contagiosa(Non bullous form) ItiImpetigo Ecthyma DfiitiDefinition and EtiEtilology

Ecthyma is a cutaneous infection characterized by thickly crusted erosions or ulcerations. Ecthyma is usually a consequence of neglected impetigo and often follows impetigo occluded by footwear or clothing.

Diagnosis Diagnosis is by clinical presentation and confirmation by culture Ecthyma y Ulceration , covered by adherent crusts. y Poor hygiene. y Vesicles, bullae, ulcer, crust. y Legs, less than 10 lesions. y Scarring. y Strep and staph. y Oral ab ,10 day

EilErysipelas and ClllitiCellulitis Definition and Etiology

Erysipelas is a superficial cutaneous infection of the skin involving dermal lymphatic vessels. Cellulitis is a deeper process that extends to the subcutis.

Diagnosis

Diagnosis is by clinical presentation and confirmation by culture (if clinically indicated, ie., bullae or abscess formation) Cellulitis and erysipelas y Erythema , edema, pain. May be fever ,leukocy tosis, ,y lymp hang itis, ,y lymp hadenitis. y Dermis and subcutaneous. y Strep and staph (adults) .haemophilus influenzae type B in children younger than 3 years. y Ce llu litis occur in norma l s kin (like erys ipe las ), or cutaneous ulcer , or surgical wounds. cellulitis y In adults with underlyyging disease, diabetes, malignancy, drug abuse, aids, chemotherapy, is caused byyg other organisms like actinobacter, clostridium, enterobacter, E coli, ppg.aeruginosa. y In children buccal infection is most common presentation. y Needle aspiration from the point of maximal inflammation help culture. (45%). Erysipelas

Ce llu litis cellulitis

Cellulitis. Folliculitis,Furunculosis, Carbunculosis definition and Etiology

Folliculitis is a superficial infection of the hair follicles characterized by erythematous, follicular- bdbased papules and pustltules.

Diagnosis

Diaggypnosis is by clinical presentation and confirmation by culture folliculitis y Inflammation of hair follicle by infection, chemical irritation, physical injury. y Superficial :upper part of hf. Pustule heals without scar. y Deep: pain fu l ,with scar. y Staph folliculitis is most common. y Injury, abrasion, nearby surgical wounds or draining abscesses.

Folliculitis

) FlFuruncles are deeper infections of the hair follicle characterized by inflammatory nodules with pustular drainage, which can coalesce to form larger draining nodules (b(carbunc les) Furuncle furuncle

Furunculosis

Furuncle Carbuncle carbuncle

CrbCarbunc le Necrotizing Fasciitis Definition and Etiology Monomicrobial and polymicrobial form Necrotizing fasciitis is a rare infection of the subcutaneous tissues and fasci a thtthat even tua lly ldleads to necros is. Predisposing factors include injuries to soft tissues, such as abdominal surgery, abrasions, surgical incisions, diabetes, intravenous drug abuse.alcoholism, cirrhosis

Diagnosis

Diagnosis is by clinical presentation; CT or MRI; skin biopsy for pathology, Gram stain, and tissue ; .culture;culture of fluid from bullae or fluctuant plaques blood cultures Necrotising Fasciitis

• Rare, but serious and fatal condition • Deep-seated infection of subcut fat and fascia which spreads along fascial planes. Vascular thrombosis leads to rapidly progressiiftiddthfkiding infarction and death of skin and tissue, with systemic infection • If suspect ed – reftlfer urgently Necrotizing Fasciitis Necrotizing fasciitis Staph yl ococcal scalded skin synd rome y Staphylococcal epidermolytic toxin syndrome, by lack of immunity to toxin and renal immaturity in children. Toxin A&B. y Blister just below stratum corneum. y Children 6 or younger( 98% ). Adults with abnormal immunity. y Tender erythema, like scarlet fever, accentuated in flexural and periorificial. y Transient bulla, peels off in large sheets. desquamation y Nikolosky`sign . y Increased fluid loss and dehydration. y Must be differentiated from TEN Staphylococcal scalded skin syndrome MRSA

‡ Methicillin-resistant Staphylococcus aureus ‡ “super-b”bug” –caused by staph , unnecessary antibi oti c use ‡ Outwits all but the most powerful of drugs – vancomycin ‡ Enters through cuts & wounds ‡ Types: CA (community acquired) or HA (Hospital acquired) ‡ S/S: small red bumps that resememble pimples, quicky turn to painful abscesses that can burrow deep into the body, swelling, redness, pus ‡ Risk Factors: recent hospitalization, long-term care, recent antiobiotic use, young age, contact sports, sharing towels, weak immune system, living in groups, health-care workers ‡ Dx: Tissue sample – 48hrs ‡ Prevention: WASH HANDS, surfaces, cover wounds, use only personal items MRSA

P.Aeru infection y Pseudomonas folliculitis, hot tub f. y Pseudomonas cellulitis. y External otitis. And malignant external otitis y Toe web infection. y Ecthyma gangrenosum. y Severe life-threatening infection occur in patient with impaired immunity , serious burns, acute leukemia or immunocompromised and immunosuppressive therapy. Hot tub folliculitis †Pseudomonas folliculitis Gram negative cellulitis Gram negative cellulitis infection

Pseudomonas aeruginosa

†nontuberculosis mycobacteria

Cutaneous atypical mycobacterial infections are caused by: †Mycobacterium marinum †Mycobacterium ulcerans Nontuberc ulo us mycobacteria y Systemic or only skin disease. y Most cutaneous disease is caused by M.marinum. y Swimming pool granuloma, in fisherman as a chronic granulomatous iifinfection. y Occurs at sites of minor truma, finger, han ds; e lbow, knees. M.ulcerans, M.fortuitum, M.chelonei, MiM.avium -illlintracellulare yA papule o r nodu le, may ulcerate, discharge a serosanguineous fluid, or verrucous surface. yM.avium complex cause disseminated disease in 15-40% of patient with HIV . †Consider a nontuberculous mycobacterial ifinfect ion when a lesion develops at the site of truma with chronic course. mycobacterium †Mycobacterium marinum infection Erythrasma y Results in pppink patches to brown scales ,y, may be pruritic. Lichenification and hyperpigmentation common y Caused by Corynebacterium minutissimum y Commonly found in intertriginous areas/ toe webs y Prevalent among diabetics, obese, and in warm climates, worsened by wearing occlusive clothing y DDx: tinea, acanthihosis y Dx: KOH neg, Wood’s lamp : coral pink fluorescence Erythrasma Coral pink florescence Pitted Keratolysis

• Caused by Cornebacteria, which colonise the surface stratum corneum and produce areas of sharply demarcated maceration. • LtLater deve lops a c harac ter itiistic p ittditted appearance. • Smells like rotten fish • More common in young males, who wear tight occlusive shoes • Treatment is aimed at reducing sweating and reducing bacterial colonisation: – Breathable footwear – Topical antibiotics (fusidin or mupirocin) – PtPotassi um permangana te, 20%l% alum iiinium c hlidhloride hhdthexahydrateor 4% formaldehyde soaks can be affective عفونت ھای قارچی پوستی سطحی کليات

• تخمين زده می شود که درماتوفيت ھا، ٢۵- ٢٠% کل مردم دنيا را درگير می کنند، که آنھا را به يکی از شايعترين عفونت ھا تبديل می کند. • عفونت ھای قارچی پوستی سطحی برخالف عفونت ھای قارچی سيستميک (مثل: ماي کوز اندميک و عفونت ھای فرصت طلب)، محدود به اپي درم ھستند. • سه گروه از قارچ ھای پوستی، عفونت سطحی توليد می کنند: درماتوفيت ھا، گونه ماالسزيا و گونه کانديدا. • درماتوفيت ھا ( که شامل گونه تريکوفيتون، گونه ميکروسپوروم و گونه اپيدرموفيتون است)، بافت ھای کراتينيزه را درگير می کند: اليه شاخی (خارجی ترين اليه اپي درم)، ناخن يا مو. • واژه تينه آ برای درماتوفيت ھا به کار می رود و برحسب محل آناتوميک عفونت تغيير می کند. مثال: تينه آپديس

83 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان Fungal and yeast infections

Dermatophytosis

Dermatophytosis implies infection with fungi, organisms with high affinity for keratinized tissue, such as the skin, nails, and hihair. Trichophyton rubrum is the most common dermatophyte worldwide.

Diagnosis

Diagnosis is by clinical presentation, KOH examination, and fungal culture. Dermatophyte infections

• 3 main genera: – TiTrich op hy ton – Microsporum – Epidermophyton • Invade the keratin of the stratum corneum • Can be: – Anthopophilic – contracted from humans – ZhiliZoophilic – conttdftracted from an ilimals – Geographic – contracted from soil

Clinical appearance depends on the organism involved, the site and the host reaction Tinea infections y T. corporis –Ringgyworm of the body y T. capitis scalp y T. cruris groin y T. pedis foot y T. unguim nail y Tinea//py dermatophyte infections caused b y Trichophyton, Epidermophyton and Microsporum انواع غير التھابی تينه آ کاپيتيس

نوع نقطه سياه نوع سبورئيک

87 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان Tinea Capitis

Scalp تينه آ كورپوريس

* تينه آكورپوريس (ring worm) به درماتوفيتوز پوست اطالق مي شود كه معموال" تنه و اندام ھا را درگير مي كند. - تمام گروه ھاي سني را درگير مي كند. - ب ارز ترين عالمت آن خارش است. - گسترش غير قرينه - حاشيه ضايعه فعالترين قسمت است، مناطق مركزي تمايل به بھبودي دارند. - نمونه براي تست ھيدروكسيد پتاسيم بايد از حاشيه قرمز پوسته دار گرفته شود. - نوع ديگر آن تينه آكروريس يا خارش ورزشكاران (Jock itch) است كه تظاھ رات يك ساني داردداد ولي در كشاله ران رخ مي دھد.

89 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان Tinea capitis Tinea corporis تينه آ کاپيتيس التھابی : کريون

ƒ کريون يک توده التھابی دردناک شبيه باتالق با فوليکولھای موھای شکسته شده می باشد. ƒ درصد قابل توجھی از تينه آ کاپتيس ھای درمان نشده به سمت کريون پيشرفت می کنند. ƒ اغلب نواحی حاوی ترشحات چرکی ھستند که با عفونت ھای باکتريايی اشتباه می شوند. ƒ احتمال به جای گذاشتن اسکار در کريون بيش از ساير انواع تينه آ کاپيتيس می باشد. ƒ ارجاع سريع به يک متخصص پوست (طی يک ھفته) توصيه می شود.

91 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان Kerion Dermatoppyhytosi s (ringworm) Tinea Corporis - Presents as scaly erythematous plithlaques with central clearing تينه آكورپوريس

ƒ ﺿﺎﻳﻌﻪ ﺣﻠﻘﻮي ﺑﺎ ﭘﺎك ﺷﺪن ﻣﺮﻛﺰي ﺑﺮاي ﺗﻴﻨﻪ آﻛﻮرﭘﻮرﻳﺲ ﺗﻴﭙﻳﻚ اﺳﺖ.

94 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان Tinea CrpriCorporis Tinea Pedis: 2 main presentations: - Moist scaling between the toes, esp 4/5 webspace. - MiMocassin type – fine, d ry diffuse sca ling over t he w ho le sole. Athlete’s foot

تينه آپديس، نوع بين انگشتي

ƒ ﺷﺎﻳﻊ ﺗﺮﻳﻦ اﺳﺖ. ƒ ﺑﺎ ﭘﻮﺳﺘﻪ رﻳﺰي و ﻗﺮﻣﺰي ﺑﻴﻦ اﻧﮕﺸﺘﺎن ﺑﺮوز ﻣﻲ ﻛﻨﺪ و ﻣﻤﻜﻦ اﺳﺖ ﻣﺎﺳﺮﻳﺸﻦ ﻳﺎ ﻟﻴﭻ اﻓﺘﺎدﮔﻰ (ﺳﺎﻳﻴﺪﮔﻰ ﺑﺮاﺛﺮ ﻣﺮﻃﻮب ﺑﻮدن ﻃﻮﻻﻧﻲ ﻣﺪت) ﻣﺮﺗﺒﻂ ﺑﺎ آن وﺟﻮد داﺷﺘﻪ ﺑﺎﺷﺪ.

98 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان

تينه آپديس, نوع موكازين

• ﻫﻤﭽﻨﻴﻦ ﺑﻪ ﻋﻨﻮان ﻫﻴﭙﺮﻛﺮاﺮا ﺗﻮ ﺗﻴﻚ ﻣﺰﻣﻦ ﺷﻨﺎﺧﺘﻪ ﻣﻲ ﺷﻮد. • - ﭘﻮﺳﺘﻪ رﻳﺰي ﺑﺎ ﺣﺪود ﻛﺎﻣﻼ ﻣﺸﺨﺺ ﻛﻪ در اﻣﺘﺪاد ﺳﻄﻮح ﻟﺘﺮال ﭘﺎ، ﭘﺎﺷﻨﻪ و ﻛﻒ ﭘﺎ ﺗﻮزﻳﻊ ﻣﻲ ﺷﻮد. • - ﮔاﻫﺎاﺎ"، وزﻳﻜﻮلﻜل و ارﻳﺘﻢ درﺣﺎﺷﻴﻪ وﺟﻮد دارد. - اﻏﻠﺐ ﺑﺎ • اوﻧﻴﻜﻮﻣﺎﻳﻜﻮزﻳﺲ(ﻋﻔﻮﻧﺖ ﻗﺎرﭼﻰ ﻧﺎﺧﻦ) ﻣﺮﺗﺒﻂ اﺳﺖ.

99 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان تينه آپديس نوع موكازين

• -ﻧﻮع ﻣﻮﻛﺎزﻳﻦ ﻣﻤﻜﻦ اﺳﺖ ﺑﻪ ﺷﻜﻞ ﺳﻨﺪرمﺳﻨﺪم " ﻳﻚ دﺳﺖ ، دو ﭘﺎ " ﺑ ﺮوز ﻛﻨﺪ. • - دردﺳﺖ ﻣﺒﺘﻼ، ﭘﻮﺳﺘﻪ ﻇﺮﻳﻒ ﻳﻜﻄﺮﻓﻪ ﺧﺼﻮﺻﺎ" در ﺷﻴﺎرﻫﺎ ،(ﺷﻜﻞ زﻳﺮ) دﻳﺪه ﻣﻲ ﺷﻮد: ﻧﺎﺧﻦ ﻫﺎ ﻫﻢ اﻏﻠﺐ درﮔﻳﺮﻧﺪ.

100 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان Tinea pedis تينه آپديس، نوع وزيكولوبولوس

• - وزيكوزكلل يا بول ھاي ٣- ٢ ميليمتري گروھي ديده مي شود، اغلب روي قسمت خارجي قوس پا يا پشت پا. ممكن است بسيار خارش دار يا دردناك باشند. • - تينه آپديس نوع وزيكولوبولوس نشان دھنده يك پاسخ ايمني افزايش حساسيت تأخيري به درماتوفافيت است.

102 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان Tinea unguiiim Tinea pedis Tinea Cruris – commoner in males, assymmetrical erythema spreading from groin to upper thigh. Scaly advancing edge. Tinea Cruris Tinea cruris. Tinea Cruris Tinea Manuum – diffuse dry scaling over the palm Tinea Unguium – Different presentation including: - White Onchomycosis - Oncholysis - Sub-ungural hyperkeratosis - Thickening of nail plate Onychomycosis TnilFnToenail Fungus تست ھيدروكسيد پتاسيم

- مطالعه ميكروسكوپى ھيدروكسيد پتاسيم آسانترين و مقرون به صرفه ترين روش مورداستفاده براي تشخيص عفونت ھاي قارچي پوست، مو و ناخن استات. - تكنيك جديد نيازمند آموزش ديدن است. * حساسيت ،وابسته به تجربه انجام دھنده تست است. - ھيدروكسيد پتاسيم كراتينوسيتھا را حل مي كند تا ديدن ھايفاھا آسان تر شود. - حرارت براي سرعت بخشيدن به اين واكنش استفاده مي شود.

112 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان آزمايش KOH

ƒ آرترواسپور ھا در داخل تنه موھا(اندوتريکس) توجه: رنگ آبی اسپور ھا ناشی از اضافه کردنرن رنگ کلور ازول سياه به ھيدروکسييرويد پ تاسيم می باشد.

113 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان چرا كشت قارچ انجام مي دھيم؟

- كشت، گونه اختصاصي قارچى كه موجب عفونت شده است را شناسايي مي كند. - برخالف ت ينه آپديس، ت ينه آكورپوريس توسطتط گونهنه ھاي مختلفي از قارچ ھا با منابع محيطي مختلف ايجاد مي شود. - يوحيوانات (گربه/ سگ)، تينه آي سر، تينه آ پ يسديس. - استفاده از كشت قارچ براي شناسايي گونه ھا به شناخت منبع و درمان كمك مي كند. - حتي ممكن است علي رغم تست ھيدروكسيد ٻتاسيم منفي، كشت مثبت باشد.

114 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان Candidiasis Definition and Etiology

Candidiasis refers to a diverse group of infections caused by Candida albicans or by other members of the genus Candida. These organisms typically infect the skin, nails, mucous membranes, and gastrointestinal tract, but they also cause systemic disease. Diagnosis

Diagnosi s is by c lin ica l presentat ion, KOH examination, and fungal culture. اي نترتررريگوي كاندي دايي: اصول اولوييه * اينترتريگوي كانديدايي: كانديديازيس چين ھاي پوستي بزرگ * ممكن است در مناطق زير بروز كند: - كشاله ران يا زير بغل - در شيار باسن - زير پستان ھاي بزرگ - زير چين ھاي شكمي روي ھم افتاده * درتست ھيدروكسيد پتاسيم پسودوھايفا ديده مي شود. * بيشتر سوزش دارد تا خارش

116 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان ItInter titrigo Diaper Candidiasis Angular cheilitis Cutaneous Candidiasis Chronic Paronychia Acute Paronychia. Tinea (Pityriasis) Versicolor Definition and Etiology

Tinea versicolor is a common opportunistic superficial ifinfecti on of the skin caused by the ubiitbiquitous yeast Malassezia furfur

Diagnosis

Diagnosis is by clinical presentation. Potassium hydroxide preparation exhibits short hyph ae and spores with a spagh etti -and-meatba lls appearance Tinea versicolor ƒ ﻣﺎﻛﻮل ﻫﺎ و ﭘﭻ ﻫﺎي ﺻﻮرﺗﻮرﻲﻲ و ﺑﺮﻧﺰ ﻛﺎﻣﻼ" ﻣﺸﺨﺺ.

125 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان Pityriasis versicolor hypopigmented يك نگاه نزديك تر به تينه آورسي كالر

127 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان Tinea VriVersicol lror نماي ميكروسكوپى

ا پسپورھا ( وعنوع مخمري)

ھايفاھاافااي ك وتاه

تست ھيدروكسيد پتاسيم ھايفاھاي كوتاه و اسپورھاي گرد كوچك را نشان مي دھد.نماي شاخص "اسپاگتي و توپ ھاي گوشتي"

129 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان نماي ميكروسكوپى با رنگ آميزي نمونه

Magnificat i on 40x

الگوي شاخص " اسپاگتي و توپ گوشتي" مطابق ھايفاھا و اسپورھا.

130 ﻣﻌﺎوﻧﺖ ﭘﮋوﻫﺶ و ﻓﻦ آوري- داﻧﺸﮕﺎه آزاد اﺳﻼﻣﻲ - واﺣﺪ ﻋﻠﻮم ﭘﺰﺷﻜﻲ ﺗﻬﺮان Viral infections Herpes Simplex Definition and Etiology Herpes simplex virus (HSV) infection is a painful, self-limited, often recurrent dermatitis, characterized by small grouped vesicles on an erythematous base. Disease is often mucocutaneous. HSV type 1 is usually associated with orofacial disease, and HSV type 2 is usually associated with genital infection. Diagnosis Viral culture helps to confirm the diagnosis; direct fluorescent antib od y (DFA) is a hel pf ul but less-specific test. Serology is helpful only for primary infection. The Tzanck smear can be helpful in the rapid diagnosis of herpesviruses infections, but it is less sensitive than culture and DFA.. PCR- gold standard for HSV-2 Herpes Simplex Herpes labialis Herpetic gingivostomatitis Oral herpes lesions Herpes simplex Herpes Simplex Herpetic whitlow Herpes Zoster Definition and Etiology

Herpp(g),pes zoster (shingles) is an acute, painful dermatomal dermatitis that affects approximately 10% to 20% of adults, often in the presence of immunosuppression.

Diagnosis Diagnosis is by clinical presentation, viral culture,,y or direct fluorescent antibody Skin Disorders: Shingles

Reactivation of the varicella-zoster virus HrpHerpes Zos trter Herpes zoster Warts Definition and Etiology

Warts are common and benign epithelial growths caused by human papillomavirus (HPV)

Diagnosis The clinical appearance alone should suggest the diagnosis. Skin biopsy may be per forme d, if warrante d Human Papillomavirus (HPV): Overview

ƒ Warts are caused by HPV ƒ HPV infects skin and mucosal epithelia ƒ HPV causes a varietyypg of wart morphologies • Verruca vulgaris: common warts • Verrucae planae: flat warts • Palmoplantar warts • Condylomata acuminata: external genital warts ƒ The type of HPV determines the wart morphology

144 Clinical Features of Verrucae Planae: Flat Warts

• Skin-coldlored or p ikink • Smooth-surfaced, slightly elevated, flat- topped papules • Dorsal hands, arms, face (exposed surfaces)

145 Clinical Features of Palmoplantar Verruca

• Thick, endophytic papules • Central depression • Plantar warts may be painful when walking • Mosaic warts: plantar war ts coal escin g in to large plaques

146 Various kinds of warts--lesions caused by papillomaviruses Verruca vulgaris Common wart Plantar wart HPV Infection

Frequently Associated Clinical Presentation HPV Type External genital warts 6, 11

High grade intraepithelial 16, 18,31, 33-35, 40, 45 neoplasia Genital infection with HPV is transmitted by sexualfl contact from partners wi ihliilth clinical or subclinical infection

150 Molluscum Contagiosum Definition and Etiology Molluscum contagiosum is an infectious viral disease of the skin caused by the poxvirus.

Diagnosis

Diagnosis is by clinical presentation and by skin biopsy, if warranted Henderson-Paterson Bodies

ƒ Henderson-Patterson Bodies, aka Molluscum bodies • Intracytoplasmic inclusion bodies, contaiiining poxv irus particles, seen in keratinocytes

152 Molluscum contagiosum Molluscum contagiosum Molluscum Contagiosum Summary

ƒ Viral infection due to a pox virus ƒ Three main groups at risk (children, sexually active adults and immunosuppressed patients) ƒ Various treatment options available ƒ In children spontaneous remission frequently occurs and no treatment is a reasonable option

155 Molluscum Contagiosum in Immunosuppressed Patients ƒ Adults with chronic MC outside the genital area should be evaluated for immunosuppression ƒ Patients with untreated HIV often have lesions concentrated on the face or genitalia. Oral and genital mucosa may be involved

156 Molluscum Contagiosum as a STD

When it occurs in the genital region, MC is classified as a sexually transmitted disease. Most adults with MC present with genital disease.

157 Comparison of molluscum and genital warts

Molluscum Contagiosum External Genital Warts (smooth, dome-shaped papules with (hyperkeratotic, exophytic central umbilication) papules and plaques)

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Boby Lice Pediculosis

Scabies

„ Scabies is usually transmitted by direct contact with an affected individual although transmission from fomites is also possible. Scabies

„ The characteristic linear or SS--shapedshaped burrows are clustered on the web spaces of the fingers, flexor surfaces of the wrists, elbows, axillae, belt line, feet, and scrotum in men and areolae in women. Burrows are commonlyyp found on palms and soles in infants. „ The examination of skin scrappgings from burrows under light microscopy usually reveals mite, eggs, larvae and scybala.scybala. „ Koh or oil preparation show mites.

Scabies Scabies under the microscope Scabies mites و س موفق ال م ت الت باشيد