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Mycologic Disorders of the Skin Catherine A Mycologic Disorders of the Skin Catherine A. Outerbridge, DVM, MVSc, DACVIM, DACVD Cutaneous tissue can become infected when fungal organisms contaminate or colonize the epidermal surface or hair follicles. The skin can be a portal of entry for fungal infection when the epithelial barrier is breached or it can be a site for disseminated, systemic fungal disease. The two most common cutaneous fungal infections in small animals are dermato- phytosis and Malassezia dermatitis. Dermatophytosis is a superficial cutaneous infection with one or more of the fungal species in the keratinophilic genera Microsporum, Tricho- phyton,orEpidermophyton. Malassezia pachydermatis is a nonlipid dependent fungal species that is a normal commensal inhabitant of the skin and external ear canal in dogs and cats. Malassezia pachydermatis is the most common cause of Malassezia dermatitis. The diagnosis and treatment of these cutaneous fungal infections will be discussed. Clin Tech Small Anim Pract 21:128-134 © 2006 Elsevier Inc. All rights reserved. KEYWORDS dermatophytosis, Malassezia dermatitis, dogs, cats, Microsporum, Trichophyton, Malassezia pachydermatis ver 300 species of fungi have been reported toDermatophytosis be animal O pathogens.1 Cutaneous tissue can become infected when fungal organisms contaminate or colonize the epider- Etiology mal surface or hair follicles. The skin can be a portal of entry Dermatophytosis is a superficial cutaneous infection with for fungal infection when the epithelial barrier is breached or one or more of the fungal species in the keratinophilic genera it can be a site for disseminated, systemic fungal disease. Microsporum, Trichophyton,orEpidermophyton. Dermato- Canine and feline skin and hair coats can be transiently con- phyte genera that infect animals are divided into 3 or 4 taminated with a large variety of saprophytic fungi from the groups based on their natural habitat. Geophilic dermato- environment some of which can cause opportunistic infec- phytes are normally soil inhabitants. The most common geo- tions.1,2 The diagnosis of a fungal infection must bephilic made dermatophyte to infect dogs or cats is Microsporum based on isolation of the organism from affected tissues and gypseum. Zoophilic dermatophytes are adapted to living on visualization of tissue invasion by organisms with compatible animals and are rarely found in the soil. The most common 3 morphology. Actual mycologic pathogens of the skin canzoophilic be dermatophyte to infect dogs and cats is Microspo- divided based on what layers of the skin, hair coat or claws rum canis. Sylvatic dermatophytes are zoophilic dermato- they infect. Superficial mycoses include dermatophytosis phytes adapted to living on rodents or hedgehogs. The most (predominantly Microsporum and Trichophyton species), common sylvatic dermatophytes are Trichophyon mentagro- Malassezia spp., Candida, and Trichosporon (piedra). Subcuta- phytes, Trichophyton mentagrophytes erinacei (hedgehogs), and neous mycotic infections include sporotrichosis, dermato- in EuropeM. persicolor(does not infect hair 1,2shafts). An- phytic mycetoma, oomycosis (pythiosis and lagenidiosis), throphilic dermatophytes are adapted to living on humans zygomycosis (mucormycosis and entomophthoromycosis), and do not survive in the soil and can be a cause of reverse hyalohyphomycosis, and phaeohyphomycosis. The deep sys- zoonosis when dogs or cats acquire the infection from in- temic mycoses (blastomycosis, histoplasmosis, cryptococco- fected humans. T. tonsurans was the most commonly isolated sis, and coccidiodomycosis) can also cause subcutaneous le- dermatophyte from human patients in the United States in sions of the skin. This paper will review the etiology, the mid 1990s.4 prevalence, clinical presentation, diagnosis, and treatment The most common fungal organisms identified in the dog for the two most common cutaneous fungal infections in or cat with dermatophytosis are M. canis, M. gypseum, and T. small animals; dermatophytosis and Malassezia dermatitis. mentagrophytes. These fungal organisms are adapted to colo- nize hair and the cornified layers of the skin where they can Department of Medicine and Epidemiology, School of Veterinary Medicine, digest keratin protein for their nutrition. Most animals must University of California, Davis, CA. contact a minimum infective dose of dermatophyte spores to Address reprint requests to Catherine A. Outerbridge, DVM, MVSc, DACVIM, Department of Medicine and Epidemiology, School of Veter- have an infection establish. This dose will vary with each inary Medicine, University of California, Davis, CA 95616. E-mail: individual animal’s overall health status. Some animals may [email protected] have predisposing factors for developing a dermatophyte in- 128 1096-2867/06/$-see front matter © 2006 Elsevier Inc. All rights reserved. doi:10.1053/j.ctsap.2006.05.005 Mycologic disorders of the skin 129 fection. These predisposing factors include stress, poor nu- trition, debilitating disease, compromised immune status, or young age.1 Prevalence Dermatophytosis is more common in cats than in dogs but the reported prevalence in a population varies considerably with geographic location, particularly between different con- tinents. Several studies have cited the prevalence of dermato- phytosis in dogs and cats, presenting to North American veterinary clinics for skin disease, to be 10.26 The to 5.6%. reported prevalence of dermatophytosis is higher in areas with a warm, humid climate. When healthy pet cats in North America were microbiologically sampled the prevalence of dermatophytosis was very 5 rare.North American studies in which shelter cats were similarly sampled (using a tooth- Figure 2 Dermatophytosis caused by T. mentagrophytes. There is brush technique) found a higher prevalence of dermato- marked alopecia, erythema, scaling, and crusting involving the head phytes within a shelter population of cats. Pathogenic der- and extremities. Scarring is also evident. The dog had been treated matophytes were cultured in 5.5 to 19% of all shelter cats with systemic glucocorticoids before the diagnosis of dermatophyt- 6,7 depending on the geographical region.M. canis, specifi- osis with resultant temporal muscle atrophy. (Color version of fig- cally, was found in 4 and 5% of cats but only in those geo- ure is available online.) graphical areas with a humid and warm climate. Of particular note is that 90 to 100% of the shelter cats that cultured positive in these studies were lesion6,7 Cats free.infected with FeLV or FIV did not have an increased incidence of isolation localized inflammatory lesion that results from the host’s in- of M. caniscompared with noninfected 8 incats one study butflammatory response to a dermatophyte. It is a well-circum- immunosuppression is a risk factor for the development of scribed, boggy, nodular lesion of furunculosis with draining dermatophytosis. Cats positive for these retroviruses did fistulae often on the face or a distal extremity. M. gypseum and have more diverse fungal organisms isolated from their hair T. mentagrophytes are the most common organisms to result 1 coats.8 Persian and Himalayan cats and Yorkshire terriersin kerions. appear to be predisposedM. canisto dermatophytosis. 1 Dermatophytosis lesions in cats are more pleomorphic. Classic lesions include one or more areas of partial alopecia Clinical with scaling and crusting most commonly on the head or forelimbs. Lesions may be hyperpigmented.2,9 Dermatophyt- Dermatophytosis in dogs often results in localized lesions osis can also result in lesions that resemble miliary dermatitis most commonly on the face, feet, or tail. Dogs are more likely or focal, pruritic lesions that resemble eosinophilic to present with the classical circular alopecia with scale and plaques.1,9 Long haired cats may present with a complaint of crust and follicular papules and pustulesT. (Fig.menta- 1). a poor hair coat or excessive shedding as infected hairs are grophytes infection often results in much more dramatic clin- prone to breakage.9 Kerions are uncommon in cats - but Per ical scaling, crusting and even scarring (Fig. 2). A kerion is a sian and Himalayan cats can develop subcutaneous nodular lesions caused by dermatophyes called dermatophytic pseudomycetomas. These lesions are often exudative or draining and coalescing nodules (Fig. 3). Visible tissue grains may be associated with these lesions. Systemic lesions of dermatophytic pseudomycetomas have also been reported in a Persian 10cat. Diagnosis Dermatophytosis in dogs and cats is common but is often misdiagnosed, particularly in dogs. Occasionally the diagno- sis is never considered but more frequently animals are in- correctly given the presumptive diagnosis based solely on the appearance of visible, circular skin lesions. This can result in some animals receiving unnecessary therapy with antifungal drugs. This is concerning when the drugs being prescribed are expensive or capable of causing serious side effects and when the misdiagnosis results in delays in determining the Figure 1 Multifocal, well demarcated areas of alopecia because of M. actual cause of the animal’s skin lesions. canis dermatophytosis in a terrier cross dog. Scaling and follicular The clinical appearance of skin lesions is unreliable as the papules are present along the lesional borders. (Color version of sole criteria to diagnose dermatophytosis. A Wood’s lamp figure is available online.) examination can be helpful in some cases but it is also not a 130 C.A. Outerbridge
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