Table 4.

Clinical presentation of dermatophytes

Name of superficial infectionClinical presentationExtension to hair follicleFungus(i)Systemic diseaseKOH preparationsMorphology in tissue sections
Tinea or ringworm, followed by the location in the bodyRound lesions with scaly border, accompanied by pruritus and burningYes; when suppurative known as kerion, when chronic known as Majocchi's granulomaDermatophytes (Epidermophyton spp., Trichophytum spp., Microsporum spp.)Very rare but can invade the dermis and soft tissues, causing mycetomasHyphae with or without septationsHyphae cannot be visualized in the keratin with H&E, special stains are needed
Tinea versicolorHypo and hyperpigmentation in patients with oily and sweaty skin, fine scales when scratchingYes, known as Pityrosporum folliculits Malassezia spp.Systemic infections may occur in premature neonates receiving parenteral nutrition and in other immunosuppressed hostsYeasts and hyphae (“spaghetti and meat balls”)Faintly basophilic hyphae in the stratum corneum
Tinea nigraBrown to black macule, usually in palms, with some scalingNo Phaeoannellomyces werneckii Not describedDarkly pigmented, septated, and branching hyphaePigmented hyphae in the stratum corneum
White piedraCreamy-white, small, soft nodules in hair shaftsNo Trichosporon spp.Immunosuppressed patients may have lung infiltrates, renal involvement, and fungemiaSeptate hyphae perpendicular to hair shaftNot used for diagnosis
Black piedraHard dark nodules in hair shaftsNo Piedraia hortae Not describedCollections of crescent ascospores surrounded by pigmented hyphaeNot used for diagnosis
Superficial candidiasisIntertrigo, chronic paronychia, onychodystrophy, cheilitisYes Candida spp.Yes, particularly in patients with AIDS and depending on the level of immunosuppressionYeasts, pseudohyphae may be observedFungal elements may be seen through the biopsy, vascular invasion must be determined