Tinea nigra

	Dermatophytosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Dermatophytosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiographic Findings
X-Ray Findings
CT scan Findings
MRI Findings
Ultrasound Findings
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Tinea nigra On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Tinea nigra All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA onTinea nigra
CDC on Tinea nigra
Tinea nigra in the news
Blogs on Tinea nigra
Directions to Hospitals Treating Dermatophytosis here
Risk calculators and risk factors for Tinea nigra

	Tinea nigra;
ICD-10	B36.1
DiseasesDB	32450
eMedicine	derm/890

File:Hortaea-werneckii-fungus--causes-tinea-nigra.jpg

Micrograph of the fungus Hortaea werneckii, the causative agent of tinea nigra

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Tinea nigra (also known as "superficial phaeohyphomycosis,"^[1] and "Tinea nigra palmaris et plantaris"^[1]) is a superficial fungal infection that causes dark brown to black painless patches on the palms of the hands and the soles of the feet.^[2]^:311

Causes

This infection is caused by the fungus formerly classified as Exophiala werneckii but more recently classified as Hortaea werneckii.^[3]

The causative organism has also been described as Phaeoannellomyces werneckii.^[4]

Diagnosis

Diagnosis of tinea nigra causing fungus is made on microscopic examination of skin scrapings, mixed with potassium hydroxide (KOH).^[5] The KOH lyses the nonfungal debris.^[5]

Physical Examination

Skin

Extremities

Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]
Tinea nigra. Adapted from Dermatology Atlas.^[6]

Differential diagnosis

Tinea nigra must be differentiated from other diseases presenting with an erythmatous, scaly, annular and pruritic rash. The differentials include the following:

Name of superficial infection	Clinical presentation	Extension to hair follicle	Fungus(i)	Systemic disease	KOH preparations	Morphology in tissue sections
Tinea or ringworm	Round lesions with scaly border, accompanied by pruritis and burning	Yes; when suppurative known as kerion, when chronic known as Majocchi's granuloma	Dermatophytes (Epidermophyton spp., Trichophyton spp., Microsporum spp.)	Very rare but can invade the dermis and soft tissues, causing mycetomas	Hyphae with or without septations	Hyphae cannot be visualized in the keratin with H&E, special stains are needed
Tinea versicolor	Hypo and hyperpigmentation in patients with oily and sweaty skin, fine scales when scratching	Yes, known as Pityrosporum folliculits	Malassezia spp.	Systemic infections may occur in premature neonates receiving parenteral nutrition and in other immunosuppressed hosts	Yeasts and hyphae (“spaghetti and meat balls”)	Faintly basophilic hyphae in the stratum corneum
Tinea nigra	Brown to black macule, usually on palms, with some scaling	No	Phaeoannellomyces werneckii	Not described	Darkly pigmented, septated, and branching hyphae	Pigmented hyphae in the stratum corneum
White piedra	Creamy-white, small, soft nodules in hair shafts	No	Trichosporon spp.	Immunosuppressed patients may have lung infiltrates, renal involvement, and fungemia	Septate hyphae perpendicular to hair shaft	Not used for diagnosis
Black piedra	Hard dark nodules in hair shafts	No	Piedraia hortae	Not described	Collections of crescent ascospores surrounded by pigmented hyphae	Not used for diagnosis
Superficial candidiasis	Intertrigo, chronic paronychia, onychodystrophy, cheilitis	Yes	Candida spp.	Yes, particularly in patients with AIDS and depending on the level of immunosuppression	Yeasts, pseudohyphae may be observed	Fungal elements may be seen through the biopsy, vascular invasion must be determined

Treatment

Treatment consists of topical application of dandruff shampoo, which contains selenium sulfide, over the skin. Topical antifungal imidazoles may also be used, such as Ketoconazole. This is the same treatment plan for tinea or pityriasis versicolor.

References

↑ ^1.0 ^1.1 Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. Chapter 76. ISBN 1-4160-2999-0.
↑ James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
↑ Murray, Patrick R.; Rosenthal, Ken S.; Pfaller, Michael A. (2005). Medical Microbiology (5th ed.). Elsevier Mosby.
↑ 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.
↑ ^5.0 ^5.1 Gladwin, Mark; Trattler, Bill. Clinical Microbiology (4th ed.). p. 196.
↑ ^6.00 ^6.01 ^6.02 ^6.03 ^6.04 ^6.05 ^6.06 ^6.07 ^6.08 ^6.09 ^6.10 ^6.11 ^6.12 ^6.13 ^6.14 ^6.15 ^6.16 ^6.17 ^6.18 ^6.19 ^6.20 ^6.21 ^6.22 ^6.23 ^6.24 ^6.25 ^6.26 ^6.27 ^6.28 ^6.29 ^6.30 ^6.31 ^6.32 ^6.33 ^6.34 ^6.35 ^6.36 ^6.37 ^6.38 ^6.39 ^6.40 ^6.41 ^6.42 ^6.43 ^6.44 ^6.45 ^6.46 ^6.47 ^6.48 ^6.49 ^6.50 ^6.51 ^6.52 ^6.53 ^6.54 ^6.55 ^6.56 ^6.57 ^6.58 ^6.59 ^6.60 ^6.61 "Dermatology Atlas".

External links

Template:Mycoses Template:Disease-stub

[Bolognia-1] 1.0 ^1.1 Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. Chapter 76. ISBN 1-4160-2999-0.

[Andrews-2] James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.

[3] Murray, Patrick R.; Rosenthal, Ken S.; Pfaller, Michael A. (2005). Medical Microbiology (5th ed.). Elsevier Mosby.

[pmid12869152-4] 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.

[Gladwin4-5] 5.0 ^5.1 Gladwin, Mark; Trattler, Bill. Clinical Microbiology (4th ed.). p. 196.

[Dermatology_Atlas-6] 6.00 ^6.01 ^6.02 ^6.03 ^6.04 ^6.05 ^6.06 ^6.07 ^6.08 ^6.09 ^6.10 ^6.11 ^6.12 ^6.13 ^6.14 ^6.15 ^6.16 ^6.17 ^6.18 ^6.19 ^6.20 ^6.21 ^6.22 ^6.23 ^6.24 ^6.25 ^6.26 ^6.27 ^6.28 ^6.29 ^6.30 ^6.31 ^6.32 ^6.33 ^6.34 ^6.35 ^6.36 ^6.37 ^6.38 ^6.39 ^6.40 ^6.41 ^6.42 ^6.43 ^6.44 ^6.45 ^6.46 ^6.47 ^6.48 ^6.49 ^6.50 ^6.51 ^6.52 ^6.53 ^6.54 ^6.55 ^6.56 ^6.57 ^6.58 ^6.59 ^6.60 ^6.61 "Dermatology Atlas".

[1]

[2]

[3]

[4]

[5]

[6]