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Tinea versicolor

Top: Manifestation in 18-year-old male
Bottom: Causative yeast cells

Unlike the other skin mycoses (called tinea - from Latin, “meaning a gnawing moth, or bookworm”), tinea versicolor is not caused by the same dermatophytes of the genus Ascomycota that most “ringworm”-type afflictions belong to.

Tinea versicolor is a yeast, which is a fungus of the phylum Basidiomycota, and a fairly common condition. Between 2 and 8% of people in the United States express this condition, especially during the summer months, as tinea versicolor thrives in hot and humid conditions when there is excess skin oil and dead skin cells to consume. Among young adults and adolescents, this condition affects almost 10% of individuals.

These yeasts (Malassezia furfur and Malassezia globosa) are not considered harmful, and are generally asymptomatic aside from its dermatological manifestation. When the condition recurs during multiple summers, the source of the yeast is generally high environmental concentrations of the spores; unlike many vegetable or animal parasites, the yeasts that cause tinea versicolor are not known to lay dormant on humans for more than a few weeks.

The original cures for this condition included both oral and topical mercury treatments - needless to say, topical mercury did kill the fungus, but you can’t exactly justify the harm done, just to clear up a harmless condition that isn’t all that disfiguring to begin with. These days, tolnaftate (brand name Tinaderm) and selenium sulfide (like in Selsun Blue shampoo) are used to treat the condition, and can generally clear up the condition. However, when the source is due to high environment concentrations, it can often recur, especially while one is maturing, and skin oil/dead skin cells are more prevalent than usual.

Treatise on Diseases of the Skin, for the use of Advanced Students and Practitioners. Henry W. Stelwagon, 1914.

Epidermophyton floccosum, wet prep.

The person who was teaching me mycology had an incredible accent and for the longest time I thought she was telling me to look for “puddle shaped macroconidia”. I couldn’t figure out for the life of me why anyone would describe anything as puddle shaped. It wasn’t until the end that I realized she was saying paddle shaped. Oops. They remain “puddles” in my mind though.

Epidermophyton floccosum is one of the dermatophytes, fungi that cause superficial infections of hair, skin, and nails. They generally aren’t a big deal, but there’s a lot of money in antifungals because man, do people hate dandruff and athlete’s foot.

"Ringworm" - Tinea faciei

As most of you know, ringworm isn’t really a “worm”, or even an animal parasite. The condition is caused by one of over forty species of fungi (called dermatophytes) that live on the skin surface, and feed on keratin. The spores thrive on warm, wet surfaces, but can entrench themselves almost anywhere on the body. The name of the condition is determined by the location of infection - tinea capitis is on the scalp, tinea pedis is on the foot (athlete’s foot), tinea cruris is in the groin (jock itch/”crotch rot”), etc.

As the fungi are extremely easily spread by person-to-person contact, kids and people in institutional settings tend to contract the condition much more often than independent adults.

The original treatments for ringworm included mercury (oral and topical), sulfur, and iodine. Treatment of the scalp (tinea capitis) was considered more difficult than on the body, and frequently, x-ray treatment was used to kill the fungus.

The routine and accepted use of ionizing radiation to cure tinea capitis led to a long-standing incident among the Ashkenazi communities in Europe and the Middle East, called the "Ringworm affair". Starting in 1910, several hundred thousand people (mostly children) from close-knit Jewish communities were treated for the condition, in an attempt to eradicate it from a population known to routinely harbor or manifest the condition. However, the treatments were poorly-executed, the patients rarely had full information as to what was being done to them, and the excessive exposure to ionizing radiation is estimated to have killed at least 6,000 children shortly after receiving treatment (within 2 weeks). At least 100,000 other people have had long-term effects from the program, such as cancers, genetic anomalies in their children, and thyroid function problems.

The x-ray treatment program, which was for the most part well-intentioned but disastrously-executed, did not end until 1959, when the first effective and relatively safe antifungal compound, griseofulvin, was developed.

Illustrated Skin Diseases, An Atlas and Text-Book. William S. Gottheil, 1906.

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