eMedicine Specialties > Dermatology > Fungal Infections

Tinea Nigra: Differential Diagnoses & Workup

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): George Kihiczak, MD, Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital
Contributor Information and Disclosures

Updated: Jul 24, 2009

Differential Diagnoses

Addison Disease
Atypical Mole (Dysplastic Nevus)
Malignant Melanoma
Nevi, Melanocytic
Syphilis
Yaws

Other Problems to Be Considered

Hyperpigmentation due to pinta
Chemical stains

Workup

Procedures

  • Microscopic examination of skin scrapings treated with 20% KOH reveals thick, septate, branching hyphae that contain a dark pigment in their walls. Blastospores or chlamydoconidia may also be present.
  • Culture of skin scrapings on Sabouraud agar at 25°C yields growth in approximately 1 week.
    • Initially, yeastlike colonies that are shiny, black, and mucoid are present.
    • Subsequently, the colonies become olivaceous brown and develop aerial mycelia in 2-3 weeks.
    • Microscopic examination of the colonies reveals dematiaceous 2-celled yeast that produce annelloconidia in addition to dematiaceous, septate hyphae with conidia on intercalary annelides.

Histologic Findings

Examination of biopsy specimens reveals hyperkeratosis and mild acanthosis. Periodic acid-Schiff (PAS)–positive septate hyphae are present in the stratum corneum. A scant amount of perivascular lymphocytic infiltrate may be found in the papillary and subpapillary layers of the dermis.

Tinea nigra, showing hyperkeratosis and mild acan...

Tinea nigra, showing hyperkeratosis and mild acanthosis. A scant amount of perivascular lymphocytic infiltrate may be found in the papillary and subpapillary layers of the dermis (hematoxylin and eosin stain). Courtesy of Thomas N. Helm, MD.

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Tinea nigra, showing hyperkeratosis and mild acan...

Tinea nigra, showing hyperkeratosis and mild acanthosis. A scant amount of perivascular lymphocytic infiltrate may be found in the papillary and subpapillary layers of the dermis (hematoxylin and eosin stain). Courtesy of Thomas N. Helm, MD.



Tinea nigra, with histologic section demonstratin...

Tinea nigra, with histologic section demonstrating periodic acid-Schiff–positive septate hyphae within the stratum corneum. Courtesy of Thomas N. Helm, MD.

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Tinea nigra, with histologic section demonstratin...

Tinea nigra, with histologic section demonstrating periodic acid-Schiff–positive septate hyphae within the stratum corneum. Courtesy of Thomas N. Helm, MD.

More on Tinea Nigra

Overview: Tinea Nigra
Differential Diagnoses & Workup: Tinea Nigra
Treatment & Medication: Tinea Nigra
Follow-up: Tinea Nigra
Multimedia: Tinea Nigra
References
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References

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  2. Perez C, Colella MT, Olaizola C, Hartung de Capriles C, Magaldi S, Mata-Essayag S. Tinea nigra: report of twelve cases in Venezuela. Mycopathologia. Oct 2005;160(3):235-8. [Medline].

  3. Badali H, Carvalho VO, Vicente V, et al. Cladophialophora saturnica sp. nov., a new opportunistic species of Chaetothyriales revealed using molecular data. Med Mycol. Feb 2009;47(1):51-62. [Medline].

  4. Blank H. Tinea nigra: a twenty-year incubation period?. J Am Acad Dermatol. Jul 1979;1(1):49-51. [Medline].

  5. Lenassi M, Vaupotic T, Gunde-Cimerman N, Plemenitas A. The MAP kinase HwHog1 from the halophilic black yeast Hortaea werneckii: coping with stresses in solar salterns. Saline Systems. 2007;3:3. [Medline].

  6. Chen GY, Cheng YW, Wang CY, Hsu TJ, Hsu MM, Yang PT, et al. Prevalence of skin diseases among schoolchildren in Magong, Penghu, Taiwan: a community-based clinical survey. J Formos Med Assoc. Jan 2008;107(1):21-9. [Medline].

  7. Hall J, Perry VE. Tinea nigra palmaris: differentiation from malignant melanoma or junctional nevi. Cutis. Jul 1998;62(1):45-6. [Medline].

  8. Tseng SS, Whittier S, Miller SR, Zalar GL. Bilateral tinea nigra plantaris and tinea nigra plantaris mimicking melanoma. Cutis. Oct 1999;64(4):265-8. [Medline].

  9. Uezato H, Gushi M, Hagiwara K, Kayo S, Hosokawa A, Nonaka S. A case of tinea nigra palmaris in Okinawa, Japan. J Dermatol. Jan 2006;33(1):23-9. [Medline].

  10. Zalaudek I, Giacomel J, Cabo H, Di Stefani A, Ferrara G, Hofmann-Wellenhof R, et al. Entodermoscopy: a new tool for diagnosing skin infections and infestations. Dermatology. 2008;216(1):14-23. [Medline].

  11. Burke WA. Tinea nigra: treatment with topical ketoconazole. Cutis. Oct 1993;52(4):209-11. [Medline].

  12. Marks JG Jr, King RD, Davis BM. Treatment of tinea nigra palmaris with miconazole. Arch Dermatol. Mar 1980;116(3):321-2. [Medline].

  13. Shannon PL, Ramos-Caro FA, Cosgrove BF, Flowers FP. Treatment of tinea nigra with terbinafine. Cutis. Sep 1999;64(3):199-201. [Medline].

  14. Babel DE, Pelachyk JM, Hurley JP. Tinea nigra masquerading as acral lentiginous melanoma. J Dermatol Surg Oncol. May 1986;12(5):502-4. [Medline].

  15. Carr JF, Lewis CW. Tinea nigra palmaris. Treatment with thiabendazole topically. Arch Dermatol. Jul 1975;111(7):904-5. [Medline].

  16. Cutlip BD Jr, Varkonyi NT, Grant D. Tinea nigra palmaris. Mil Med. Mar 1970;135(3):192-3. [Medline].

  17. Feng B, Wang X, Hauser M, et al. Molecular cloning and characterization of WdPKS1, a gene involved in dihydroxynaphthalene melanin biosynthesis and virulence in Wangiella (Exophiala) dermatitidis. Infect Immun. Mar 2001;69(3):1781-94. [Medline].

  18. Gupta G, Burden AD, Shankland GS, Fallowfield ME, Richardson MD. Tinea nigra secondary to Exophiala werneckii responding to itraconazole. Br J Dermatol. Sep 1997;137(3):483-4. [Medline].

  19. Hughes JR, Moore MK, Pembroke AC. Tinea nigra palmaris. Clin Exp Dermatol. Sep 1993;18(5):481-2. [Medline].

  20. McKinlay JR, Barrett TL, Ross EV. Picture of the month. Tinea nigra. Arch Pediatr Adolesc Med. Mar 1999;153(3):305-6. [Medline].

  21. Meletiadis J, Meis JF, de Hoog GS, Verweij PE. In vitro susceptibilities of 11 clinical isolates of Exophiala species to six antifungal drugs. Mycoses. Sep 2000;43(7-8):309-12. [Medline].

  22. Merwin CF. Tinea nigra palmaris. Review of literature and case report. Pediatrics. Oct 1965;36(4):537-41. [Medline].

  23. Mok WY. Nature and identification of Exophiala werneckii. J Clin Microbiol. Nov 1982;16(5):976-8. [Medline].

  24. Palmer SR, Bass JW, Mandojana R, Wittler RR. Tinea nigra palmaris and plantaris: a black fungus producing black spots on the palms and soles. Pediatr Infect Dis J. Jan 1989;8(1):48-50. [Medline].

  25. Reid BJ. Exophiala werneckii causing tinea nigra in Scotland. Br J Dermatol. Jul 1998;139(1):157-8. [Medline].

  26. Sayegh-Carreno R, Abramovits-Ackerman W, Giron GP. Therapy of tinea nigra plantaris. Int J Dermatol. Jan-Feb 1989;28(1):46-8. [Medline].

  27. Whiting DA, Bisset EA. Tinea nigra. S Afr Med J. Sep 15 1973;47(36):1659-61. [Medline].

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Further Reading

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Keywords

tinea nigra palmaris, tinea nigra plantaris, keratomycosis nigricans palmaris, dermatomycosis nigricans, mycosis of the stratum corneum, Hortaea werneckii, H werneckii, Phaeoannellomyces werneckii, P werneckii, Exophiala werneckii, E werneckii, Cladosporium werneckii, C werneckii

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

George Kihiczak, MD, Clinical Associate Professor, Department of Dermatology, New Jersey Medical School and University Hospital
George Kihiczak, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Medical Society of New Jersey
Disclosure: Nothing to disclose.

Medical Editor

Neil Shear, MD, Professor and Chief of Dermatology, Professor of Medicine, Pediatrics and Pharmacology, University of Toronto Faculty of Medicine; Head of Dermatology, Sunnybrook Women's College Health Sciences Center and Women's College Hospital, Canada
Neil Shear, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Clinical Pharmacology and Therapeutics, Canadian Dermatology Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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