Biomedical subjects
Publications and source records attributed to J Faergemann.
Twenty-five patients with seborrhoeic dermatitis localised to the face were treated with bifonazole cream once daily for 4 weeks. Twenty-one (84%) were free of lesions, 2 improved and in 2 no improvement was seen. Bifonazole is not only an effective antimycotic agent, it also has anti-inflammatory activities and this combination may be beneficial in the treatment of seborrhoeic dermatitis.
Twenty three patients with culture positive onychomycosis were treated topically twice daily for 2-6 month with a solution containing 10 g urea, 15 g lactic acid, 4 g NaOH, 21 g water, and 50 g propylene glycol. Trichophyton rubrum was cultured in 17 patients and Candida albicans in 6 patients. The solution was effective in 21 of the 23 patients with cure in 2 patients, marked improvement in 11 patients and improvement in 8 of the patients. In the patients with marked improvement some nails were often completely cured. The good effect of this solution in the treatment of onychomycosis is in correlation with a good in vitro activity with MICs of 5% against Tr. rubrum and 10% against C. albicans and a high penetration into nails in vitro. The patients found the solution cosmetically attractive and no side effects were noticed by the patients. Even if the treatment period was short the good effect in the majority of the patients indicates that this solution is effective in topical treatment of onychomycosis.
A 72-year-old immunocompromised man with myelodysplastic syndrome who developed multiple erythematous, scaly abscesses like lesions on his left foot and lower leg is described. He also had dry scaly lesions on his soles and lesions on several toe nails. A punch biopsy showed abscesses with fungal elements and Trichophyton rubrum was cultured from skin scales and the biopsy. A diagnosis of T. rubrum abscesses should be suspected in all immunocompromised patients with signs of superficial dermatophyte infection.
Seborrhoeic dermatitis is associated with Pityrosporum ovale, but the exact role of the organism is not clarified. In order to study this connection we have investigated 30 patients with seborrhoeic dermatitis with quantitative culture for P. ovale, serum IgG antibodies against P. ovale and lipid measurements. We compared the patients with 60 healthy individuals and found no significant difference in the number of P. ovale or serum antibodies. The lipid content on the skin was significantly higher in the patient group (p = 0.0001). There was no difference in the number of P. ovale in lesions compared to healthy skin in the patient group. This study support our theory that an abnormal reaction in the skin to P. ovale causes the inflammation and the number of P. ovale is of minor importance.
A new standardized method for testing phototoxicity of chemicals against microorganisms is described. The inoculum size of the microorganism, application of test chemicals, prediffusion time, incubation time and incubation period are defined. Staphylococcus aureus, S. epidermidis, Candida albicans, and Pityrosporum orbiculare were studied. Both 8-methoxypsoralen and trimethylpsoralen were phototoxic against all microorganisms tested, while tetracycline and doxycycline were not phototoxic. C. albicans may be chosen for phototoxicity testing because it has been used earlier, it is easy to maintain in culture, it grows easily when tested, and its pathogenicity is low. The phototoxicity of S. aureus, S. epidermidis, Pseudomonas aeruginosa, Propionibacterium acnes, C. albicans, and P. orbiculare against each other were also investigated. Only P. orbiculare was inhibitory. It inhibited the growth of S. aureus, S. epidermidis, and Ps. aeruginosa - both in the dark and after irradiation. The growth inhibition was markedly enhanced after UVA irradiation, indicating phototoxicity. The phototoxic effect of P. orbiculare may play a role in the ecology of the human skin flora.
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The in vitro antimycotic activity and the in vivo antimycotic activity (in a rabbit model) of itraconazole against P. orbiculare were compared to the corresponding activities of ketoconazole. Fluconazole's in vitro antimycotic activity and in vivo antimycotic activity against P. orbiculare were tested in the same models. The MIC values of itraconazole against P. orbiculare were 0.1-0.2 micrograms/ml compared to 0.02-0.05 micrograms/ml for ketoconazole. For fluconazole, the MIC values were 12.5-50.0 micrograms/ml against P. orbiculare. In a rabbit model, orally administered itraconazole (5 mg/kg) afforded protection against experimental pityriasis (tinea) versicolor in four out of five rabbits. Ketoconazole (1 mg/kg) was effective in all four animals. The in vivo results with fluconazole were in contrast to its low in vitro activity. Fluconazole (5 mg/kg) afforded protection against experimental pityriasis (tinea) versicolor in five out of six animals.
A 15-year-old female with a brown hyperkeratotic plaque in the pubic region confirming with the diagnosis of confluent and reticulate papillomatosis (CRP) is presented. The lesion disappeared rapidly after 3 weeks of treatment with 50% propylene glycol in water. The etiological role of Pityrosporum orbiculare in CRP is discussed.
Pityrosporum ovale has been implicated in the pathogenesis of seborrheic dermatitis, a dermatosis occurring with high prevalence in symptomatic HIV-infected individuals. Quantitative cultures for P. ovale were taken in 12 HIV-seropositive patients and in 12 HIV-seronegative controls. Sera were analysed for antibodies to P. ovale. In HIV-seropositive patients, lymphocyte subsets were analysed. The mean number of P. ovale/cm2, the mean serum antibody titres against this yeast and the occurrence of cutaneous disorders did not differ significantly between the two studied groups. No correlation was found between the number of P. ovale/cm2 and the immune status of the HIV-seropositive subjects. The absence of more serious immunological deterioration in the studied HIV-seropositive men may explain the results of this study.
Pityrosporum orbiculare was cultured from clinically normal skin in 60 adults, 30 to 80 years of age. Antibody titers against P. orbiculare in serum and lipid measurements were also estimated. There was a parallel between a reduction in number of cultured organisms and an increase in age (p = 0.002, multiple linear regression analysis). The lipid content of the skin in older people was lower than that in young and middle aged (p = 0.0002). This may be an explanation for the decrease in number of P. orbiculare on the skin in elderly individuals. Antibody titres decreased significantly as age increased (p = 0.02). One explanation may be a reduced stimulation of the immune system due to a drop in the number of organisms.
Many studies now indicate an association between the lipophilic dimorphic yeast Pityrosporon ovale and dandruff. Propylene glycol has been proved effective in the treatment of pityriasis versicolor, Pityrosporon folliculitis, and seborrheic dermatitis. The patients in this study found treatment with a combination of propylene glycol, ethanol, and water, used with a shampoo, to be effective, easy to use, and cosmetically attractive. No side effects were observed by the patients.
Thirty-nine patients with seborrheic dermatitis of the scalp were treated in a double-blind controlled study with a solution containing either 15 percent propylene glycol, 50 percent ethanol, and 35 percent water, or a solution containing 50 percent ethanol and 50 percent water. Two patients did not return for follow-up. Sixteen of eighteen (89 percent) in the group treated with propylene glycol showed healing, compared to six of nineteen (32 percent) in the other group. In twenty patients quantitative cultures for Pityrosporum orbiculare were taken. The number of organisms was reduced significantly after treatment with the propylene-glycol-containing solution but not in the other group. This propylene-glycol-containing solution was easy to apply, cosmetically attractive, and may be an alternative to corticosteroids for the treatment of seborrheic dermatitis of the scalp.
Pityrosporum orbiculare, Candida albicans, Staphylococcus epidermidis and S. aureus were irradiated with UVA and UVB light in vitro. UVB inhibited growth much more effectively than UVA. P. orbiculare was the most sensitive and S. aureus the least sensitive organism. With a dose of 900 mJ cm-2 of UVB a 50 times reduction in number of colony forming units was seen for S. aureus and for the other organisms a total inhibition of growth was seen. When P. orbiculare was irradiated with monochromatic light at 300, 330 and 360 nm the highest antimicrobial activity was seen at 300 nm. If these in vitro observations correlates with the effect of UV-light treatment of various skin disorders is still unclear.
In 49 consecutive leg ulcer patients fungal cultures were taken from 4 different locations: the ulcer; the ulcer edge; 10 cm below the knee; and the toe-web. The patients had been treated with ACO Medicated Stockings in half of the cases, and the others were treated with several different bandages. Sera were analysed for antibodies against Candida albicans with the indirect immunofluorescence technique (IIF). The mean antibody titer was 434 in the patients with C. albicans in their ulcers, 123 in control patients with negative cultures in their ulcers and 258 in control patients with basalioma or actinic keratoses. Seven patients were culture positive for C. albicans, two patients had C. parapsilosis and one had growth of Trichophyton rubrum in their ulcers. Nine out of 10 patients with positive cultures had been treated with ACO Medicated Stockings (p less than 0.05). Covering a large area of the leg with an ointment impregnated stocking without preservatives seems to increase the risk for fungal infections.
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In patients with Pityrosporum folliculitis the mean serum antibody titer against Pityrosporum orbiculare was significantly higher than in healthy control subjects (p less than 0.01). The mean number of P. orbiculare organisms per square centimeter cultured from normal-looking skin in patients was not significantly higher than the number cultured from normal-looking skin in control subjects. Results of prick tests against P. orbiculare extract were negative or weak, indicating that patients with Pityrosporum folliculitis had no type I hypersensitivity against P. orbiculare. Immunohistochemical staining of skin lesions showed perivascular dermal cell infiltrates near the hair follicles dominated by anti-Leu 3a-reactive T lymphocytes. Human lymphocyte antigens with the DR locus, but not those with the DQ locus, on keratinocytes were observed in one case.