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Multiple open and double-blind studies have confirmed the efficacy of ketoconazole in the treatment of pityriasis versicolor. Single-dose (400 mg) or short-course (200 mg/d for five days) therapy may be highly effective for selected patients with pityriasis versicolor. Toxicity seems to be minimal at this dosage.
Pityriasis versicolor and malassezia folliculitis were studied clinically and mycologically. The main results were as follows: 1) The average age of pityriasis versicolor patients has gradually become higher. 2) Negative rates of Malassezia furfur after treatment were very high by direct examination but relatively low by culture. 3) Patients who were negative by culture on completion of treatment seldom recurred within 2 months. 4) We can evaluate the effectiveness of antifungal application by using Malassezia furfur as normal skin flora on the volunteer's back. 5) Malassezia furfur (orbiculare or ovale type) is detected in follicular contents of steroid acne and acne vulgaris, which makes it necessary to establish criteria for diagnosis of malassezia folliculitis.
Thirty patients suffering from Pityriasis versicolor were treated with fenticonazole in cream or lotion form with two applications a day. At microscopy, Malassezia furfur was encountered in 25 cases and Pityrosporum orbiculare in 5. Disappearance of the yeast was obtained on average in 2 weeks of treatment. Measurement of sebum content with a Sebumeter apparatus did not reveal significant difference (p greater than 0.05) between patients suffering from Pityriasis versicolor and controls and in treated patients, in the course of topical therapy.
The efficacy of fenticonazole 2% lotion was studied in patients suffering from pityriasis versicolor in a double-blind comparison with bifonazole 1% lotion, both applied once daily for three weeks. Forty-six patients were recruited and randomly allocated to one or other treatment group. Clinical and mycological examinations, performed at baseline and at weekly intervals, have shown an excellent response to both treatments. Two cases of mild transient desquamation were reported in the fenticonazole group. Fenticonazole 2% lotion appears active in the treatment of pityriasis versicolor and its efficacy is comparable to that of bifonazole.
Clinical efficacy of fenticonazole 2% cream has been tested on 30 patients with dermatomycoses and the 2% nebulized lotion on 10 patients with pityriasis versicolor. Treatment consisted of two topical applications of the drug for up to 5 weeks and clinical improvement and mycology were assessed at one-week intervals. Thirty-six patients (90%) were cured at the end of the 5-week period; 26 were cured from dermatomycoses and 10 from pityriasis versicolor. No recurrency/reinfection nor side-effects were encountered. The success attained by fenticonazole treatment indicates that it is a first choice drug in the therapy of superficial dermatomycoses.
The cellular response in pityriasis (tinea) versicolor lesions was analysed in situ with an immunohistochemical double staining technique combined with periodic acid-Schiff staining in frozen sections of skin biopsies from 9 patients. The proportions of B and T cells and subpopulations of T cells in the blood were normal as were the proliferative responses of blood mononuclear cells against various B- and T-cell mitogens and antigens. Fungi were observed in stratum corneum in all lesions, and there were moderate cell infiltrates in both epidermis and dermis as compared to biopsies from normal-looking skin. The majority of the infiltrating perivascular cells reacted with anti-Leu 1 antibodies (all mature peripheral T cells). Anti-Leu 2a reactive cells ('suppressor/cytotoxic' phenotype) were few and scattered, whereas anti-Leu 3a reactive cells ('helper/inducer' phenotype) dominated. This investigation demonstrates that pityriasis versicolor is not a simple overgrowth of the fungus in stratum corneum, but is accompanied by infiltrating immunocompetent cells in both epidermis and dermis.
A case of pityriasis versicolor was reported on a child 29 days old. The source of infection probably was the mother who also was noted to have the mycosis. The differential diagnosis of hypochromic lesions should include pityriasis versicolor, even in very young children and direct examination is quick and easy can confirm the diagnosis of this condition.
Eleven patients with chronic pityriasis lichenoides chronica were treated with topically applied bland emollient cream and minimally erthemogenic doses of UV radiation from fluorescent sunlamps. The conditions of all patients cleared completely in an average of 29 treatments, requiring an average UV dose of 388 millijoules/sq cm at clearance. Phototherapy provides a convenient effective outpatient therapy for pityriasis lichenoides chronica.
A review of the literature concerning the pityriasis lichenoides and the study of 34 personal cases show that three main clinical patterns are found in pityriasis lichenoides: maculo-papular, leukomelanodermal, necrotic. The course is very variable: rarely seven weeks, more often seven months and sometimes seven years. The disease is issued from an angiitis including a mostly lymphocytic infiltration. The epidermis is secondarily invaded by inflammatory cells and shows focal parakeratosis. There is no specific immunologic disorder: immunohistopathologic study is generally normal (rarely IgM or C3 deposits); no circulating immune complex is found. Some patients improved with dapsone or photochemotherapy.
Pityriasis versicolor is a superficial fungal infection of the skin caused by Malassezia furfur (Pityrosporum orbiculare) which is a part of the normal flora of the human skin. The factors which govern the pathogenic conversion of this fungus are not fully understood but a hot humid environment is considered to be a predisposing factor and the disease is very common in tropical countries. Clinically the disease is characterized by scaly hypo- or hyperpigmented macular lesions that are typically located in the trunk, neck and upper arms. The penis is rarely affected. In this report a patient of pityriasis versicolor with involvement of the shaft of the penis is presented.
BACKGROUND: Cutaneous lesions of pityriasis lichenoides et varioliformis acuta (PLEVA), a T cell-mediated cutaneous inflammatory condition, are clinically similar to lymphomatoid papulosis (LyP), leading some authors to hypothesize that they are part of the same spectrum of lymphoproliferative disorders, although reports of the development of cutaneous lymphoma in patients with PLEVA are not as frequent as they are for patients with LyP. Furthermore, unlike in cases of LyP, no systematic search for a dominant T-cell clone has been carried out in cases of PLEVA, whereas clones have been detected in a few cases of PLEVA using mainly Southern blot analysis. OBJECTIVE: To investigate T-cell clonality in a series of archival PLEVA lesions. TISSUES: Archival paraffin-embedded biopsy specimens from 20 clinically and pathologically typical cases of PLEVA were selected. MAIN OUTCOME MEASURE: Identification of a dominant T-cell clone by polymerase chain reaction and heteroduplex analysis targeted on the TCRgamma gene. Peripheral blood mononuclear cells (PBMCs) and Jurkat cells were used as negative and positive controls. Serial dilutions of Jurkat T-cell lymphoma DNA in PBMC DNA were used to assess the sensitivity of the method. RESULTS: Analysis of 13 (65%) of 20 PLEVA biopsy specimens revealed the presence of a dominant T-cell clone. Positive and negative controls confirmed the specificity of the procedure. The sensitivity was determined to be between 1% and 5% of the total T-cell infiltrate. CONCLUSIONS: This study provides further evidence for the presence of a dominant T-cell clone in skin lesions of some patients with PLEVA and supports the hypothesis that PLEVA is part of the spectrum of clonal-T-cell cutaneous lymphoproliferative disorders.
Pityriasis rubra pilaris (PRP) refers to a group of erythematous, scaling dermatologic conditions that have been associated with seronegative arthritis. We report a case of polyarthritis in a young man with PRP in which magnetic resonance imaging suggested an entheseal-based pathology for the joint disease. The arthritis, but not the skin condition, demonstrated dramatic response to anti-tumor necrosis factor immunotherapy.
Five patients with pityriasis rubra pilaris (PRP) were analyzed by means of light and electron microscopy as well as by histochemistry and autoradiography. The results were compared with findings in psoriasis vulgaris. In PRP we found a moderate increase of the labeling index of epidermal cells, a highly increased labeling index of dermal infiltrating cells, and a mild spongiosis, and in the stratum granulosum, a decreased number of tonofilaments and an increased number of keratinosomes. The horny layer in PRP showed a pronounced histochemical and electron microscopical parakeratosis, even when histological parakeratosis was absent. In contrast with psoriasis vulgaris, there was no exocytosis of polymorphonuclear leucocytes into the epidermis, the papillomatosis index was normal, and there were no tortuous capillaries in the dermal papillae. The stratum granulosum was always present and sometimes thickened, showing electron microscopical changes different from those referred to in psoriasis. These changes point to a relatively distinct pattern of epidermal changes in PRP.
In 15 patients with pityriasis rosea, we studied the evolutionary changes of the immunohistological characteristics of the secondary lesions. Many CD1a+ cells were seen in the epidermis and dermis of early lesions. In the well-developed lesions, the number of CD1a+ cells greatly increased in the dermis. In the late lesions, CD1a+ cells in the dermis significantly decreased as compared with the well-developed lesions. Early lesions showed a moderate T-cell infiltrate. In the well-developed lesions, the dermal T-cell infiltrate was dense, and the CD4 CD8 ratio was 2.9. The late lesions had a moderate T-cell infiltrate, in which the CD4 CD8 ratio significantly decreased as compared with the well-developed lesions. Thus, the relative decrease in CD4+ helper inducer cells during lesion regression, concomitant with a decrease in number of CD1a+ Langerhans cells, is in accordance with a broader concept of increased suppressor mechanisms during healing.
Various treatment options for pityriasis rubra pilaris (PRP) are evaluated and new aspects of the pathogenesis are reviewed.with. Furthermore, 3 cases of adult onset PRP (type I), treated with acitretin, are presented.
Pityriasis rubra pilaris (PRP) is a rare papulosquamous disease with typical onset during the first and fifth decades. The skin disorder normally starts on the scalp and spreads caudally within a few weeks. It often results in a generalized erythroderma with sharply demarcated islands of sparing ("nappes claires"). A 65-year-old patient with severe PRP showed good clinial improvement after 8 months of treatment when treated with acitretin in combination with phototherapy and systemic gluocorticosteroids.
Pityriasis rosea (PR) is an acute, inflammatory skin disease of unknown cause. Clinical and experimental findings indicate an infectious etiology of PR. Various infectious agents including viruses have been proposed as causative agents and their presence in PR samples has been extensively investigated. Recently, human herpesvirus 7 was linked to PR, but contradictory findings have been reported by various investigators. Here, we describe the features of PR that suggest an infectious cause and review the data from viral studies in PR reported in the literature. In addition, we present a pathogenetic model of PR which may be helpful in planning and evaluating studies for the search of a putative PR-associated virus. Based on the current state of knowledge, none of the known viruses could, so far, be conclusively associated with PR.
We report the case of a 46-year-old woman presenting cutaneous lesions similar to those of pityriasis rubra pilaris, characterized by diffuse scaling erythroderma and palmoplantar keratoderma; skin biopsy showed follicular hyperkeratosis with a perivascular lymphocytic infiltrate. One year later she developed an inflammatory myopathy; on the basis of clinical features, a diagnosis of dermatomyositis was made. Treatment with prednisone and hydroxychloroquine led to complete control of the cutaneous and muscular involvement, which was maintained during prednisone tapering.