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We describe a 53-year-old woman with pityriasis versicolor together with erythrasma that was localized in the axillary and genitocrural region. The coexistence of these infections is rare and we propose the use of methylene blue stain for the diagnosis of both diseases.
BACKGROUND: The genus Malassezia (Pityrosporum), recognized as a member of microbiological flora of the skin in humans and warm-blooded animals, has been recently revised to include 10 Malassezia species. The aim of the study was the isolation, identification and analysis of Malassezia species distribution in skin of healthy volunteers and lesions of pityriasis versicolor (PV). MATERIAL AND METHODS: Specimens were taken from 100 patients with PV and 30 healthy volunteers. Cultures were made in modified Dixon agar medium and the isolates were identified by morphological and physiological methods: macroscopy, microscopy, catalase, beta-glucosidase and lipid assimilation tests. RESULTS: Malassezia globosa was the predominant species in lesional skin of PV (65%). It was isolated alone in 47% of cases and associated in 18% with M. furfur (13%) or M. sympodialis (5%). In healthy skin M. globosa was found alone in 7.77% and associated in 15.54%, respectively, with M. furfur (4.44%), M. sympodialis (4.44%), M. restricta (3.33%) and M. slooffiae (1.11%). CONCLUSION: From these findings it was suggested that M. globosa presents the main species implicated in the pathogenicity of PV and M. furfur as the second agent of importance.
A case of pityriasis versicolor atrophicans caused by Malassezia globosa is reported in a 49-year-old woman. Diagnosis was based on direct microscopic examination and culture. Differential diagnosis was performed with respect to other skin diseases manifesting with cutaneous atrophy.
Pityriasis versicolor (PV) is a superficial mycosis, theoretically unusual in children. Epidemiologic and clinical data for children with PV over 11 years was collected. Some explanations are given for the conditions that favored this mycotic infection in children. This study confirms that the face is a usual site of PV in children, in contrast to its rarity as a site in adults. Clinical features are variable and similar to adults. Both sexes are equally affected. The family history is often positive for PV.
Modification of pigmentation and damage of melanocytes are characteristic features of skin colonisation of Pityrosporum orbiculare hyphae in pityriasis versicolor (PV). The yeast is lipophylic and lipid-dependent, capable of oxidising unsaturated lipid components of skin surface, i.e., unsaturated fatty acids, cholesterol and squalene (SQ). The oxidation of unsaturated fatty acids gives rise to dicarboxylic acids (DA) which behave, in vitro, as competitive inhibitors of tyrosinase. In this work, we further investigate the oxidase activity of Pityrosporum in vitro, by evaluating (a) the generation of lipoperoxides in cultures supplemented with fatty acids at various degrees of unsaturation; (b) the mechanism of SQ oxidation; (c) the chemical characteristics of some by-products of lipoperoxidation; (d) the formation of peroxisomes in fungal cells. In cultures supplemented with the saturated palmitic acid (C16:0) and monounsaturated oleic acid (C18:1 n-9), low amounts of lipoperoxides were detected by a spectrophotometric test, whereas in cultures supplemented with di-unsaturated linoleic acid (C18:2 n-6), significant concentrations were found. Gas chromatography-mass spectrometry analyses showed the generation of linoleic acid hydroperoxides both in Pityrosporum cultures and following incubation of acetone powder of the fungus with the unsaturated fatty acid, indicating the presence of a lipoxygenase activity in the fungus. In cultures supplemented with linoleic acid plus SQ, and increase of lipoperoxide generation was observed and trans-trans farnesal and squalene epoxides have been identified. Electron microscopic examinations have evidenced peroxisomes in cells grown in the presence of linoleic acid, whereas they were not detected in cultures supplemented with oleic acid and palmitic acid. The metabolic activities of peroxisomes, through the formation of hydrogen peroxide and the subsequent generation of hydroxyl radicals, may account for the peroxidation of SQ, which is not a substrate of lipoxygenase. Following these results, we propose a mechanism for DA generation by Pityrosporum metabolism and hypothesize that the lipoperoxidation process induced by lipoxygenase activity of the fungus may be the key to understanding the clinical appearance of skin manifestation of PV.
Out of 2,353 primary school children aged 4-16 years in Cross River State of Nigeria examined, 88 (3.7%) showed lesions mycologically proven to be pityriasis versicolor. Incidence was highest (6.3%) in children aged 12-16. Lesions were much more common on the face than on other sites.
In a series of 60 patients (42 males, 18 females) with widespread lesions of pityriasis versicolor, 200 mg of oral ketoconazole was administered daily for a period of 24 days. Routine laboratory examinations, including microscopic and Wood's light examinations, were performed prior to initiation of treatment and twice during the treatment period as well as 3 and 6 months, and 1 and 2 years after completion of treatment. In 95% of the patients the clinical cure was maintained after 3 months but after 6 months it was still present in only 80% and after one year in only 57%. At the end of two years 60% showed relapse of the disorder. In 75% hypopigmented macules persisted after 6 months but without microscopic evidence of the fungus. No side effects were reported. It is evident that oral ketoconazole is effective in maintaining a clinical cure mainly during the first 3 months after treatment. The question as to whether side effects might appear with a more prolonged course of the drug should be given serious consideration before continuation of treatment is contemplated.
The observation of a 51-year-old male patient with transient acantholytic dermatosis (TAD) is briefly reported. The discrete eruption, composed of erythematous escoriated papules and papulovesicles, moderately itching, was located on the back and chest, more permanent during the summer season. The biopsy revealed suprabasal acantholysis and Darier-like elements. Lesions of pityriasis versicolor, confirmed by microscopic examination and fluorescence in Wood's light, were intermingled with TAD in the same patient. A topical treatment with selenium sulfide brought TAD lesions to the disappearance in 1 week. Comments are made in relation with the possibility of Malassezia furfur to induce acantholytic phenomena.
300 patients with pityriasis versicolor, 168 males and 132 females, of different ages were included in this study. Each was subjected to a detailed structured questionnaire. All the available relatives had been examined. Pedigrees were constructed and segregation analysis was done using the mathematics of population genetics. The collected data showed genetic susceptibility which is inconsistent with any of the single gene defects but fulfill the criteria of multifactorial (genetic-environmental) inheritance. The heritability was estimated to be 22.2% in the first-degree relatives.
59 patients with pityriasis amiantacea (PA) were followed up after 8 years on average. 15% had suffered from psoriasis and 19% were aware of psoriasis in their relatives. The incidence of psoriasis was significantly higher (p less than 0.01) than in the Scandinavian population, and the predisposition to psoriasis was significantly higher than in the population (p less than 0.001), but significantly lower (p less than 0.01) than in psoriatic patients. PA seems to be a manifestation of psoriasis in many cases.
Pityriasis versicolor is a common disorder of the skin, which is characterised by scaly hypo- or hyperpigmented lesions on the body. The lipophilic yeast, Malassezia, is considered to be the aetiological agent of this disease. A number of treatment options, both topical and systemic, have been shown to be effective. A critical evaluation of treatment options is presented.
Pityriasis versicolor (PV) is a superficial infection of the stratum corneum caused by Malassezia. Eleven species have been recognized within this genus, namely M. globosa, M. restricta, M. sympodiasis, M. furfur, M. obtusa, M. slooffiae, M. pachydermatis, M. dermatis, M. japonica, M. yamatoensis, M. nana. To examine the distribution of the microorganism in the skin of patients with PV, we detected Malassezia species without M. pachydermatis and M. nana using a non-culture-based method that consisted of nested PCR with specific primers. The most frequently isolated species were M. globosa and M. restricta (both 93.9%). M. globosa was detected in scales in which only the mycelial form (yeast cells, < 10/sample) were observed microscopically; M. restricta was not found. We suggest that M. globosa is the causative agent of PV.
BACKGROUND: Pityriasis versicolor (PV) is a mild chronic infection of the skin caused by Malassezia yeasts. Although it is primarily seen in adults, children are often affected in the tropics . METHODS: Over a period of 2 years, children (up to the age of 14 years) who were clinically and mycologically diagnosed as PV were included in the study. The clinical and epidemiological pattern in different age groups was noted. RESULTS: PV in this age group formed about 31% of the total cases of PV; 4.8% cases presented in infancy. The commonest site of involvement was the face in 39.9% of the cases. Most of the cases presented in summer months. CONCLUSIONS: PV is not an uncommon disease among children in the tropics. There is a sudden resurgence of cases in the hot monsoons and even infants are not spared.
Twenty-four patients with extensive or recurrent pityriasis versicolor were treated with a single oral dose of 400 mg of fluconazole. Twenty-three patients returned for follow up. Seventeen or 74%, were free of lesions 3 weeks after treatment and no recurrences were seen 6 weeks after treatment. The majority of the patients found the treatment effective, safe and convenient.
We experienced an atypical case of pityriasis versicolor with a unique clinical appearance and undescribed mycological features. Although Malassezia sp. was cultured from the keratotic material, the fungal elements observed in the material were not readily identified as Malassezia. The diagnosis was established with the aid of immunohistochemical and ultrastructural studies with the aetiological agent being identified as M. globosa.
We report six typical cases with pityriasis versicolor (PV) rubra, with a background of collagen diseases in five cases and none in one case. Two cases of systemic lupus erythematosus (SLE) and one case of systemic scleroderma (SSc) had both PV rubra and nigra on the trunk. Diagnosis of superficial infections of PV was made by microscopic examination of skin scrapings following KOH, and many small whitish colonies were obtained in Sabouraud's slant agar medium culture containing cycloheximide with olive oil in all cases. Malassezia sympodialis was isolated from the scales of two different lesions at a 6 week-interval in a same person (a 32 year-old male without SLE nor SSc) by the method of Makimura et al. [5], although the other five cases were not examined for the isolation. Histopathological features of the lesion on the dorsum of the trunk showed no epidermal hyperplasia without elongation of rete ridges and no inflammatory cell infiltration in the dermis, however there was only dilatation of small blood vessels in the dermis, which was reconfirmed capillaroscopically. In the horny layers, several yeastlike and fine filamentous structures were seen which were positive with PAS and Grocott stains. Both clinical and histological features led us to speculate PV rubra. All the patients were treated with anti-fungal ointment, and the lesions diminished in less than 2 weeks. No recurrence has been seen in any of the cases. This PV rubra may be independent from PV nigra, although Horiuchi [2] suggested the earlier lesion occurs in advance of PV alba or nigra.
Pityriasis versicolor (tinea versicolor) is a common superficial fungal infection of the skin involving the hyphal (filamentous) form of Pityrosporum orbiculare. Clinical cutaneous infection is common in humid, tropical climates, but declines to less than 5 percent in temperate climates. Isolated face or scalp involvement is rare. We present a boy living in a temperate region who had sudden onset of scalp and hairline involvement with tinea versicolor.
Pityriasis (tinea) versicolor, which consists of hyperpigmented and hypopigmented scaly patches, is often difficult to treat. A double-blind comparative study between once-a-day sodium sulfacetamide lotion and selenium sulfide lotion was undertaken. Both treatments were safe and efficacious. Selenium sulfide was statistically more efficacious (76.2% vs 47.8%, P=.013).