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PubMed1987

The influence of food on the pharmacokinetics of itraconazole in patients with superficial fungal infection.

Itraconazole in a new, orally active triazole, which is related to ketoconazole and which is active against dermatophytes and Candida and Cryptococcus organisms. It is more potent than ketoconazole, is better absorbed with food, and does not suppress testosterone or cortisol synthesis. In previous studies, daily 200 mg doses of itraconazole for 5 days cleared 80% of cases of pityriasis versicolor, and 90% of dermatophyte infections were cleared by daily 100 mg doses administered for 1 month. Twenty patients with superficial dermatophyte, Candida albicans, and pityriasis versicolor infections were treated with doses of 50 or 100 mg per day; in the first group of 10 patients, the drug was administered before breakfast and the other 10 patients were given their dose with breakfast. Itraconazole concentration was determined by high-performance liquid chromatography 3 hours after administration of first and last doses. Our findings showed that although treatment with 50-mg doses led to poorer results and lower plasma levels than 100-mg doses, taking the drug with breakfast gave much better results than taking it before.

Adolescent↗
PubMedDate not supplied

A prospective survey of pediatric dermatology clinic patients in Kuwait: an analysis of 10,000 cases.

Skin diseases are common in children. However, only a very few prospective epidemiologic surveys are available in the literature. The present survey was directed at determining the spectrum and pattern of skin diseases of children in Kuwait. A total of 10,000 consecutive new patients were studied; 96% were children of Arab descent. A female preponderance (52%) was observed, and infants constituted the largest group within the patient population (28.7%). A total of 162 dermatoses were recorded. Atopic dermatitis was the most prevalent dermatosis (31.3%), followed by viral warts (13.1%), alopecia areata (6.7%), pityriasis alba (5.25%), psoriasis (4%), and diaper dermatitis (4%). Atopic dermatitis was the most frequently seen dermatosis in children of all age groups, whereas, viral warts were more prevalent in school-age children. The prevalence of alopecia areata and psoriasis was higher than reported earlier in other ethnic groups. A female preponderance was seen in children with alopecia areata, psoriasis, vitiligo, acne vulgaris, contact dermatitis, and pityriasis rosea. Dermatitis, superficial cutaneous infections, and nevi/nevoid disorders were the important groups studied.

Age Distribution↗
PubMedDate not supplied

Prevalence of skin conditions in primary school children in Turkey: differences based on socioeconomic factors.

Skin diseases are associated with environmental factors and a public health approach is particularly important. We determined the prevalence of skin conditions and associated socioeconomic factors in primary school children in Turkey. A questionnaire for determining the socioeconomic level and a complete dermatologic examination were performed in 785 children in two primary schools in different socioeconomic areas of suburban and central Manisa, Turkey. The study included 345 (43.9%) girls and 440 (56.1%) boys with a mean age of 9.25 +/- 1.55 (range 6-14 years). Infectious skin diseases were frequently observed: pediculosis capitis in 74 children (9.4%), scabies in 17 (2.2%), viral skin diseases in 30 (3.8%), and fungal infections in 6 (0.7%). The other common conditions were melanocytic nevi (14.4%), keratosis pilaris (12.5%), pityriasis alba (12%), xerosis (11.8%), and atopic dermatitis (6.8%). Pediculosis capitis, acne, and dandruff were more common in girls. The rate of infections, atopic dermatitis, xerosis, and pityriasis alba were significantly higher in the school children with poor socioeconomic conditions. Improvement in socioeconomic conditions along with education may be needed to decrease the prevalence of some of these skin disorders in order to decrease costs related to treatment.

Adolescent↗
PubMed1975

[Evaluation of econazol in 594 cases of skin mycosis (author's transl)].

A total of 594 patients were treated with the new antimycotic agent econazol (Pevaryl). The diagnosis was proven microscopically and on culture except in cases of pityriasis versicolor where it was proven microscopically only. Econazol was given to 130 patients as a 1% solution, to 128 patients as a 1% milk, and to 336 patients as a 1% spray solution. In 333 cases of foot mycosis or eczema marginatum econazol spray powder was given in addition. As measured by the cure rate the spray solution (92%) was not significantly more effective than the milk (89%) or the simple solution (87%). Criteria for cure included negative microscopy and fungal cultures a week after treatment had ceased as well as clinical cure. A total of 90% of all cases (n = 536) could be considered as cured microscopically and on culture after an average of 3.6 weeks (pityriasis versicolor) and 4.8 weeks (tinea pedis, manus, inguinocruralis). In a further 4.4% (n = 26) the fungus could be demonstrated microscopically despite a clinical cure and in 7 of these cases culture was also positive. The cure rate was independent of the responsible pathogen. The preparations were tolerated extremely well. In 7 cases, however, transient dermatitic irritations were seen in the inguinocrural region, mainly caused by the simple solution.

Aerosols↗
PubMed2001

Production of the mycelial phase of Malassezia in vitro.

To study the pathogenicity of Malassezia, the agent of pityriasis versicolor, it is necessary to obtain the mycelial form in vitro. A range of different components and conditions were tested to induce yeast cells of the organism to produce mycelia in vitro using different culture media. A mycelial culture medium was developed that consisted of bacteriological peptone, glucose, yeast extract, ox bile, glycerol, glycerol monostearate, Tween 80, squalene, glycine, potassium nitrate, sodium chloride, ferrous sulphate and magnesium sulphate with or without agar. The liquid and solid medium had a pH of 5.6 and the temperature of incubation was 30 degrees C. Cultures were incubated in air. This medium was able to induce some strains of Malassezia to produce up to 40% mycelium in vitro. In total, 33 different strains of Malassezia obtained from the skin of the healthy individuals and patients with pityriasis versicolor were tested for mycelium production. The strains of Malassezia capable of producing mycelium in vitro all possessed the serovar A antigen.

Culture Media↗
PubMedDate not supplied

Itraconazole in the treatment of superficial mycoses: an open trial of 40 cases.

Forty patients with superficial mycoses were treated with itraconazole, a new triazole derivative, in an open study. In 29 cases the diagnosis was dermatophytosis; in five, candidosis; and in six, pityriasis versicolor. Each patient received 50 mg of itraconazole orally once a day for 30-60 days. Thirty-three patients completed therapy; at the end of therapy, 21.2% were considered clinically cured and 57.6% were considered mycologically cured. Results of direct microscopic examination were negative at 30 days for the patients with pityriasis versicolor; none of the patients with candidosis responded to therapy. Pruritus and other symptoms or signs of infection improved after the 15th day, but even after 60 days of therapy, nine of the 10 patients who finished the trial at that time had residual lesions. The drug was well tolerated. It appears that a dosage of 50 mg of itraconazole daily is not adequate for the treatment of these mycoses.

Adolescent↗
PubMed2003

The utility of the in situ detection of T-cell receptor Beta rearrangements in cutaneous T-cell-dominant infiltrates.

The diagnostic assessment of cutaneous T-cell infiltrates is problematic for dermatopathologists. A variety of conditions, including lymphomatoid hypersensitivity reactions and lymphomatoid lupus erythematosus, can demonstrate lymphoid atypia and phenotypic changes that can mimic cutaneous T-cell lymphoma (CTCL). A similar issue revolves around lymphoid dyscrasias, which includes parapsoriasis, atypical pigmentary purpura, pityriasis lichenoides chronica, indeterminate lymphocytic lobular panniculitis, and lymphomatoid papulosis, which can progress to CTCL. A reverse transcription (RT) in situ PCR assay for T-cell receptor beta rearrangements (TCRbeta) was used to assess T-cell clonality in formalin-fixed, paraffin-embedded tissues. In 7 of 8 cases of classic CTCL, the RT in situ PCR assay for TCRbeta rearrangement showed monoclonality; the other was biclonal. Further, in cases with multiple lesions over time, the same T-cell clone could be detected including in those patients whose biopsies showed large-cell transformation. Monoclonality was also demonstrated in each of 2 cases of cutaneous lymphomatoid papulosis. Demonstration of oligoclonality (and one case of biclonality) by RT in situ PCR was confined to those cases that either represented prelymphomatous conditions such as large plaque parapsoriasis or pityriasis lichenoides or lesions of drug-induced lymphomatoid hypersensitivity that all demonstrated clinical regression. In conclusion, RT in situ PCR for TCRbeta, which can be done on formalin-fixed biopsies and allows direct correlation of the molecular data with the histology, is a useful adjunctive test in the differentiation of CTCL from its mimics.

Adult↗
PubMed2000

Species identification and strain typing of Malassezia species stock strains and clinical isolates based on the DNA sequences of nuclear ribosomal internal transcribed spacer 1 regions.

This study demonstrated the application of internal transcribed spacer 1 (ITS1) ribosomal DNA sequences to the species identification and strain typing of 28 standard strains and 46 clinical isolates of the genus Malassezia. The size of ITS1 regions ranged from 162 to 266 bp. Members of the genus Malassezia (M. pachydermatis, M. furfur, M. sympodialis, M. globosa, M. obtusa, M. restricta and M. slooffiae) were classified into seven ITS1-homologous groups and 22 ITS1-identical, individual groups. The 46 clinical isolates of lipophilic Malassezia spp. were identified as belonging to just three ITS1-homologous groups, i.e., M. furfur (19 strains: 11 from pityriasis versicolor, 4 from seborrhoeic dermatitis and 4 from atopic dermatitis). M. sympodialis (22 strains: 7 from pityriasis versicolor, 3 from seborrhoeic dermatitis, 1 from atopic dermatitis and 11 from healthy controls) and M. slooffiae (five strains: three from chronic otitis media and two from healthy controls).

Base Sequence↗
PubMed1996

Cutaneous mycoses in children.

This article describes common cutaneous mycoses in children: mucocutaneous candidiasis, pityriasis versicolor, tinea corporis, tinea pedis, onychomycosis and tinea capitis. Topical therapy is effective in tinea corporis and pedis, pityriasis versicolor and cutaneous candidiasis. It is ineffective in tinea capitis, in immunocompromised children and onychomycosis. Griseofulvin has been the main treatment until now in children, but it is only fungistatic, may cause interactions and has to be given for long periods. Ketoconazole has not been widely accepted for use in children because of hepatotoxicity and it is not an effective as griseofulvin. There are few data on paediatric use of fluconazole, although it is available in liquid form, has an excellent safety profile and may become important for treating paediatric mycoses. Similarly, there are only limited data on itraconazole in this area, with most experience in tinea capitis. There is only a 100-mg capsule available, which is not easy to administer in paediatric dosages. All azoles have the potential for drug interaction. Most experience in the treatment of children with the allylamine, terbinafine, has been in tinea capitis. A treatment time of 4 weeks with terbinafine and 8 weeks with griseofulvin has produced similar results at 12 weeks. There are also limited data on the use of terbinafine in paediatric onychomycosis. Terbinafine has the best safety profile, least risk of drug interactions and may be the most suitable alternative to griseofulvin in children. The lack of a liquid formulation may preclude its use. Itraconazole and fluconazole are also potential replacement drugs for griseofulvin.

Administration, Cutaneous↗
PubMed1989

Clinical efficacy and tolerability of terbinafine (Lamisil)--a new topical and systemic fungicidal drug for treatment of dermatomycoses.

Terbinafine (Lamisil) is the newest compound within a class of antimycotic drugs called allylamines. It is active against a broad range of dermatophytes and yeasts and exerts its fungicidal action by inhibiting squalene epoxidation during sterol synthesis in fungal membranes. Effective therapy (complete cure or mycological cure with minimal signs and symptoms) has been observed in 70-90% of 1200 patients treated topically with 1% cream for tinea corporis/cruris, tinea pedis, cutaneous candidiasis and pityriasis versicolor. Cure in patients treated systemically (125 mg b.i.d. orally) has been documented to be 75-90% in tinea corporis and chronic tinea pedis (plantar type), 60-70% in cutaneous candidiasis, and 90-100% in onychomycosis. Particularly noteworthy is the low rate of relapse of infection after cure of chronic dermatophyte infections, since frequent relapse is a recognized problem with presently available antifungal drugs. Terbinafine is ineffective when used systemically for pityriasis versicolor. Side-effects following oral administration of the recommended dose of 125 mg b.i.d. include gastrointestinal symptoms (3-4%), allergy (1%), and miscellaneous mild non-specific symptoms (1%). No significant haematological, hepatic or renal effects have been observed. Based on the drug's fungicidal action and the early appearance of negative cultures in these studies, a short duration therapy is predicted to be effective.

Administration, Oral↗
PubMed1994

Antibodies to proteins from Pityrosporum ovale in the sera from patients with psoriasis.

In order to analyse the humoral immune response to the commensal yeast Pityrosporum ovale, we developed a western immunoblot technique with a salt soluble extract of P. ovale cytoplasm. In the present study, we tested sera from patients with psoriasis (n = 15), seborrhoeic dermatitis (n = 10), pityriasis versicolor (n = 8), and normal controls (n = 10). Seventy-three per cent (11/15) of the patients with psoriasis showed specific reactivity with a protein derived from P. ovale of estimated molecular mass 120 kDa, and 46% (7/15) of the cases recognized a 100-kDa protein. Sera from pityriasis versicolor and normal donors showed nonspecific reactivity with several bands of lower molecular weight. To characterize the location of the 100 and 120-kDa proteins, we performed a lyticase digestion of the cell wall, and analysed the soluble digested products by western blotting. The sera from psoriasis patients detected several bands in the range 100-120 kDa. The finding of the immunoreactive 120-kDa protein in this fraction suggests its location at the space between cell wall and membrane (periplasmic space). As a control, we performed an extraction of the cytoplasmic proteins of the dimorphic yeast Candida albicans. C. albicans showed a different pattern of banding in SDS-PAGE. Immunoblots with C. albicans did not allow the detection of any related band. A smear was observed in the high molecular weight range consistent with the presence of lipopolysaccharides. The role of the immune response in infection by P. ovale has not yet been fully explored.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Fungal↗
PubMed1987

The morphology of keratohyalin granules in orthokeratotic and parakeratotic skin and oral mucosa.

We compared morphologic features of keratohyalin granules (KHG) that were directly related to keratinization in oral mucosa (tongue, cheek, gums, palate; n = 4) with those in parakeratotic epidermis (psoriasis, n = 2; pityriasis rubra pilaris, n = 1; acute dermatitis, n = 1) and normal orthokeratotic epidermis. Among others, the ultrastructural features of globular KHG were observed in the cheek, nonspecialized tongue mucosa, and parakeratotic epidermis occurring in psoriasis, pityriasis rubra pilaris, and acute dermatitis, whereas gums and palate showed a mixture of characteristics, also resembling stellate KHG as seen in normal skin. From literature as well as from our studies, the impression was gained that globular KHG were found especially in quickly dividing epithelia and could easily be distinguished from the irregular or stellate KHG that were found in slowly dividing normal epidermis. Therefore, we studied keratinization features on days 3, 7, and 14 after autografting normal human skin (n = 4), thus inducing high cell turnover. Stellate KHG, present in granular cells of normal skin, were almost absent on the third day. Active cell division on the seventh day resulted in sparse keratohyalin formation inside globular granules of low electron density, whereas numerous, rather electron-translucent lipid droplets occurred in upper spinous and horny cells. These two phenomena seemed to be interrelated. After 14 days, round and increasingly electron-dense KHG were noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Cytoplasmic Granules↗
PubMed2004

Epidemiology of childhood psoriasis: a study of 419 patients from northern India.

BACKGROUND: We undertook this study in order to determine the pattern and prevalence of childhood psoriasis in northern India and to highlight the differences and similarities with previous studies. MATERIALS AND METHODS: In this retrospective epidemiologic study, the data from 419 children (less than 14 years of age) with psoriasis registered at the Psoriasis Clinic between January 1990 and December 2002 were included. RESULTS: The 419 children registered at the Psoriasis Clinic constituted 0.3% of the dermatology outpatients and 12.5% of the total psoriasis patients seen over a period of 13 years in the department. There were 219 (52.2%) boys and 200 (47.7%) girls, with a male to female ratio of 1.09 : 1. The age of onset ranged from 4 days to 14 years. The mean age of onset was 8.1 +/- 2.1 years in boys and 9.3 +/- 2.3 years in girls. The peak age of onset in boys was in the 6-10-year age group, whereas the majority of girls showed an onset of psoriasis between the ages of 10 and 14 years. A positive family history was present in only 19 (4.5%) patients. The extensors of the legs were the most common initial site affected [105 (25%) cases], followed by the scalp [87 (20.7%)]. Classical plaque psoriasis was the most frequent clinical presentation [254 (60.6%) patients], followed by plantar psoriasis [54 (12.8%)]. Nail involvement was observed in 130 (31%) cases. All types of nail changes described in psoriasis were seen in these patients. Pitting was the most common nail change, followed by ridging and discoloration. Five children (1.1%) (three girls and two boys) had psoriatic arthropathy. Precipitating factors that brought about the onset of the disease or were associated with exacerbation could be recalled in only 28 (6.6%) patients. Koebnerization was observed in 27.9% of patients. Pruritus was the most frequent symptom, reported by 365 (87.1%) children. Twenty-seven (6.4%) children had other concurrent mucocutaneous diseases (vitiligo, pityriasis alba, alopecia areata, ichthyosis vulgaris, halo nevus, aphthous stomatitis, urticaria, pityriasis versicolor, nummular eczema, salmon patch, and verrucous epidermal nevus). Eighteen children had systemic disorders, including seizures, bronchial asthma, mitral regurgitation, scleroderma, Down's syndrome, high arched palate, cholelithiasis, anterior mongoloid slant, and prognathism; however, these conditions were possibly chance findings only and no correlation with the age of onset or severity of the disease was found. CONCLUSIONS: Our findings differ from those of previous studies in showing a delayed onset, equal sex distribution, less frequent facial involvement, uncommon guttate lesions, more frequent involvement of the soles, and a less frequent history of familial occurrence.

Adolescent↗
PubMedDate not supplied

A double-blind, randomized comparative trial: flutrimazole 1% solution versus bifonazole 1% solution once daily in dermatomycoses.

In a double-blind, randomized study the efficacy and tolerance of flutrimazole 1% solution were compared with bifonazole 1% solution, applied once daily for 4 weeks, in 40 patients with culturally proven dermatophytosis or cutaneous candidosis. Forty patients with mycologically proven pityriasis versicolor were treated with once-daily application for 1 week. The four groups of patients and distribution of target lesions were similar, although in the flutrimazole group more patients had cutaneous candidosis (n = 8 versus n = 1). The distribution of the sum of clinical scores was also similar in both groups. At the end of therapy the proportion of patients with negative microscopy and culture was 85% in the flutrimazole group and 65% in the bifonazole group. There was a significant difference (P = 0.022) in terms of efficacy, since 80% of patients in the flutrimazole group versus 40% in the bifonazole group were judged to have received effective treatment. At the assessment 6 weeks after the end of therapy the percentages of flutrimazole- and bifonazole-treated patients with negative mycology were 75% and 65% respectively. There were two relapses (one in each group), which represents a 5% rate. Fifteen flutrimazole-treated patients (75%) compared with 12-bifonazole-treated patients (60%) had overall effective therapy. Two patients treated with bifonazole (10%) and one treated with flutrimazole (5%) had a premature termination due to adverse events attributable to the medication. On assessment 3 weeks after the end of treatment, the patients with pityriasis versicolor were all clinically and mycologically healed with negative fluorescence, including the patients who withdrew from the full course of treatment (one in each group). Nine weeks after the end of therapy all the patients remained cured, with no relapses. The overall incidence of adverse events (mild local reactions such as irritation, burning and itching) was one and seven cases for bifonazole and flutrimazole respectively. One patient in each group had to abandon treatment owing to severe intolerance.

Administration, Topical↗
PubMedDate not supplied

Phospholipase activity in Malassezia furfur pathogenic strains.

The lipophilic dimorphic yeast Malassezia furfur is a common skin commensal and the aetiological agent of pityriasis versicolor. A source of lipids is essential for its growth, and there are already demonstrations of in vitro lipase and lipoxygenase production. In eight wild strains, isolated from patients with pityriasis versicolor, we showed a phospholipase activity using a medium containing egg yolk emulsion as the only source of lipids; in this medium M. furfur grows and produces a phospholipase zone. Adding manganese sulphate, an unspecific inhibitor of phospholipase activity, M. furfur does not grow, because the lipophilic fungus cannot utilize the egg yolk as a source of fatty acids. Adding Tween 60 to the same medium, M. furfur also grows in presence of manganese sulphate.

Culture Media↗
PubMed1996

[Morphology of Malassezia-associated diseases].

Fine-structural investigations were done with surface material and slides of pityriasis versicolor, Malassezia-folliculitis and seborrheic eczema. Aspects of the microorganism Malassezia furfur, such as its presence, its distribution on the skin surface, and its shape, and changes in the host skin tissue, such as the structure of the horny layer and signs of an inflammation were registered. Two main types of Malassezia-associated dermatoses were defined. One type is characterized by a considerable number of microorganisms, adhering to regular cells of the horny layer (exemplified by pityriasis versicolor), the other type is characterized by signs of an inflammation and a very low number of visible fungal cells (exemplified by seborrheic eczema).

Dermatitis, Seborrheic↗
PubMed1997

Pityrosporum yeasts--what's new?

The lipophilic yeast Pityrosporum ovale is a member of the normal human cutaneous flora in adults but also associated with several skin diseases. In pityriasis versicolor, under the influence of predisposing factors, P. ovale changes from the round blastospore form to the mycelial form. A great problem in pityriasis versicolor is the high rate of recurrence and to avoid this a prophylactic treatment is mandatory. Pityrosporum folliculitis is a chronic disease characterized by pruritic follicular papules and pustules located primarily on the upper trunk, neck and upper arms. In direct microscopy clusters of round budding yeast cells are found. The disease responds rapidly to antimycotic therapy. There are now many studies indicating that P. ovale plays an important role in seborrhoeic dermatitis. Many of these are treatment studies showing a good effect of antimycotics paralleled by a reduction in number of organisms. Severe seborrhoeic dermatitis often difficult to treat is associated with AIDS. In peripheral blood from a high number of patients with seborrhoeic dermatitis we found an increase in number of natural killer T-cells and decreased PHA and Con-A stimulation. Secondary we found low serum IgG antibody titres in patients compared to controls. Other studies have found a reduced lymphocyte stimulation reaction when lymphocytes from patients with seborrhoeic dermatitis were stimulated with a P. ovale extract. Additionally, IL-2 and IFN gamma production by lymphocytes from patients was markedly depressed and IL-10 synthesis were increased after stimulation with P. ovale extract. The majority of adult patients with atopic dermatitis localized to the head, neck and scalp are prick-test positive to a protein P. ovale extract. One study showed that p. ovale extracts increased IL-4, IL-10 and IgE synthesis in patients with atopic dermatitis. There are also treatment studies indicating that antifungal treatment may be beneficial in these patients.

AIDS-Related Opportunistic Infections↗
PubMed1988

Activity of triazole derivatives against Pityrosporum orbiculare in vitro and in vivo.

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.

Animals↗