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Hyperkeratotic head and neck Malassezia dermatosis.

BACKGROUND: Pityriasis versicolor (tinea versicolor) is a common skin disorder due to Malassezia usually affecting adolescents and young adults, more frequently in the tropics. Facial involvement, isolated or not, is not frequent in white adults. OBJECTIVE: Here, we report a possible atypical hyperkeratotic form of dermatosis of the face, in two young immunocompetent Caucasian patients, particularly recalcitrant to therapy. RESULTS: Skin scrapings grew yeasts belonging to the genus Malassezia, including both M. globosa and M. sympodialis. This unusual variant needs long-term therapy with systemic and topical imidazoles together with facial cleansing. CONCLUSION: We propose the name hyperkeratotic head and neck Malassezia dermatosis for this distinctive clinical entity. This variant of pityriasis versicolor should be considered in the differential diagnosis of seborrheic dermatitis and dermatitis neglecta.

Administration, Oral↗

The effect of povidone-iodine paint on fungal infection.

Povidone-Iodine (Betadine) Paint was used in thirteen patients with a proven fungal infection. Ten patients had pityriasis versicolor, two had trichophyton rubrum and one M. canis. In the pityriasis versicolor group, seven out of the ten patients were either improved or cleared up completely within 7 days. There were no adverse reactions in this group of patients and the material proved quite acceptable to them. Scanning electron micrographs were carried out on three of the patients and demonstrated the decrease in fungal elements after treatment and clinical improvement.

Humans↗

Clinical evaluation of fenticonazole cream in cutaneous fungal infections: a comparison with miconazole cream.

A randomized, double-blind, parallel-group, multi-centre clinical trial was undertaken in 60 patients with dermatophytosis or pityriasis versicolor to compare topical 2% fenticonazole cream with topical 2% miconazole cream. Treatment, by twice-daily application, was for 4 weeks or until earlier complete resolution of disease. Assessment was by laboratory mycological investigation and regular clinical/symptomatic evaluation, both during and for 2 to 6 weeks after therapy. Fifty-three patients satisfactorily completed the trial, 28 of whom received fenticonazole and 25 miconazole. The groups were adequately well-matched. All assessment criteria showed fenticonazole to be at least as efficacious as miconazole, with no statistically significant differences between the two treatments. A number of assessment criteria, however, did show trends in favour of fenticonazole. Fenticonazole resulted in mycological findings becoming negative in 92%, i.e. all but 2 of 25 patients, by the end of treatment and a similar proportion (91%, 21 of 23 patients) remained mycologically negative 2 to 4 weeks after the end of therapy. With miconazole, only 79% (19 of 24 patients) became mycologically negative during treatment and this figure decreased further to 74% (14 of 19 patients) after therapy. Essentially similar results were seen for clinical assessments of erythema, itching and desquamation, these features being significantly and progressively eliminated or improved by both treatments in high proportions of patients during therapy, followed by little tendency to return after the cessation of therapy. Overall clinical assessments demonstrated statistically significant improvement during the second, third and fourth weeks of treatment with both drugs. Only 4 patients (two with each treatment) were reported as showing clinical deterioration at any stage during the trial, in all cases after the end of therapy. There were no reports of local or systemic adverse reactions to either drug, and laboratory screening investigations failed to reveal any signs of toxicity. These results indicate that a 4-week course of twice daily topical 2% fenticonazole cream is extremely well tolerated and is at least as efficacious as an equivalent regimen of 2% miconazole for the treatment of cutaneous dermatophytosis or pityriasis versicolor. Trends in the results suggest that fenticonazole may prove to be more efficacious than miconazole, particularly in relation to elimination of laboratory evidence of persistent fungal infection, which could be reflected in a lower incidence of subsequent relapse of the disease.

Adolescent↗

[First case of Malassezia globosa isolation in Serbia].

Today is known that genus Malassezia includes seven species: M. furfur, M. sympodialis, M. obtusa, M. globosa, M. restricta, M. sloofflae and M. pachydermatis, but role of each of the species in the pathogenesis of disease has not been elucidated yet, so further laboratory isolation and identification are necessary. We report the first case of isolation of Malassezia globosa in Serbia (Belgrade), in a patient suffering from Pityriasis versicolor. Identification of M. globosa was based on macroscopic, microscopic and biochemical characteristics. Isolation was done on Leeming and Notman medium and on mDixona agar, at 350C, during 7 days in aerobic conditions. Also the yeast's biochemical phenotype was determined as catalase (+), lipase (+), esculin degradation (-), Tween (20, 40, 60 and 80) assimilation (-). M. globosa is a lipophilic yeast of the genus Malassezia and the common member of the skin flora. In concordance with some predisponing factors M. globosa is implicated in the pathogenesis of several skin diseases (pityriasis versicolor, malassezia foliculitis, seborheic dermatitis and some forms of atopic dermatitis). In immunocompromised patients and neonates this yeast can even cause fatal systemic infections. Because the role of Malassezia spp. In pathogenesis of skin disease is not still determined, we suggest laboratory diagnosis and identification of these species as a routine diagnostic procedure.

Aged↗

[Guidelines for clinical evaluation of topical antifungal agents].

The Japanese Society for Medical Mycology (JSMM) decided in 2002 to establish guidelines for the clinical evaluation of antifungal agents. The JSMM committee presents here guidelines for the clinical evaluation of topical antifungal agents in the dermatology field. Guidelines for the Clinical Evaluation of Antibiotic Agents established by the Japanese Society of Chemotherapy were referred to, and the diseases subjected to clinical evaluation include tinea (tinea pedis and tinea glabrosa), cutaneous candidiasis, and pityriasis versicolor. Among superficial mycoses, tinea pedis is viewed as the pivotal disease because it is intractable and is the most common. Therefore, the clinical efficacy of antifungal agents for external use in this condition should be established, and tinea pedis is subjected to phase III clinical studies. If efficacy of the antifungal agents is confirmed in the treatment of tinea pedis, a comparative study need not necessarily be performed for tinea glabrosa. If the number of patients is adequate for statistical analysis, a comparative study should be considered for both cutaneous candidiasis and pityriasis versicolor. However, if the number of patients is low, the efficacy of the agents should be evaluated based on their antifungal activity on pathogens and the results of open trials, and a comparative study is not necessarily performed for such diseases. The safety should be strictly evaluated.

Anti-Infective Agents, Local↗

Papular spongiotic dermatitis of smallpox vaccination: report of 2 cases with review of the literature.

We report 2 cases of nonspecific postvaccinial dermatitis following smallpox vaccination. The patients presented with diffuse, pruritic, erythematous macules and papules 11 days (case 1) and 7 days (case 2) following routine smallpox vaccination. Biopsies of the lesions demonstrated spongiotic dermatitis without evidence of viral cytopathic changes. One case showed a pityriasis rosea-like histologic pattern. The exanthema resolved without sequelae with symptomatic treatment (case 1). Review of historical literature demonstrated the association of a variety of nonspecific cutaneous complications with vaccinia inoculation, including erythema multiforme, urticaria, and pityriasis rosea. The association of these various dermatitides with smallpox immunization is not well known and is likely underreported.

Adult↗

Isolation of dermatophytes, Candida species and systemic fungi from dermatologic specimens in Montréal, 1963 to 1973.

Of 10 057 specimens of scrapings from skin, nails and scalp examined for dermatophytes, yeasts, pityriasis versicolor and systemic mycoses between 1963 and 1973, 30.4 percent were positive for fungi. Skin produced the highest proportion (68.6 percent) of positive scrapings, scalp the lowest (4.2 percent). Trichophyton rubrum was the predominant species (23.6 percent); of lesser prevalence were Microsporum canis (9.3 percent), T. mentagrophytes (8.4 percent) and Epidermophyton floccosum (4.8 percent). Double infections were encountered on 102 occasions; T. rubrum and Candida parapsilosis were the most frequent cohabiting species. The introduction in 1966 of periodic acid-Schiff staining for routine examination of scrapings resulted in better diagnostic results, particularly in the case of culturally nonproductive specimens and cases of pityriasis versicolor. Blastomyces dermatitidis and Cryptococcus neoformans were isolated from two patients in the course of routine investigation for dermatophytes.

Arthrodermataceae↗

Drug susceptibility testing of Malassezia furfur strains to antifungal agents.

The minimal inhibitory concentration of the three most commonly used antifungal agents--ketoconazole, fluconazole and intraconazole against 28 strains of Malassezia furfur, was studied. The strains were recovered from patients with pityriasis versicolor, pityriasis simplex capitis and dermatitis seborrhoides and were cultured on Dixon's agar. Diagnostic sensitivity test agar was used to determine the minimal inhibitory concentrations of the antifungal agents. The established minimal inhibitory concentration of ketoconazole against Malassezia furfur was 0.02 mg/l, the minimal inhibitory concentration of intraconazole--0.05 mg/l and that of fluconazole--0.09 mg/l. The results of the study are consistent with the data reported by other European authors in their studies. On the basis of the accumulated data it is concluded that the tested antifungal agents are effective in the treatment of infections caused by Malassezia furfur but ketoconazole is superior to intraconazole and fluconazole in the treatment of these infections. This is the first study on the drug susceptibility of Malassezia furfur in Bulgaria.

Antifungal Agents↗

Study of the titer of common antibodies against superficial antigens of Pityrosporum ovale in dermatitis seborrhoides.

Pityrosporum ovale is the yeast form of the dimorphic lipophilic fungus Malassezia furfur which is part of the normal skin microflora in adults. It is suggested that Pityrosporum ovale has a primary role in the pathogenesis of Dermatitis seborrhoides. The aim of the present study was to determine the titer of the common antibodies against superficial antigens of Pityrosporum ovale in the serum of Dermatitis seborrhoides patients and compare the results with the findings of examinations of serum antibodies in healthy subjects and patients with Pityriasis simplex capitis, Pityriasis versicolor, Pityrosporum folliculitis. Indirect immunofluorescent technique was used in the study. The Pityrosporum ovale antigen was obtained using own method. The results show that Dermatitis seborrhoides patients have an antibody titer of 1:640 and above, which is a higher titer than the antibody titers of healthy subjects and patients with other forms of the infection. The study results suggest that Pityrosporum ovale yeast might be implicated in causing a humoral immune response, which is important for the developing inflammatory reactions in Dermatitis seborrhoides. The results help to elucidate the pathogenic mechanisms and supplement the therapy strategy of the disorder. The authors are the first in Bulgaria to study the immune response to Pityrosporum ovale in healthy subjects and patients suffering from different forms of the infection.

Antibodies, Fungal↗

[Contribution to the study of dermatomycosis in Catalonia].

We report the results of a study which aim was the mycological identification of specimens coming from patients included in a clinical trial. A total of 445 specimens from patients with clinical diagnosis of dermatomicosis were processed during 8 months (138 pityriasis versicolor, 28 cutaneous candidosis and 279 dermatophytosis). A 48% of pityriasis versicolor cultures were positive for Malassezia furfur, 50% of candidosis cultures were positive for yeasts and 67% of dermatophytosis cultures were positive for dermatophytes. According to our results Candida albicans was the principal causative agent for cutaneous candidosis and Trichophyton mentagrophytes and Trichophyton rubrum were the most frequent isolated species causing dermatophytosis.

English Abstract↗

Psoriasis guttata with palmoplantar involvement clinically mimicking secondary syphilis.

Papulosquamous eruptions involving the palms and soles are thought to be particularly suggestive of secondary syphilis. Alternative diagnoses exist, however, and include psoriasis guttata, atypical pityriasis rosea, and pityriasis lichenoides chronica (PLC). We describe the case of a patient with an abrupt onset of psoriasis guttata and extensive palmoplantar involvement. Results of serologic testing were negative for treponemicidal antibodies. Results of histopathologic examination demonstrated psoriasiform dermatitis with neutrophils in the epidermis; plasma cells were absent. Spirochetes were not demonstrated in a tissue sample using silver or immunohistochemical stains for Treponema pallidum. A broad differential diagnosis is required when evaluating papulosquamous eruptions with palmoplantar involvement. Although not well referenced in the medical literature, psoriasis guttata can indeed cause palmoplantar lesions that mimic those of secondary syphilis.

Adult↗

Carcinogenesis in porokeratosis. Evidence for a role relating to chronic growth activation of keratinocytes.

Porokeratoses are known to give rise to squamous and basal cell carcinomas. In this study, we examined 15 lesions of porokeratosis immunohistochemically for evidence of aberrant keratinization using several markers of keratinocyte (KC) maturation and differentiation, including involucrin, filaggrin, cytokeratins, and the growth activation marker psi-3. The staining patterns obtained were compared with several non-premalignant parakeratotic skin lesions including psoriasis, pityriasis rosea, pityriasis rubra pilaris, irritated seborrheic keratosis, atopic dermatitis, seborrheic dermatitis, and verruca vulgaris. The centers of porokeratoses stained in a pattern identical to that observed in other premalignant keratinocytic lesions including actinic keratoses, recessive dystrophic epidermolysis bullosa, and nonhealing wounds. KCs beneath the cornoid lamella (CL) stained in a pattern similar to that observed in squamous cell carcinomas. KCs peripheral to the CL in the epidermis showed a normal staining pattern. The control non-premalignant parakeratotic lesions displayed a variety of staining patterns, but none showed a pattern identical to that observed in porokeratosis. The failure of KCs in porokeratoses to mature and differentiate normally may be related to the increased incidence of carcinomas associated with these lesions.

Epidermis↗

[Amyloidosis maculosa: diagnosis in primary care].

Amyloidosis maculosa is a clinical entity with low incidence factor in our medium, which basically affects middle-aged women. The lesion is characterised by the presence of poorly defined, hyperpigmented, brownish or greyish maculae that converge and focus basically on the upper back and shoulders, usually accompanied by pruritus. Three patients were erroneously catalogued for years as having pityriasis versicolor. Two of these patients presented a typical clinical amyloidosis maculosa, and the third presented a less common manifestation of the disease: a single, well-defined lesion in the subscapular region. We believe that the approach to the diagnosis of pityriasis versicolor with hyperpigmented lesions that do not respond to specific treatment should be revised. Although amyloidosis maculosa has a low incidence in our medium, it is an entity which should not be discarded in these cases.

Adult↗

Epidermal DR+T6- dendritic cells in inflammatory skin diseases.

T lymphocyte and dendritic cell subpopulations were counted in three biopsies each of endogenous eczema and pityriasis rosea and two of lichen planus and compared with previous findings in psoriatic lesions. In common with psoriasis, proportionately more CD4 T cells than CD8 T cells were DR+ in both epidermis and dermis of all lesions. In addition, total numbers of epidermal dendritic cells were significantly increased in endogenous eczema and pityriasis rosea, and variably in lichen planus lesions. Interestingly, a DR+T6- subpopulation of dendritic cells was present in varying proportions in all three skin lesion types. Electron microscopy of DR+T6- dendritic cells from psoriatic lesions, using an immunogold staining technique, showed the cells to be of the Langerhans' cell lineage. DR+T6- dendritic cells are a subpopulation of Langerhans' cells which are not specific to psoriasis, but present in the lesions of other benign, inflammatory skin conditions in which CD4 T cells are preferentially activated.

Antigens, Differentiation, T-Lymphocyte↗

Comparative study of miconazole and clotrimazole in superficial mycosis.

Two hundred cases of superficial mycosis (100 dermatophytosis, 40 candidiasis and 60 pityriasis versicolor) were studied for the comparative effect of miconazole and clotrimazole. The patients were evaluated both clinically and mycologically every 2 weeks for a period of 12 weeks. In dermatophytosis, miconazole showed accelerated response (75% cleared in 6 weeks) than clotrimazole (56%). In candidiasis, both were found to be effective (80-85%) cure though clotrimazole showed slightly earlier response (40% cure in 6 weeks) against miconazole (30% cure). In pityriasis versicolor both were, effective (miconazole 99.6% and clotrimazole 86.7%).

Candidiasis, Cutaneous↗

[Experience in the treatment of skin mycoses with ciclopirox olamine].

Ciclopirox olamine cream 1%, a new antifungal agent has been studied in 30 patients with dermatophytosis and pityriasis versicolor. Diagnosis of dermatophytosis was confirmed by microscopic examination of KOH preparations and culture in Sabouraud medium. Pityriasis versicolor was diagnosed by direct exam preparation. Cultures and direct exam preparations were performed before starting treatment and weekly thereafter. Cultures and KOH preparations were positive in all patients. Treatment with ciclopirox olamine cream 1% was applied topically twice daily. Direct examination and cultures were negative in 26 cases (86.6%) after one week treatment and in 4 cases (13.4%) after two weeks. A parallel improvement in clinical signs and symptoms was evident with disappearance of erythema, pruritus and scaling. Clinical cure was achieved in most all cases (96.7%), between the third and fourth week of treatment.

Adolescent↗

The associated diseases with leprosy.

The prevalence of cutaneous, medical and surgical disorders was studied in 846 leprosy patients. Common cutaneous disorders among leprosy patients were pityriasis versicolor, tinea, pyodermas, warts, acquired ichthyosis, scabies, pediculosis and callosities. Only pityriasis versicolor had higher incidence when compared to general population. Common medical diseases were tuberculosis, infective hepatitis and diabetes mellitus. The epidemiological importance of their co-existence with leprosy is discussed and relevant literature of other diseases found to be frequently associated with leprosy is reviewed.

Adult↗

Current treatment of cutaneous Pityrosporum and Candida-infections.

Pityrosporum and Candida-yeasts are opportunistic pathogens and infections require predisposing factors. These factors are also of major importance in treatment and the reason for recurrence and sometimes chronicity of the disease caused by these yeasts. Pityrosporum orbiculare and P.ovale are both lipophilic, probably identical, and both are members of the normal human cutaneous flora. In pityriasis versicolor they change from the blastospore form to the mycelial form. My favourite treatment for pityriasis versicolor is propylene glycol 50% in water applied with a gauze pad twice daily for 2 weeks. This will clear 95-100%. Other treatment modalities are: zinc pyrithione shampoo, selenium sulfide shampoo and the imidazoles. For extensive cases, patients who frequently relapse, and infections refractary to other treatments ketoconazole orally may be an effective alternative both therapeutically and prophylactically. In another disease caused by these yeasts, Pityrosporum folliculitis, both propylene glycol and ketoconazole are effective. Although Candida species are only seldom found on normal-looking skin predisposing factors are still the main reason for disease. Under the influence of these factors the organism changes from the blastospore to the mycelial form. The main predisposing factors important to control are: occlusion, underlying skin diseases, diabetes mellitus and immunodeficiency diseases. The imidazoles in a cream vehicle are very effective for many infections and applied for 2-3 weeks they will clear most lesions. The addition of a corticosteroid to the imidazole will not shorten the time of treatment but will give a more prompt symptomatic relief. In extensive cutaneous lesions and lesions refractary to other treatments ketoconazole is an effective alternative.

Adrenal Cortex Hormones↗