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PubMed1986

Epidemiology and clinical features of dermatomycoses and dermatophytoses.

Dermatophytosis, candidosis and pityriasis versicolor account for the majority of fungal skin diseases in Denmark and are seen in 8% of patients with dermato-venerological problems. In children, zoophilic species like Microsporum canis (from cats), Trichophyton (T) verrucosum (from cattle) and T. mentagrophytes granulare (from rodents) are the common causes of dermatophytosis and are seen in approximately 15% of all cases. Anthropophilic species are the main cause of dermatophytosis in adults and are isolated more often in males than in females. T. rubrum (48%), T. mentagrophytes interdigitale (14%) and Epidermophyton floccosum (10%) are the species usually involved. The feet are the site of infection in about 50% of the cases, toenails, glabrous skin and inguinal folds equally often in 42%, palms in 6% and the scalp in 2%. The prevalence of tinea pedis in 15-year-old school children and 20-year-old males was found to be 4% and 6%, respectively. A relative risk of 3.1 for contracting tinea pedis when being an atopic or having an atopic family was demonstrated in the former group. Pityriasis versicolor and candidosis of skin and mucosal membranes are both secondary dermatomycoses caused by endosaphrophytic yeasts. Local or systemic predisposing disorders are usually required for the development of symptoms.

Adolescent↗
PubMed1986

Ketoconazole: therapeutic results obtained in the district of Cagliari.

The therapeutic results of ketoconazole treatment in 61 patients affected by mycoses at various locations are reported. The mycotic conditions in these patients were: pityriasis versicolor (26), tinea cruris (14), tinea corporis (8), tinea pedis (6), kerion celsi (6) and monilial granuloma (1). Clinical and mycological cure was obtained in 56 cases (91.8%) over a mean treatment period from a minimum of 29 days (pityriasis versicolor) to a maximum of 39 days (tinea pedis) and 150 days (monilial granuloma), with a mean daily dosage of 200 mg in adults and 100 mg in children. The authors stress the high level of tolerability of the drug and its high therapeutic activity. They indicate the conditions for its use in superficial epidermomycoses and kerion celsi and note its unparalleled effect in chronic mucocutaneous candidosis.

Adolescent↗
PubMed1986

Ketoconazole treatment in superficial mycoses.

Ketoconazole is a new antifungal drug, used for oral treatment, with a broad spectrum of activity. It is a member of the imidazole series and is active in superficial and deep mycotic diseases, in candidosis and pityriasis versicolor. This new imidazole derivative has been successfully administered in several cases of dermatophytosis, yeasts and pityriasis versicolor in the authors' clinic, as well as in many other research centres. Treatment has been given to patients with tinea corporis, tinea cruris, tinea pedis, with or without location in interdigital spaces, while the cases of tinea capitis are still under investigation. The following variants of candida infections have been treated: onychomycosis, intertrigo and mucocutaneous candidosis due to prolonged immunosuppressive therapy. No remarkable haematochemical disorders have been observed after treatment.

Adolescent↗
PubMed1980

[Epidermodysplasia verruciformis (2 cases). Immunological study (author's transl)].

Flat wart-like lesions of two patients with epidermodysplasia verruciformis (EDV) were associated with pink, tan or depigmented pityriasis-like macules. There was no familial history nor mental retardation. Human papilloma virus (HPV) type 5 was demonstrated in the two patients and was responsible for the pityriasis-like lesions. Malignancies seem to be closely related to HPV-5 infection since bowenoid transformation occurred in the 2 patients. Immunological studies showed an increase of serum IgE in both patients and an important decrease of IgM in one of them. Most of delayed hypersensitivity skin tests were negative. T-cell percentages (E rosettes) were decreased in one patient, normal for the other one. The mitogenic response to PHA and ConA was markedly depressed in the two patients but returned to normal values in one of them after 3 months of aromatic retinoid (Ro 10-9359) treatment. Beside the viral type, the defect of cell mediated immunity could play an important role in the disease and in the malignant conversion of the lesions. A long-term preventive treatment by retinoic acid derivatives could be of interest for patients with HPV type 5 EDV.

Adolescent↗
PubMed1980

Multicentre clinical study with tolciclate in the local treatment of skin mycoses in 1083 patients.

A multicentre clinical trial with tolciclate was carried out in Italy on 1083 patients suffering from skin mycoses (tinea corporis, tinea cruris, tinea pedis, tinea manuum and pityriasis versicolor). Both preparations (1% cream and lotion) showed a good activity evaluated weekly by clinical examinations and mycological assessments, i.e. culture for tineas and microscopy for pityriasis versicolor. Favourable clinical results ranged from 83% to 97% according to diagnoses. Cultural or microscopic conversions obtained in a mean time of about 2 weeks varied from 70% to 91%. Mycological relapses a month after the end of treatment were seen in 6.5% of cases examined. Adverse reactions were observed in 5.6% of patients but the treatment was discontinued only in 2.6%.

Administration, Topical↗
PubMed1980

[Experimental dermatitis caused by Pityrosporum ovale and (or) Pityrosporum orbiculare in the guinea pig and the mouse].

An experimental dermatitis was established for the guinea pig and Swiss white mouse by topical application of cultures of Pityrosporum ovale, isolated from pityriasis capitis and from P. arbiculare isolated from pityriasis versicolor. Histology showed the development of the yeasts in the stratum corneum, with hyperkeratosis at the follicular ostium and in the pilous bulb: the clinical and histological appearances resembled human seborrheic dermatitis. The nude (nu/nu) mouse, the hair-less mouse and the nude rat were not susceptible to this experimental infection, probably because of the dystrophy of their pilous follicles and sebaceous glands. The experimental model permitted evaluation of antifungal agents. The Pityrosporum dermatitis disappeared rapidly after topical application of econazole or amphotericin B. No pathological differences were observed between the strains tested.

Administration, Topical↗
PubMed1995

[Hypopigmented mycosis fungoides].

INTRODUCTION: Isolated areas of hypopigmented skin can be a manifestation of mycosis fungoides. This is a rare clinical form with a particular clinical course and histology which has been described only in black subjects. CASE REPORT: Over a 10-year period, a 28-year-old woman from Mali developed non-infiltrated hypopigmented and discretely squamous macules involving the entire body. The diagnosis of mycosis fungoides was made on pathology evidence of epidermotropic lymphocyte infiltration with a few small nests. PUVA led to rapid regression of the lesions. DISCUSSION: Hypopigmented mycosis fungoides has been described in young black subjects (mean age 19 years). The diagnosis is usually made late because benign skin affection is usually the first diagnosis (pityriasis alba, pityriasis versicolor). The pathogenesis of these hypopigmented lesions is not known. PUVA appears to be effective in most cases.

Adult↗
PubMed1997

Susceptibility of Malassezia furfur subgroups to terbinafine.

Malassezia furfur, the fungus causing pityriasis versicolor, has been reported to be sensitive to terbinafine in vitro but although topical therapy is effective in the treatment of pityriasis versicolor, oral therapy is not. This phenomenon was investigated by determining the susceptibility to terbinafine of different M. furfur subgroups in vivo (during topical or oral application) and in vitro. All M. furfur subgroups were suppressed (approximately 10-fold) by topical terbinafine. Oral treatment resulted in no significant suppression of cutaneous M. furfur populations with the exception of a single subgroup (A), which was reduced to undetectable levels on the skin of eight of 10 patients receiving oral terbinafine. Isolates of subgroup A were also markedly more susceptible to terbinafine in laboratory tests. The importance of the recognition of distinct subgroups within the cutaneous lipophilic yeasts when evaluating their antifungal susceptibility and their role in disease is discussed.

Administration, Cutaneous↗
PubMed1997

In vitro susceptibility testing of Malassezia furfur against rilopirox.

The in vitro antifungal activity of the new hydroxypyridone antimycotic rilopirox has been evaluated against 29 separate clinical isolates of Malassezia (M.) furfur obtained from patients with pityriasis versicolor, seborrhoeic dermatitis or dandruff. Minimum inhibitory concentrations (MICs) of rilopirox were measured by the agar dilution technique and, in comparison, by a recently described microdilution method with colorimetric detection of the MIC end points. Rilopirox was found to be able to inhibit growth of all clinical yeast isolates. For the investigated M. furfur strains MIC values from 12.5 to 50 micrograms ml-1 with a median of 25 micrograms ml-1 were determined by the agar dilution method. Using the microdilution technique, MIC values between 16 and 128 micrograms ml-1 (median 32 micrograms ml-1) were found for the M furfur isolates. It has to be taken into account that with a 0.3% solution concentrations of 300,000 micrograms ml-1 are applied to the skin. Furthermore, due to its extreme low penetration rilopirox is long-term available in the skin in inhibiting concentrations. In comparison with rilopirox, the in vitro susceptibility of M. furfur against the systemically applicable triazole antimycotic itraconazole and clotrimazole, an established topical antifungal, was tested. As expected, low MIC values for these azoles were found by the agar dilution method. The median of the MIC of M. furfur was 0.1 microgram ml-1 for itraconazole, and 6.25 micrograms ml-1 for clotrimazole. The inhibitory effectivity of rilopirox against clinical isolates of M. furfur seems to justify its therapeutic evaluation in clinical trials. This new antifungal may be a useful alternative not only in pityriasis versicolor but also in seborrhoeic dermatitis due to the growth inhibition of M. furfur.

Antifungal Agents↗
PubMed1998

[Yeast-like fungi malassezia (pityrosporum): clinical and immunological aspects fo study].

The normal flora is typified by the yeast-like fungi Malassezia (Pityrosporum). Successful attempts at treating patients with atopic and seborreic dermatitis, pityriasis versicolor, and psoriasis with antifungicides confirm the involvement of these fungi in the etiology and development of these diseases. In patients with various skin diseases, an immune response to M. furfur is specific. In those with psoriasis, it is characterized by the higher chemoatractant activity of polymorphonuclear leukocytes stimulated by a M. furfur extract and by the immune response of IgG antibodies with immunoreactive proteins having a molecular weight of 100-120 kD. Patients with atopic dermatitis show a hyperimmune IgE-mediated response to M. furfur, with its specific Th2-lymphocytes inducing the atopic cytokines (IL-4, IL-10) that stimulate allergic reactions to other allergens. Those with pityriasis versicolor had impaired keratinocytic pigment exchange due to azelainic acid produced by M. furfur. The cause of transformation of the yeast phase of M. furfur to the mycelial one is presumably to be changes in the composition of fatty acids of the sebaceous glands due to increased androgen concentrations.

Antibodies, Anti-Idiotypic↗
PubMed2000

Improving diagnostic accuracy using a hierarchical neural network to model decision subtasks.

A number of quantitative models including linear discriminant analysis, logistic regression, k nearest neighbor, kernel density, recursive partitioning, and neural networks are being used in medical diagnostic support systems to assist human decision-makers in disease diagnosis. This research investigates the decision accuracy of neural network models for the differential diagnosis of six erythematous-squamous diseases. Conditions where a hierarchical neural network model can increase diagnostic accuracy by partitioning the decision domain into subtasks that are easier to learn are specifically addressed. Self-organizing maps (SOM) are used to portray the 34 feature variables in a two dimensional plot that maintains topological ordering. The SOM identifies five inconsistent cases that are likely sources of error for the quantitative decision models; the lower bound for the diagnostic decision error based on five errors is 0.0140. The traditional application of the quantitative models cited above results in diagnostic error levels substantially greater than this target level. A two-stage hierarchical neural network is designed by combining a multilayer perceptron first stage and a mixture-of-experts second stage. The second stage mixture-of-experts neural network learns a subtask of the diagnostic decision, the discrimination between seborrheic dermatitis and pityriasis rosea. The diagnostic accuracy of the two stage neural network approaches the target performance established from the SOM with an error rate of 0.0159.

Chronic Disease↗
PubMed1977

Sickle cell anemia in an American white boy of Greek ancestry.

A 7-year-old American white boy of Greek ancestry had sickle cell anemia. The disease in this patient was not accompanied by painful episodes or recognizable hematologic complications, although he did demonstrate considerable delay in skeletal maturation. The patient sought medical attention for a dermatologic problem that was ultimately diagnosed as pityriasis rubra pilaris. To our knowledge, this is the first demonstrated example of sickle cell anemia in a white male described in the United States.

Anemia, Sickle Cell↗
PubMed1984

Extractable immune complex in soluble substances from psoriatic scales.

Soluble substances of psoriatic scales (Pso-exts) were analysed immunologically to detect immune complex (IC) related to the immune reactions in psoriatic lesions and compared with extracts of scales from a patient with erythroderma due to pityriasis rubra pilaris (PRP-exts) as control. Immunoelectrophoretically IgG, IgA and C3 were detected in Pso-exists, but in PRP-exists only IgG was seen as immunological reactive substances. When analysed by Sephadex G-200 column chromatography, IgG and IgA eluates were found in Pso-exts with a molecular weight of more than 200,000 daltons. By Raji cell assay, the IgG and IgA eluates were shown to have IC characteristics and they were the IC composed of IgG-IgA, which was also confirmed using anti-IgG affinity chromatography. The IC seemed to be binding the epidermal proteins as antigen. These findings suggest that deposits of immunoglobulins and complement in the stratum corneum of psoriatic lesions are not just secondary to the underlying inflammation in the dermis but that the IC detected is related to the immune reactions in psoriatic lesions.

Agglutination Tests↗
PubMed1975

[Tumor- and drug-induced cutaneous axonal dystrophy. An electronmicrocopy proof of multiple lamellated bodies].

A marked cutaneous axonal dystrophy has been observed electronmicroscopically for the first time in the skin of three patients: (a) lesion of pityriasis lichenoides chronica in a patient with bronchogenic carcinoma, (b) non involved skin of a patient with malignant melanoma and (c) non involved skin of a patient with gout and retinal damage after prolonged use of chloroquine. The affected myelinated and non myelinated axons showed distinct alterations of mitochondria and multiple osmiophilic lamellated bodies (LK). These changes were interpreted as a (poly-)neuropathy, due to the influence of toxic systemic agents, such as malignant tumor and abuse of drugs. Chloroquine is known to induce neural damage. Moreover, some other compounds (ergotamine, ethaverine, analgetic preparations) may also be responsible for the drug-induced axonal dystrophy described in this study.

Adult↗
PubMed1981

Superficial mycoses in Italy.

A total of 1244 cases suspected of superficial mycoses were analysed in a period of 12 months in Italy. Dermatophytoses were found in 62.4%; the other common disease was Pityriasis versicolor (44.1%)., The predominant species Epidermophyton floccosum (34,2%) was strikingly high in relation to other statistics; this species was commonest in tinea cruris. Among the other dermatophytes M. canis was predominant (31.3%) commonest in tinea corporis, followed by T. mentagrophytes (17,8%) and T. rubrum (10,3%). A high rate of yeasts was found in tinea manum (81.6%) and tinea pedis (47.7%). ?

Adolescent↗
PubMed1993

Retinoid hepatitis.

A 65-year-old woman treated with etretinate for pityriasis rubra pilaris developed chronic active hepatitis. The elevated transaminases were noted 2 months after initiation of therapy and peaked 2 months after discontinuation of etretinate. The spectrum of liver toxicity induced by etretinate is reviewed. We suggest that reported cases of retinoid-induced liver disease can be divided into four distinct categories: nonspecific reactive hepatitis, acute hepatitis, chronic active hepatitis, and severe fibrosis or cirrhosis.

Aged↗
PubMed1993

Febrile ulceronecrotic Mucha-Habermann disease.

Febrile ulceronecrotic Mucha-Habermann disease in an 18-year-old man is reported. This disease is a severe form of pityriasis lichenoides et varioliformis acuta (PLEVA) and is characterized by the sudden onset of diffuse coalescent ulcerations associated with high fever and systemic symptoms. In the present case the disease was preceded by typical PLEVA. Histologically, a leukocytoclastic vasculitis was seen in addition to the usual features of PLEVA. Findings of laboratory studies revealed an elevated erythrocyte sedimentation rate, a high white blood cell count, and a mild increase in liver enzymes. No systemic involvement was detected. Findings of T cell receptor gene analysis in skin and peripheral blood showed no abnormality. The patient was treated with PUVA and methotrexate with a good response. We review the eight previously reported cases of febrile ulceronecrotic Mucha-Habermann disease.

Adolescent↗
PubMed2006

[Abrupt onset of papulovesicular lesions: diagnostic features and outcome].

INTRODUCTION: Abrupt onset of papular lesions, with ulcero necrotic evolution could refers to many dermatitis. Febrile ulceronecrotic Mucha-Habermann disease is an unusual severe form of pityriasis lichenoides and varioliform acuta (PLEVA) characterized with ulceronecrotic eruption potentially associated with high fever and systemic symptoms leading to death. Lymphomatoid papulosis is a recurrent papulonodular eruption with an initial presentation close to PLEVA. While this disorder usually has a benign course, about 10% of the patients develop lymphoproliferative disorders such as CD30+ lymphoma. EXEGESIS: The authors reported an acute form of PLEVA in a young man hospitalized in internal medicine unit with fever and ulcero-necrotic papulo-vesicular lesions. Treatment with tetracycline was successful. They also report a case of lymphomatoïd pustulosis that occurred in a 34 years old woman with an extensive nodulo-pustular eruption characterized by central necrosis and ulceration. Histopathological examination revealed CD30 lymphocytic infiltration leading to diagnosis. CONCLUSION: Theses two dermatosis, uncommon and clinically similar, are both characterized with an unpredictable evolution that to be known by internist.

Adult↗