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PubMed2002

Dermatophytes and other fungi associated with skin mycoses in Tripoli, Libya.

This study sought to determine the prevalence of skin infections and their causative agents in the Libyan population. Samples were collected from 2224 patients attending the Dermatology Clinics of the Tripoli Medical Centre (TMC) between August 1997 and December 1999 and were submitted to a mycology laboratory for analysis. Diagnosis was confirmed by microscopic examination in 1180 cases (53.1%) and the causative agent was isolated and cultured in 1160 cases (52.2%). Dermatophytes, Malassezia furfur and Candida albicans were the most common etiological agents isolated. Tinea corporis accounted for 45.9% of cases (85% of cases occurred in children below 15 years of age). The frequency of the other clinical types in descending order was pityriasis versicolor 27.8% (322 cases), candidiosis 13.4% (156 cases), tinea pedis 8.1% (94 cases), tinea manuum 2.6% (30 cases) and tinea barbae 2.2% (26 cases). Trichophyton violaceum was the most common etiological agent, responsible for 44% (300 cases) of dermatophyte infections. Malassezia furfur was ranked the second most frequent causative agent being found in 27.8% of cases, followed by Trichophyton rubrum 13.8% (160 cases) and Candida albicans 10% (116 cases). Other species isolated included Microsporum canis 8.1% (94 cases), Epidermophyton floccosum 6.6% (76 cases) and Trichophyton mentagrophytes 3.1% (36 cases).

Adolescent↗
PubMed2003

Prevalence and causative agents of superficial mycoses in a textile factory in Adana, Turkey.

This study was carried out in a textile factory settled in the city center of Adana, Turkey. The workers were evaluated for the presence of superficial mycoses and the interaction of their working environment or working condition. A total of 431 textile workers were included in the study, with a male to female ratio of 378 (87.7%) to 53 (12.3%) and an age range of 19-52 (mean: 33.7 +/- 6.8). Direct examination and/or culture revealed superficial mycoses in 73 (16.9%) workers, among them 56 (76.7%) were classified as dermatophytoses, 8 (11.0%) as Pityriasis versicolor while in nine (12.3%) of the cases, no causative agent could be determined. Trichophyton rubrum (57.1%) and T. mentagrophytes (42.9%) were the two species isolated on culture. This study emphasized that textile workers should be admitted as a risk group for superficial mycoses, especially tinea pedis.

Adult↗
PubMed2002

Identification of Malassezia species from patient skin scales by PCR-RFLP.

OBJECTIVE: This study was aimed at the development of a DNA-based procedure directly applicable to pathological skin scales and at the assessment of its value in rapid laboratory confirmation and identification of each of the seven Malassezia species. These lipophilic basidiomycetous yeasts in predisposed individuals are involved in pityriasis versicolor, seborrheic dermatitis, blepharitis, folliculitis, atopic dermatitis and fungemia. Standard identification procedures to species level are available, but so far no system for direct detection and characterization of Malassezia species in clinical specimens is available. METHODS: Malassezia DNA was extracted from pathological skin scales by a modified hexadecyltrimethylammonium bromide (CTAB) method and amplified by single and nested polymerase chain reaction (PCR), assays using the general fungal ITS 1/4 and 3/4 primers for amplification of sequences from the Malassezia major ribosomal DNA complex. Restriction fragment length polymorphism (RFLP) analysis of PCR products was used in subsequent species identification. DNA extracted from culture-positive skin scales was also tested by PCR and the RFLP patterns obtained were analyzed. RESULTS: A total of 36 isolates were tested. Distinct pure culture and skin-scale ITS 3/4 HinfI and AluI restriction patterns differentially identified M. furfur, M. globosa, M. restricta, M. sympodialis, M. pachydermatis, M. obtusa and M. slooffiae. Malassezia DNA was extracted from pathological skin scales and RFLP identified solitary and multiple Malassezia species in the same specimen. Molecular identification was confirmed by cultures and biochemical tests. Concurrent detection and identification of Candida and Yarrowia species was also feasible from skin scales. CONCLUSION: The proposed method, described for the first time, could provide a sensitive and rapid detection and identification system for Malassezia species, which may be applied to epidemiological surveys and routine practice.

Animals↗
PubMed2001

The effects of Malassezia yeasts on cytokine production by human keratinocytes.

Yeasts of Malassezia, members of the microbiologic flora of the skin, cause pityriasis versicolor and have also been implicated in the pathogenesis of other superficial dermatoses; the most important ones are seborrheic dermatitis, folliculitis, and atopic dermatitis. The mechanisms by which the yeasts cause these dermatoseş however, are not yet clear, and there have been no studies on the interaction between fungi and keratinocytes, especially the effects of fungi on the production of cytokines by human keratinocytes. Recently, the genus Malassezia has been expanded to seven species based on molecular data. In this study, we estimated the effects of Malassezia yeasts on cytokine (interleukins 1beta, 6, and 8, monocyte chemotactic protein-1, and tumor necrosis factor-alpha) production by human keratinocytes in order to examine whether the pathogenicity of the respective Malassezia yeasts is different from each other and to elucidate the mechanism by which Malassezia yeasts cause the dermatoses with different clinical and pathologic manifestations. Variable levels of interleukin 6 and 8, and tumor necrosis factor-alpha in the supernatants in response to Malassezia yeasts (except M. furfur) increased from 1 to 24 h co-culture, but the monocyte chemotactic protein-1 was undetectable. Furthermore, cytokine levels in the supernatants were undetectable 1-24 h after the keratinocytes were harvested with only supernatants of Malassezia. These results indicate that Malassezia stimulates cytokine production by keratinocytes, the cytokine production needs the presence of Malassezia, and there are differences in ability to induce cytokine production by human keratinocytes among Malassezia yeasts. These differences may reflect the different inflammatory responses in Malassezia-associated dermatoses, resulting in different clinical and pathologic manifestations.

Cell Survival↗
PubMed2003

HCR, a candidate gene for psoriasis, is expressed differently in psoriasis and other hyperproliferative skin disorders and is downregulated by interferon-gamma in keratinocytes.

We have previously shown that HCR is a good candidate gene for psoriasis based on its location in the PSORS1 locus, predicted secondary structure change of the associated allele, and expression pattern. To understand better the function of HCR, we studied how HCR expression is altered in hyperproliferative skin diseases other than psoriasis and in cancers. We examined also its regulation by different cytokines, growth factors, and antipsoriatic agents using quantitative RT-PCR (TaqMan) analysis and its location by immunostaining of keratinocyte cultures. Compared to psoriasis, HCR protein had a different distribution in chronic dermatitis, pityriasis rubra pilaris, mycosis fungoides, and chronic skin ulcers. In three of six grade III squamous cell carcinomas of the skin, four of four adenocarcinomas of the lung, and two of two ductal breast adenocarcinomas, positive cytoplasmic staining in cancer cells was detected. As in psoriasis, Ki67 did not colocalize with HCR. In cell cultures, HCR staining was detected perinuclearly in the cytoplasm and in the nuclei, suggesting that the protein may have a role in both compartments. A 2-fold downregulation of HCR mRNA expression was observed on stimulation with interferon-gamma. Based on the observations that HCR is detected in cancers of epithelial origin in Ki67-negative areas and that interferon-gamma downregulates its expression, we suggest it to have an antiproliferative function.

Adult↗
PubMedDate not supplied

Prevalence of skin disease among school children and adolescents in a Student Health Service Center in Hong Kong.

We document the prevalence and the pattern of dermatologic diseases among primary and secondary school students visiting a Student Health Service Center in Hong Kong. In this study, the differences in prevalence of skin diseases between these two groups are pointed out. A total of 1006 students from both primary (n = 559) and secondary schools (n = 447) were seen in a regional, population-based screening center during the period from October 1996 to September 1997. Each student was asked to answer a simple questionnaire to identify any skin problems and to explore health-seeking behavior. Students were then examined for evidence of skin disease. A total of 314 students (31.3%) had one or more skin disorders, the most common of which were acne vulgaris (9.9%), eczema (6.8%), café au lait spots (4.4%), congenital melanocytic nevus (3.6%), superficial fungal infections (2.2%), keratosis pilaris (1.3%), and pityriasis alba (1.0%), which represented 93% of the skin disorders encountered. Acne vulgaris and tinea cruris were distinctly more common in secondary school students, while atopic eczema and congenital melanocytic nevi were more commonly found in primary school students. Among the 314 students with skin disease, 129 (41%) had symptoms while 185 (59%) did not. Ninety of the 129 students (70%) with symptomatic skin problems did not seek medical attention. The two predominant skin diseases, acne vulgaris and endogenous eczema, both chronic skin problems, incur not only morbidity in affected individuals and families, but also use considerable resources in the community. The lack of medical intervention reported by symptomatic students in this study was unexpectedly high. Therefore it is useful to monitor the epidemiology of skin problems in children so that relevant skin health education programs and preventive measures can be planned and implemented effectively.

Acne Vulgaris↗
PubMedDate not supplied

Rosacea-like demodicidosis in an immunocompromised child.

Demodex folliculorum is a saprophytic mite of the human pilosebaceous unit. It is rarely found in children. It has been implicated in the development of follicular pityriasis, rosacea-like demodicidosis, pustular folliculitis, blepharitis, and granulomatous rosacea. We describe a 4-year-old boy who developed asymptomatic facial lesions that histologically corresponded to demodicidosis. He was in clinical remission of acute lymphoblastic leukemia and currently receiving maintenance chemotherapy. Exanthems related to D. folliculorum are rare in children. Most cases occur in immunocompromised patients and the clinical and histologic findings are diverse. A differential diagnosis should be established with rosacea and perioral dermatitis. The role of Demodex in the pathogenesis of these disorders is controversial. Immunosuppression might increase the number of mites, favoring an inflammatory reaction, or there could exist an impaired cutaneous immunologic response to the parasites.

Animals↗
PubMed1981

Amino acid metabolism of Malassezia furfur.

The mechanism responsible for the hypopigmentation which follows pityriasis versicolor (P.V.) infection has not yet been satisfactorily explained. This work was done in order to study the effect of Malassezia furfur on the decomposition or the utilization of the amino acid tyrosine in vitro. No effect could be noted, which points to the assumption that the effect of the causative fungus of P.V. on melanogenesis is most probably due to the blocking of melanine synthesis by one of the product of M. furfur metabolism without using tyrosine.

Culture Media↗
PubMed2002

The etiology of allergic-appearing foot dermatitis: a 5-year retrospective study.

OBJECTIVES: The objectives of this 5-year retrospective investigation were threefold. (1) Among patients with dermatitis of the feet consistent with allergic contact dermatitis (ACD), what were the final diagnoses of those with dermatitis only on the feet and those whose foot dermatitis was accompanied by other cutaneous involvement? (2) Among those patients determined to have ACD, what were the relevant allergens? (3) Have the allergens in shoes in the United States changed as a consequence of modifications in footwear manufacture and style design? METHODS: Of 704 patients patch-tested at the University of Kansas Medical Center with the North American Contact Dermatitis Group's standard allergen tray and/or the University of Kansas "shoe and rubber" tray, 70 patients presented with a clinical pattern suggestive of ACD of the foot. RESULTS: Compared with those without foot dermatitis, these patients were more likely to be atopic and male with bimodal age distribution: <19 and 41 to 60 years. Despite clinical evidence suggesting allergy, only 23 (32.9%) patients had ACD to components of shoes, whereas 30 (42.9%) had psoriasis. Among the remaining patients, 4 (5.7%) had a non-shoe allergy, 3 (4.3%) had dyshidrosis, 2 (2.9%) had nummular dermatitis, 2 (2.9%) had tinea pedis, and 1 (1.4%) each had pityriasis rubra pilaris, juvenile plantar dermatosis, atopy, id reaction, and traumatic/frictional dermatitis as their primary diagnosis. One patient had not received a diagnosis when last seen. CONCLUSIONS: When evaluated by sites of involvement, psoriasis was diagnosed as often as ACD to shoes when the dermatitis was confined to the foot but was more frequent than ACD when both the hands and feet were involved. With respect to shoe dermatitis, rubber components were the principal allergens, followed by chromated leather and adhesives. Iatrogenic ACD was also common, and among all allergens, bacitracin caused the most frequently observed relevant reaction.

Adult↗
PubMed2002

Demodicidosis revisited.

Demodex mites are common commensals of the pilosebaceous unit in mammals. In humans, only two species (Demodex folliculorum and D. brevis) have been identified and have been implied to play a role in at least three facial conditions: pityriasis folliculorum, rosacea-like demodicidosis and so-called "demodicidosis gravis". However, there is no consensus to what degree the mites are causative of the skin pathology and how they might contribute to the disease. This review presents a demodicidosis case, discusses the clinical features of Demodex infestation in man and reviews its pathogenetic implications and the therapeutic options.

Adult↗
PubMed1992

Superficial fungal infections. Topical and oral treatment of common types.

Superficial fungal infections are common dermatologic conditions, and patients often visit primary care physicians for evaluation. Diagnosis can be established with direct microscopic examination, fungal culture, and Wood's light examination. Some infections (eg, tinea corporis, tinea cruris, tinea pedis, pityriasis versicolor) are often successfully treated with a topical antifungal alone. Others (eg, tinea capitis, onychomycosis) require use of a systemic antifungal. Physicians should be familiar with available agents and their adverse effects and closely follow patients receiving long-term antifungal therapy.

Administration, Oral↗
PubMed2003

Epidermodysplasia verruciformis with multiple mucosal carcinomas treated with pegylated interferon alfa and acitretin.

Epidermodysplasia verruciformis (EV) is characterized by abnormal genetically-determined susceptibility to widespread and persistent infection of the skin with human papillomaviruses (HPV). The infection results in disseminated pityriasis versicolor-like lesions and flat warts. Skin malignant changes are very common and occur on sun-exposed areas. Several treatments have been used but without consistent benefit. Recently, retinoids and alpha-interferon, alone or in combination, have been reported to be of value in the therapy of EV lesions. We present the case of a 43-year-old white female affected by EV who developed multiple squamous cell carcinomas in the oral and genital mucosae during the previous four years. Both wart and cancer lesions harbored HPV24 along with the novel putative HPV type FA51. The patient was treated with a combination of acitretin (0.2 mg/kg per day) and peginterferon alfa-2b (1 microg/kg per week s.c.) for one year, with marked improvement of verrucous lesions and no recurrence of mucosal cancer. Thereafter, interferon was stopped whereas acitretin therapy was continued, but a new Bowen's disease developed in the perianal region, and the acitretin dose was increased at 0.5 mg/kg per day. At six-month follow-up, only a low number of flat warts persisted, and no clinical signs of cutaneous or mucosal carcinoma were evident.

Acitretin↗
PubMed2000

The effects of lipid extraction on the immunomodulatory activity of Malassezia species in vitro.

Malassezia spp. are believed to be the causative agents of pityriasis versicolor and are strongly implicated in seborrhoeic dermatitis. The yeast also forms part of the normal human cutaneous microflora. We have previously shown that when Malassezia yeast cells are incubated with human peripheral blood mononuclear cells (PBMCs), they are capable of reducing the levels of pro-inflammatory cytokines produced. In order to test the hypothesis that this immunoevasive phenomenon may be related to the unusually high level of lipid in the Malassezia yeast cell wall, we have compared the immunomodulatory capacity of normal and lipid-depleted yeast cells. Stationary phase yeast cells of Malassezia sympodialis, M. globosa and M. restricta were treated with chloroform/methanol to extract the surface lipids. The lipid-depleted and non-depleted yeast cells were then co-cultured with human PBMCs from three different human donors at a ratio of 20 yeasts per leukocyte for 24 h. The levels of interleukin (IL)-1beta, IL-6 and tumour necrosis factor (TNF)-alpha were then determined by enzyme-linked immunosorbent assay (ELISA). The results demonstrated that extraction of lipid reversed the yeast cell capacity to reduce the levels of pro-inflammatory cytokines. The levels of IL-1beta, IL-6 and TNF-alpha produced in response to lipid-extracted Malassezia of all three species were either no different from or significantly greater (P < 0.05; ANOVA) than the constitutive control levels. These results suggest that the lipid microfibrillar layer of Malassezia may prevent the yeast cells from inducing inflammation and provide an explanation for the normal commensal status of the organism on human skin. The hypothesis that the lipid layer is absent or altered in seborrhoeic dermatitis may provide an explanation for the inflammatory nature of this dermatosis.

Cells, Cultured↗
PubMed2001

Quantitative culture of Malassezia species from different body sites of individuals with or without dermatoses.

Quantitative cultures were obtained using contact plates to determine whether the quantity and composition of Malassezia species at a given anatomic site in normal individuals differs from that of patients with various cutaneous dermatoses. The sample included 20 clinically healthy individuals (without any dermatosis) and 110 patients with dermatoses (including 31 with atopic dermatitis [AD], 28 with psoriasis [PS], 28 with seborrheic dermatitis [SD] and 23 with pityriasis versicolor [PV]). Contact plates filled with special culture medium were used to obtain a quantitative culture from five body sites (scalp, forehead, arm, trunk and leg) of every individual. The number of cfu were recorded for every plate that grew Malassezia yeasts, and 3-5 colonies were isolated for identification to species level using microscopic, physiological and molecular characteristics. The mean cfu counts observed among patients with AD, PS and SD was significantly lower than normal control subjects (P < 0.05). The mean cfu counts from PV patients was not different from that of healthy control subjects. Overall, for all conditions considered together, the mean cfu counts in lesional sites were significantly lower than in non-lesional sites (P <0.05). Furthermore, the mean cfu counts from lesional sites in patients with AD and PS were significantly lower than the corresponding value in patients with PV (P <0.05). Six Malassezia species were recovered from the different dermatoses. Malassezia sympodialis was the most common species associated with AD and PV patients and healthy control subjects, while M. globosa was most frequently isolated from PS and SD patients. More than one Malassezia species was recovered at any given anatomic site from both controls as well as individuals with dermatoses. M. globosa was equally likely to be recovered from scalp, forehead and trunk, but less likely to derive from arms and legs. M. restricta and M. slooffiae were recovered more frequently from the upper body (scalp and forehead) than from the lower body. Among normal individuals and for patients with AD and PV, M. sympodialis was significantly more likely to affect the forehead than the legs.

Adult↗
PubMed2004

Lymphomatoid papulosis in an HIV-positive man.

Lymphomatoid papulosis (LyP) is a rare cutaneous lymphoproliferative condition characterized by a chronic, recurrent eruption of papules and nodules that undergo spontaneous regression. The disorder is usually clinically benign; with a minority of cases progressing to malignant lymphoma. LyP is divided into two subtypes based on histologic appearance. Type A resembles Hodgkin's disease with up to 20% of large CD30+ lymphocytes. Type B resembles mycosis fungoides showing an infiltrate of CD4+ lymphocytes and scattered CD30+ cells. Clinically LyP often resembles pityriasis lichenoides et varioliformis acuta but has a strikingly different histological appearance. Histologically, LyP resembles lymphoma (anaplastic T-cell or Hodgkin's) but is distinguished by its benign course. Here we present a case of LyP in a severely immune-repressed HIV-positive patient. This patient presented with pruritic papules involving the upper extremities and a CD4+ T-cell count of 4. Histopathologic examination showed a dense superficial dermal infiltrate comprising normal-sized lymphocytes admixed with larger lymphocytes. Immunophenotyping showed most of the lymphocytes to be CD3+ (T cells). The scattered larger cells were CD30+. The smaller lymphocytes were CD8+ rather than CD4+ as expected for non-HIV-appointed LyP. This may be because of the immune disregulation of HIV disease and the absolute and relative paucity of CD4+ T cells relative to CD8+ T cells.

Adult↗
PubMedDate not supplied

Itraconazole in the treatment of human mycoses: review of three years of clinical experience.

During the first three years of clinical investigation of itraconazole, more than 1,000 patients with mycoses were treated with the drug. Almost 50% were women with vaginal candidosis; a dosage of 200 mg per day for three days appeared to be optimal for their treatment. Several treatment regimens were tested for pityriasis versicolor; the minimum total dose necessary for optimal results was 1 g. A randomized comparison of 50-mg and 100-mg daily doses for the treatment of skin mycoses indicated that the optimal dosage is 100 mg. The results of short courses of treatment for superficial dermatophytoses suggest that such regimens may be effective, and the results of an ongoing double-blind comparison of itraconazole and griseofulvin suggest that itraconazole is superior in these infections. The outcome of treatment of systemic mycoses with itraconazole, especially sporotrichosis, chromomycosis, and aspergillosis, indicates that itraconazole may be useful in therapy for life-threatening fungal infections when standard therapy has failed.

Antifungal Agents↗
PubMed1991

Developments in the management of superficial fungal infections.

In the common superficial mycoses, caused by the dermatophytes and by Candida spp., the established agents, amphotericin B and griseofulvin (themselves important advances over the previously available simple topical preparations) have been limited in effectiveness in some situations. The introduction of the azole group of drugs, with a broad spectrum of activity and availability in varied preparations, has diversified the treatment possibilities in dermatophytoses and candidosis, and also in pityriasis versicolor and related conditions. Two other introductions appear promising: terbinafine has been very effective in early trials in dermatophytoses, and amorolfine may have a particular role in isolated nail infection, whether caused by dermatophytes or by less common fungi.

Animals↗
PubMed2004

Childhood brucellosis--a microbiological, epidemiological and clinical study.

A total of 5726 blood specimens (from children aged 14 years and younger) were studied for the serological evidence of brucellosis. Ninety-three (1.6 per cent) showed diagnostic agglutinin titres with a geometric mean titre of 403 (SD +/- 547). Forty-three (59.7 per cent) blood specimens yielded the growth of Brucella melitensis. Thirty-nine patients (41.93 per cent) were shepherds, who constituted the major occupational group affected in the present series. More than 60 per cent of the patients had a history of both consumption of fresh goat's milk and close animal contact. The habit of consuming fresh goat's milk to obtain relief from chronic ailments was noted in nine patients. Seventy-three (78.49 per cent) were males and 20 (21.51 per cent) were females, with a male to female ratio of 3:1. The disease occurred mainly in the school age group (mean age 10.3 years). All the patients had an acute history of less than 2 months. Forty-nine (52.68 per cent) patients presented with persistent fever, 19 (20.43 per cent) with joint pain, and the rest with a combination of fever and joint pain with and without low backache, fever being the commonest complaint. One case presented with involuntary movements of limbs alone and the other with burning feet only. Pityriasis alba was the consistent physical finding, with fever in the majority of the patients. The major joint found to be involved was the knee (52.77 per cent). The synovial fluid obtained from the knee joint of five patients demonstrated Brucella agglutinins and also three grew B. melitensis. Eight patients presented with complications that included skin lesions (3), carditis (2), neurobrucellosis such as chorea (1), peripheral neuritis (1), and meningitis (1). Brucella melitensis biotype 1 was successfully isolated from the papular eruption of one out of three cases who presented with skin lesions. To our knowledge this is the fourth confirmed isolation of B. melitensis from skin lesions with brucellosis, reported in the literature. The cerebrospinal fluid obtained from the meningitis patient was positive for B. agglutinins. To our knowledge chorea of brucellar origin appears to be the first case reported in the literature. In 15 cases (16.13 per cent) brucellosis was suspected clinically whereas 78 (83.87 per cent) cases, only serological evidence of brucellosis confirmed the diagnosis. None of the cases relapsed. In our experience an initial combination therapy with a three-drug regimen followed by a two-drug regimen for a minimum of 6 weeks has been found to be effective in the prevention of a relapse.

Adolescent↗