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PubMed1999

[In vitro cytokine induction in leukocytes by human herpesvirus 7].

Virus infections of the immune system may alter the normal cytokine profile, which leads to symptoms of illnesses. HHV-7 revealed lately has been known as one of the causative agents of exanthem subitum and pityriasis rosea, while its latent infection can be reactivated in immunocompromised conditions. Their pathomechanism has not been explored yet, therefore, the production of some cytokines by separated leukocytes was studied upon primary and secondary infections. After combined treatments with live or inactivated viruses and/or mitogens, the cytokines were quantitated in the supernatant of cells by sandwich ELISA. It was established that, individual cytokines were produced at maximal output at different times postinfection. The quantity of their molecules depended on the primary or repeated infections. Inactivated viral particles also induced cytokine release. Production of IL-2 and IFN-gamma due to mitogen activation could be augmented in primary, but was diminished in secondary infections. Release of TNF-alpha and IL-1 beta was parallel, but the combinatory effect with mitogens increased the quantity of IL-1 beta. HHV-7 induced early IL-10 production, which is known to inhibit cytokine release from helper lymphocytes and consequently might play a role in those acute inflammatory skin diseases mentioned above. In contrast to the related HHV-6 found in severe immunosuppressed conditions, the effect of HHV-7 on the balanced production of different cytokines seems to be related to the mild symptoms of skin disorders caused and that of moderate immunosuppression upon reactivation.

Cytokines↗
PubMed1999

Common red scaly rashes. Traps for the unwary--Part 1.

BACKGROUND: Red scaly rashes often provide difficulties for general practitioners leading to a 'try and see' approach which, although successful on many occasions, may delay adequate treatment when there is lack of a correct diagnosis. OBJECTIVE: A study of 61 general practitioners, providing them with photographs and clinical history, highlighted areas of uncertainty particularly in diagnosis, but also in treatment of common red scaly rashes including seborrhoeic dermatitis, pityriasis versicolor, psoriasis, superficial basal cell carcinoma, eczema, and tinea. On the basis of their responses, practical tips have been suggested to overcome them. DISCUSSION: Simple diagnostic procedures that can be done within the general practice setting include biopsy, skin scrapings and fungal microscopy. They have been highlighted as an important component of the approach to diagnosis of common red scaly rashes. While the study showed a substantial proportion of correct treatment being recommended, there was still an area of need, particularly in diagnosis, which could be enhanced by learning these simple techniques.

Adult↗
PubMed1999

[Cutaneous complications after organ transplant].

FREQUENT DIVERSE COMPLICATIONS: Skin problems in organ recipients mainly result from the induced immunosuppression but also from specific adverse effects of immunosuppressive drugs. The degree of extension and gravity of the clinical manifestations are often proportional to the intensity and/or duration of the immunosuppressive therapy. Immunodepression mainly leads to infectious and neoplastic complications. INFECTIONS: Viral and fungal infections are the most frequently encountered. Herpes simplex and zoster infections require treatment to prevent visceral involvement. Human papillomavirus infections occur in 80% of patients 5 years after transplantation and can lead to malignant transformation. Fungal infections include pityriasis versicolor and often extensive dermatophytosis. CANCER: Increased rate of cancer occurs especially in patients with viral disease. Skin cancers involving papillomavirus are the most frequent cancers observed in transplant recipients, occurring in half of the long-term survivors. Squamous cell carcinoma of exposed areas are the most common; they are often more aggressive than in non-immunodepressed patients (multiple sites, recurrence). Exposure to sun is a proven inducer. There is a 500-fold higher risk of Kaposi disease linked to HHV8 virus. This disease can regress simply after reducing the immunosuppressive treatment. Other more uncommon tumors such as lymphomas, melanomas, sarcomas and Merkel cell tumors also appear to occur at an increased rate in transplant recipients. PREVENTION: Most malignant skin tumors are the expression of marked immunodepression and their prognosis is improved with reduction in immunosuppressive therapy. Prevention requires regular dermatology work-ups and counseling about strict protection from sun exposure.

Graft Rejection↗
PubMed1999

The epidemiology of atopic dermatitis at a tertiary referral skin center in Singapore.

Atopic dermatitis is a common chronic, relapsing, pruritic ecematous skin condition with a predilection for the flexural areas and occurs in patients with a personal or family history of atopy. The aim of this study is to describe the profile of atopic dermatitis seen at the National Skin Centre in Singapore. A retrospective chart review was conducted of all the patients with atopic dermatitis seen during the first six months of 1994. There were 492 patients whose ages ranged from one month to 74 years with an equal sex ratio. The prevalence was 2%. The onset of the disease occurred before the age of 10 years in 61.2% of patients. In 13.6% of the patients, the onset was after the age of 21 years. Two hundred and fifty-four patients (52%) had "pure" atopic dermatitis without concomitant respiratory allergies. Two hundred and thirty-eight patients (48%) suffered from a "mixed" type, with 23% having allergic rhinitis, 12% having asthma and 13% having both asthma and allergic rhinitis. Two hundred and thirty-one patients (47%) had at least one first-degree family member with atropy: atopic dermatitis (17%), asthma (15%) and allergic rhinitis (15%). Most of the patients, 416 (84.5%), had subacute eczema at presentation. Ichthyosis vulgaris was present in 38 patients (8%) and pityriasis alba in 13 patients (3%). The most common infective complication was bacterial infection (impetiginized eczema, folliculitis, cellullitis) present in 95 patients (19%) followed by viral infections (eczema herpeticum, viral warts and molluscum contagiosum) in 17 patients (3%). Allergies were noted in 43 patients (9%) based on the history given. The most common was drug allergies (penicillin and co-trimoxazole) in 28 patients followed by food allergies in 11 patients. Common aggravating factors reported include heat, sweating, stress, thick clothing and grass intolerance. Most patients could be controlled with a fairly simple regimen of moisturizers, topical steroids and antibiotics for acute flares. Short courses of systemic steroids were used in 78 patients (16%). Three patients were treated with phototherapy, Two on UVAB and one on PUVA. The pattern of atopic dermatitis in Singapore is similar to that reported in the Western literature except for a lower prevalence and a significant proportion of adult onset atopic dermatitis.

Adolescent↗
PubMed2000

[Yeasts of the genus Malassezia: taxonomic classification and significance in (veterinary and) clinical medicine].

The historical development of the taxonomic classification of Malassezia yeasts until today yielded the description of seven different species based upon molecularbiological, morphological and biochemical parameters (M. furfur, M. pachydermatis, M. sympodialis, M. globosa, M. obtusa, M. restricta, M. slooffiae). Tests like Cremophor EL assimilation, esculin degradation, catalase test, pigment production and determination of polidocanol sensitivity appear to be suitable procedures for routine identification of the different species. Their colonization of clinically healthy humans (in particular M. sympodialis, M. globosa, M. obtusa) and animals (M. pachydermatis) skin renders interpretation difficulties, when isolating Malassezia spp. from clinical specimens. Out of the seven species, in man the clinical significance of M. furfur for pityriasis versicolor and systemic infections appears to be accepted largely. In dogs and cats M. pachydermatis has been regarded as cause of otitis externa and seborrhoeic dermatitis. But, due to geno- and phenotypic variabilities described for M. pachydermatis field isolates further investigations concerning the taxonomic uniformity of the species are necessary.

Animals↗
PubMed2000

The lipophilic yeasts: state of the art and prospects.

Malassezia yeasts (lipophilic yeasts), have been classified to include seven species. Although molecular methods such as sequencing of RNA and karyotyping were used to determine the species, traditional techniques are also being explored for their identification. These include studies of morphology and the utilization of individual lipids. Reports now show the predominance of individual species recovered from normal skin and from patients with diseases such as pityriasis versicolor and seborrhoeic dermatitis. The majority of systemic infections reported have been in the bloodstream of premature neonates. Clusters of cases have occurred and molecular techniques employed to study the epidemiology. With the development of discriminatory methods to determine individual species and strains present in disease and in nature, our understanding of the pathogenicity and the epidemiology of this genus can be advanced.

Animals↗
PubMed2001

Superficial fungal infections in adolescence.

Cutaneous fungal infections occur frequently in the adolescent population, and are second only to acne in generating skin-related adolescent anguish. Though superficial fungal infections of the skin are rarely life-threatening, they can cause significant worrisome cutaneous findings (e.g., white spots from pityriasis versicolor, distorted nails from onychomycosis). Such changes are particularly threatening to an adolescent who wants to be just like everybody else. This article focuses on several of the more common cutaneous fungal infections in adolescence, including pityrosporum (tinea) versicolor and dermatophyte infections of the feet, groin, skin, and nails. The prevalence of each disease is discussed, along with its clinical presentation, differential diagnosis, and methods of treatment.

Adolescent↗
PubMed2001

Differential diagnosis of annular lesions.

Although most annular lesions will be typical of a dermatophytosis, physicians must consider other possible diagnoses. Tinea corporis can often be diagnosed on the basis of a positive potassium hydroxide examination. Topical and systemic antifungals are usually curative. Pityriasis rosea is characterized by small, fawn-colored lesions distributed along skin cleavage lines. Treatment is symptomatic. Granuloma annulare is characterized by nonscaly, annular plaques with indurated borders, typically on the extremities. One half of cases resolve spontaneously within two years. Sarcoidosis can present as annular, indurated plaques similar in appearance to the lesions of granuloma annulare. Diagnosis is based on histopathology and the involvement of other organ systems. Hansen's disease can mimic tinea corporis by presenting as one or more annular, sometimes scaly, plaques. Urticaria may affect 10 to 20 percent of the population. The annular plaques lack scale and are evanescent. Subacute cutaneous lupus erythematosus can present in an annular form on sun-exposed surfaces or in a papulosquamous form. Erythema annulare centrifugum typically presents as annular patches with trailing scale inside erythematous borders.

Antifungal Agents↗
PubMed2001

[Usefulness and necessity of unsynchronized photosolotherapy and bath-PUVA--two variants of balneophototherapy--in funded ambulatory health care].

The Standing Committee of Statutory Health Insurance Physicians and Sickness Funds is the legal body that makes decisions on reimbursement for health care services in the German ambulatory health care sector. In 1994 the committee declined the reimbursement of balneophototherapy. Balneophototherapy comprises a bath in a saline solution followed by ("non-synchronous") or simultaneous ("synchronous") UVB-irradiation. Photochemotherapy with bath-water delivery of psoralens combined with UVA light is also covered by the term balneophotherapy. The main indication for both procedures is serious psoriasis. Bath PUVA was also recommended for atopic dermatitis, pityriasis lichenoides, lichen ruber and mycosis fungoides. An effectiveness study sponsored by the sickness funds with rather poor methodological design and conduct was not able to show an unbiased effect of balneophototherapy despite inclusion of thousands of patients. On the contrary, a poor adherence of patients and doctors was documented, since 63% of patients suffering from psoriasis and treated with saline bath followed by UVB-irradiation stopped early or used additional therapies like cortisone or vitamin D3 derivatives. Only 43% of patients suffering from psoriasis and treated by bath PUVA did not stop the initial therapy and did not receive additional therapy (UVB, cortisone). In addition, the committee also conducted a thorough review of the literature, guidelines and status in other health care systems. Finally the two modifications of balneophototherapy were again declined from reimbursement in the German ambulatory health care sector. There were no controlled clinical trials showing efficacy of saline bath followed by UVB irradiation. Up to now bath PUVA was only evaluated in small equivalence trials which despite the fact that a drug was tested did not apply basic ICH standards (international conference on harmonisation) for equivalence trials. Additionally, the long-term cancer risk inherent to the application of psoralenes must be considered. Since the definition of "severe psoriasis" is not trivial a wide use of bath PUVA in ambulatory health care has to be based on the results of rigorously conducted clinical trials showing the effectiveness, safety and appropriateness in comparison to other treatment modalities. In reaction to the decision of of the committee two randomised controlled trials for the evaluation of the efficacy of balneophototherapy are planned.

Balneology↗
PubMed2001

[Education of medical mycology for dermatologists in Japan].

Inquiries were made to estimate the level of dermatological practice and to elucidate the mycological education of 147 recruits who applied to take the specialized examination offered by the Japanese Dermatological Association in August 2000. The potassium hydroxide (KOH) examination was performed on the following percentages of the 147 recruits: for tinea corporis, 79.6%; tinea manuum, 76.9%; pityriasis versicolor and tinea cruris, 74.1% and oral candidiasis, 70.1% respectively. Culture examination was applied by 30.6% of the recruits for sporotrichosis, 19.7% for dematiaceous fungal infection and 15.6% for kerion. Ninety-five percent of the recruits had been trained at university hospitals. Another inquiry was made to directors of 380 dermatology clinics (88 university hospitals and 292 other clinics), in June 2000. KOH-examinations had been made at 94% of the university hospitals and 83% of the other clinics for all of suspected mycosis, whereas culture examinations were made at only 8% and 3% respectively. Further mycological examinations such as identification of the isolates to species level had been made at 73% of the university hospitals. It is postulated that 88% of the university hospitals have facilities to offer a medical mycology education to dermatologists. From these results it is concluded that the available mycological education is insufficient to satisfy the levels of dermatology specialists for clinical practice.

Adult↗
PubMed1998

Skin diseases seen in Kazanchis health center.

Studies concerning the prevalence of skin diseases and the general dermatologic services in Ethiopia are limited. A total of 7760 patients with 9725 dermatological diseases were seen by a dermatovenereologist from September 1995 to August 1996 at Kazanchis Health center in Addis Ababa. Male to female ratio was 1.01:1.00. Three thousand eighteen (31.0%) of the total 9725 cases had prior evaluation by other health personnel, including doctors (but not dermatologists). Out of these cases, 2720 (90.1%) were misdiagnosed and mismanaged. This high percentage points to the need for further short-term dermatology training for non-dermatologists. Bacterial, fungal and viral infections were dominating, comprising 19.4%, 18.5% and 6.5% of cases respectively. Infestations (i.e., pediculosis and scabies together) represented 10% of cases. Eczemas contributed 18.1% of the total cases. Photoallergic dermatitis (4.5%), Pityriasis alba (4.4%), urticaria (2.2%), prurigo (2%), benign tumors (1.8%), lichen planus (1.6%) and melasma (1.5%) were also quite common.

Adolescent↗
PubMed2002

Butenafine: an update of its use in superficial mycoses.

Butenafine is a synthetic benzylamine antifungal agent that may be fungicidal against susceptible organisms, e.g., dermatophytes. Butenafine may be effective and safe in the treatment of interdigital tinea pedis (apply twice daily for 1 week or once daily for 4 weeks), tinea corporis/tinea cruris (apply twice daily for 2 weeks), and pityriasis versicolor (apply once daily for 2 weeks). The effectiveness of the drug persists for at least 4 weeks following the discontinuation of therapy suggesting that there is some retention of the drug in the skin following termination of active therapy.

Administration, Topical↗
PubMed1976

Freeze-fracture replication of cultured Pityrosporum orbiculare.

Skin scrapings from a patient with Pityriasis versicolor were plated on a bile salt medium containing 10% glycerol (for cryoprotection) and Pityrosporum orbiculare was harvested for freeze-fracture replication. Resting and budding cells were senn. The overall pattern of indentation of the plasma membrane towards the cytoplasm was well revealed as a spiral arrangement of major indentations with minor ones disposed more or less at right angles. Hexagonally-arranged particles were not observed. Mitochondria were elongated with constrictions at intervals, and the fracture face of the limiting membrane directed towards the exterior exhibited linear arrays of particles. An unusual type of organelle was also present, viz: a membrane-limited vesicle with regularly-spaced depressions or "dimples".

Cell Membrane↗
PubMedDate not supplied

The hair strand test - a new method for testing antifungal effects of antidandruff preparations.

Seborrheic dermatitis and its minimal variant, dandruff (pityriasis simplex capillitii), are among the most frequent diseases caused by Malassezia (M.) yeasts. Treatment studies have shown that antimycotics achieve clinical improvement, while recolonization leads to recurrent symptoms. Among the antimycotics used are azoles, hydroxypyridones, and various agents such as zinc pyrithione, tar, and selenium disulfide. However, comparative efficacy studies in vitro should not only consider the minimal inhibitory concentrations against Malassezia yeasts but also the bioavailability of the individual substances with regard to hair and scalp. By means of a new method, the hair strand test, hairs from ten volunteers were subjected to standardized 5-min incubation with different shampoo formulations. Thereafter they were rinsed with running water for 1 min and dried. Two hundred each of these hairs (length 1 cm) were given into a medium (olive oil on selective agar for pathogenic fungi) inoculated with M. sympodialis or M. globosa (5 x 10(3) CFU/microl), and the influence on growth was semiquantitatively determined over a period of up to 18 days. According to preliminary results, 1% climbazole proved to be particularly effective. The hair strand test, which can also be performed ex vivo, is a new method to find out whether antimycotic agents bind differently to the hair substance and, via a depot effect, may influence the growth of Malassezia yeasts and thus affect dandruff. This allows conclusions about the efficacy of antidandruff formulations.

Antifungal Agents↗
PubMed2002

The liver and its ultrasonographic picture in children suffering from vitiligo.

The size and the structure of the liver in 38 children with vitiligo and 43 healthy children suffering from a mild form of pityriasis capitis were measured in an ultrasonographic examination and then compared. In the examined group there were found single cases beyond the norm. No changes in the structure of the liver parenchyma were stated in any of the vitiligo cases. For the liver measured in L1 there were stated 94.7% cases of vitiligo within the range from 2.5 to 97.5 percentile values in the control group. For the liver measured in L2--92.5% cases from 2.5 to 97.5 percentile values in the control group and for the liver measured in L3--92.1% cases of vitiligo were within the range 2.5 do 97.5 percentile values in the control group.

Child↗
PubMed2003

[Early description of a pulmonary aspergillosis 1847 from Greifswald].

In 1847 the student of medicine Theodor Sluyter (1817-1895) from Greifswald published his thesis in Berlin including the first well-documented case of human pulmonary aspergillosis. In 1856 Rudolf Virchow (1821-1902) classified the depicted fungi as an Aspergillus species. Possibly Carl Ferdinand Eichstedt (1816-1892) carried out the autopsy. He is known by the first description of a fungus as the cause of pityriasis versicolor in 1846. Further involved scientists from Greifswald were Wilhelm Baum (1799-1883), Theodor Litzmann (1815-1890) and the botanist Johann Konrad Schauer (1813-1848). Their curricula vitae are given in further details as well the curriculum of T. Sluyter.

Aspergillosis↗
PubMed1975

[Therapeutic effect of vitamin A acid (retinoic acid) in various forms of palmar/plantar hyperkeratoses: experimental studies on 68 patients].

Up to date, the treatment of palmar/plantar hyperkeratoses presents a therapeutic problem. The known therapeutic procedures result in short-term improvement only, if any at all. In these investigations involving 68 patients suffering from palmar/plantar hyperkeratoses of different etiology, small doses of vitamin A acid (retinoic acid) topically applied, produced a striking improvement in hypertrophic lichen planus of palms or soles: the regression was complete and in most cases permanent. The skin texture of patients with genetic keratoses and callosities became normal within a few weeks: but this condition remained free of symptoms only as long as vitamin A acid was used as a maintenance dose once or twice weekly. In hyperkeratotic exzema, pityriasis rubra pilaris, and in verrucae plantaris vitamin A acid topically applied was found to be unsuitable for treatment. The possible side effects of this treatment are mentioned. Several possibilities regarding the way of action of vitamin A acid are discussed.

Administration, Topical↗
PubMedDate not supplied

[Acquired circinated ichthyosis revealing a lymph node tuberculosis].

BACKGROUND: Acquired ichthyosis usually reveals or is associated with an internal disease. The classical clinical aspect is vulgaris ichthyosis. We report a case of acquired ichthyosis, presenting original clinical features, revealing a lymph node tuberculosis. CASE REPORT: A 63-year-old male patient without past history of skin disease consulted for a generalized eruption. The eruption was composed of multiple erythemato-squamous plaques. The edge of the plaque was raised and circinated. Histologic examination of the edge and the centre of the lesion supported the clinical diagnosis of ichthyosis. The diagnosis of lymph node tuberculosis based on large inguinal nodes was confirmed by the fast acid-bacilli found in the lymph node. Initiation of antituberculosis therapy was followed by the rapid and complete disappearance of the skin lesions. DISCUSSION: We report a case of acquired ichthyosis with original clinical features and we propose to coin the term "acquired circinated ichthyosis". This entity was clinically distinct from ichthyosis vulgaris or pityriasis rotunda. This dermatosis was concomitant to lymph node tuberculosis and healed under antituberculosis therapy.

Antibiotics, Antitubercular↗