Adapalene gel 0.1% vs ketoconazole cream 2% and their combination in treatment of pityriasis versicolor: A randomized clinical study

Pityriasis versicolor (PV) is a chronic superficial fungal infection. Management using azole drugs leads to drug resistance. The present study aimed to compare the clinical outcome of 0.1% adapalene gel vs 2% ketoconazole cream and their combination in PV. This randomized double‐blinded study was conducted on 90 PV patients divided into three equal groups. GI was treated with topical ketoconazole 2% cream twice daily and placebo, GII was treated with topical 0.1% adapalene gel twice daily and placebo and GIII was treated with topical combination of 0.1% adapalene gel (at night) and ketoconazole 2% cream (in the morning). All patients received medications for 4 weeks. Evaluation was done at 2 and 4 weeks and included clinical assessment, laboratory assessment, and patient satisfaction. We found that after 4 weeks of treatment, all groups showed significant improvement. There was better response in GIII in terms of lower rate of positive potassium hydroxide staining, higher rate of significantly improved cases and higher rate of well‐satisfied patients. However, the difference fell short of statistical significance. We concluded that a combination of adapalene gel and ketoconazole cream is very effective in treatment of PV with no or mild side effects.     

婴儿慢性苔藓样糠疹一例

患儿，男，1岁5个月。躯干四肢丘疹、斑丘疹半年。组织病理特征符合慢性苔藓样糠疹，给予口服罗红霉素及外用他克莫司软膏后病情改善。     

The clinics of HHV‐6 infection in COVID‐19 pandemic: Pityriasis rosea and Kawasaki disease

A new type of coronavirus family (SARS‐CoV‐2), which can be found in humans and animals, with many varieties and clinical symptoms, was first seen in Wuhan, China in late 2019, under the name novel Coronavirus Disease 2019 (COVID‐19). In the literature, cutaneous symptoms related to the disease are generally emphasized. However, it is not yet known whether this new SARS‐CoV‐2 virus, which has entered our lives, plays a role in the etiopathogenesis of dermatological diseases. The patients who were admitted to the dermatology outpatient clinic between 1 April and 15 May 2019, and on 1 April and 15 May 2020 were retrospectively analyzed by searching the hospital automation system and patient files. The reason for the same months to be included in the study was to exclude seasonal effects on the diseases. After pandemic, the number of patients with Pityriasis rosea and Kawasaki disease increased significantly in patients who applied to the dermatology outpatient clinic. Our study is the first study showing Pityriasis rosea increase during the pandemic period. We think that this increase is related to HHV‐6 reactivation. Herein, we wanted to draw attention to two diseases in which Human Herpes 6 (HHV‐6) was accused in etiopathogenesis: Kawasaki disease and Pityriasis rosea.     

Synthesis of fluorochromes and pigments in Malassezia furfur by using tryptophan as the single source of nitrogen

A new minimal medium consisting only of L-tryptophan (L-trp) and a lipid source induced formation of brown pigmentation only in the species Malassezia furfur. Strains of the species M. sympodialis and M. pachydermatis failed to grow on this medium. Pigmentogenesis was already induced in M. furfur by 0.01 g% tryptophan, the pH optimum was pH = 5. Alternative amino nitrogen sources given concurrently with trp suppressed pigmentogenesis. The extract of the culture exhibited remarkable fluorescence, and several indole derivatives with a broad spectrum of colors were detected by means of mass spectroscopy and NMR. This finding may have an impact on the clinical appearance of pityriasis versicolor, a very common skin disease caused by lipophilic yeasts of the genus Malassezia. We hypothesize that in pityriasis versicolor metabolic adaptation of Malassezia yeasts to altered nitrogen conditions on superficial skin might be of pathophysiological importance. Tryptophan as inductor of pigmentogenesis probably cumulates during excessive sweating, a well known manifestation factor of pityriasis versicolor.     

红景天微粉与粗粉中有效成分的溶出度比较

目的:探讨红景天微粉(粒径99%以上分布在0～20μm),与粗粉[过50目筛(355±13)μm]体外溶出情况的变化。方法:采用透析法,选取红景天中主要成分没食子酸、红景天苷及儿茶素作为指标,用反相HPLC测定不同时间点红景天微粉和粗粉中这3种成分从透析袋中的溶出情况。结果:红景天微粉中红景天苷和儿茶素溶出的速度及程度均较粗粉有明显提高(15～45 min,P0.05,45～60 min,P0.01),但是没食子酸在2种粉体中的溶出差异并不明显。结论:红景天制成微粉后,能有效改善大部分有效成分的溶出速率和溶出效率,对药物作用有一定的促进作用,但进一步的评价有待于更多的试验数据支持。     

Antifungal activity of the aqueous extract of Ilex paraguariensis against Malassezia furfur

Malassezia furfur is a lipodependent, dimorphic and saprophyte fungus which causes pityriasis versicolor, dandruff and seborrheic dermatitis in humans. The drugs available to treat this fungal infection are few. These drugs are highly toxic and are costly when used in prolonged treatments. For these reasons, it is necessary to find new compounds to treat these infections. Ilex paraguariensis St Hilaire is a plant that grows in Argentina, Brazil and Paraguay. The aim of this study was to evaluate the effect of the aqueous extract of Ilex paraguariensis on the growth of M. furfur. High performance liquid chromatography (HPLC) was employed to identify and isolate compounds of I. paraguariensis and the agar‐well diffusion method was used to assess the antifungal activity of the extract. The fungicidal/fungistatic effect was evaluated by the modified Thompson assay. The results demonstrated that the aqueous extract of Ilex paraguariensis (1000 mg/ml) possesses inhibitory activity against M. furfur. This antimalassezial activity was equivalent to 2.7 μg/ml of ketoconazole. Therefore, the topical use of Ilex paraguariensis extract as alternative antifungal agent can be suggested. Copyright © 2009 John Wiley & Sons, Ltd.     

Acute cutaneous graft‐versus‐host disease resembling type II (atypical adult) pityriasis rubra pilaris

We present a case of cutaneous acute graft‐versus‐host disease (aGVHD) with confluent erythematous perifollicular hyperkeratosis and ichthyosiform scale in the clinical pattern of type II (atypical adult) pityriasis rubra pilaris (PRP), which developed 26 days after allogeneic peripheral blood stem cell transplant. Skin histology confirmed features of both aGVHD and PRP. The skin lesions were refractory to oral prednisolone and cyclosporine and only partially responsive to a combination of i.v. methylprednisolone, oral tacrolimus, oral mycophenolate mofetil, and infusions of anti‐thymocyte globulin and the tumour necrosis factor‐α inhibitor, etanercept.