Tinea versicolor in a premature infant

Tinea versicolor (TV) is a fungal skin infection that classically affects adolescents and young adults. Occasionally, it may be seen on the face of infants. We report an unusual case of widespread cutaneous TV in a premature infant.     

Malassezia globosa as the causative agent of pityriasis versicolor

BACKGROUND: The taxonomic revision carried out in 1996 on the genus Malassezia, which now comprises seven different species, made necessary a re-evaluation of the data concerning the ecology and pathogenicity of these lipophilic yeasts. Very little has been published since then. OBJECTIVES: The aim of this work was to contribute to the knowledge of the aetiology of pityriasis versicolor (PV) with a mycological study made according to the new species. METHODS: Ninety-six patients with PV completed the study. In all of them, samples were taken from the lesions for direct microscopy with KOH+ Parker ink and culture. Samples were also taken from normal skin of the trunk and the forehead of the same patients for culture. Cultures were made in modified Dixon medium in Petri dishes, incubated at 31 degrees C and the isolates were identified by morphological and physiological characteristics. RESULTS: In the PV lesions, direct microscopy always showed the typical mixture of globose blastoconidia and pseudomycelium. Only one patient, having received previous topical antimycotic treatment, was negative. The spherical yeasts observed in vivo were morphologically identical to the globose yeasts characteristic of M. globosa. In culture, M. globosa was found in 97% of cases, alone in 60% of them and associated with M. sympodialis in 29% and M. slooffiae in 7%. These two species were also found in similar percentages on the clinically uninvolved skin of the trunk, whereas M. globosa was not isolated at these sites. However, on the forehead, a small number of colonies of M. globosa was recovered in 12% of cases. CONCLUSIONS: These results support the data previously reported and strongly suggest that M. globosa in its mycelial phase is the causative agent of PV.     

Intertriginous lesions in pityriasis versicolor

BACKGROUND: The well-recognized sites of involvement in pityriasis versicolor are the upper part of the trunk, the neck and the upper arms. There is little documentation regarding pityriasis versicolor lesions in flexural areas. OBJECTIVES: To study the occurrence and morphology of lesions of pityriasis versicolor in flexural areas. METHODS: One hundred and ten cases of pityriasis versicolor were studied. Sites of lesions and other clinical features were determined. RESULTS: Flexural lesions in pityriasis versicolor were not uncommon. They were not correlated to age, sex, duration or relapses of the infection. CONCLUSION: Thorough inspection and examination of the skin by Wood's light before establishing treatment is prudent in cases of pityriasis versicolor located in typical sites.     

Epidemiology of pityriasis versicolor in Adana, Turkey

Pityriasis versicolor is a common superficial mycoses of the skin. It is now recognized that the causative organisms of this infection are different species of Malassezia . The aim of this study was to determine the distribution of Malassezia species in patients with pityriasis versicolor in Adana, Turkey. In total, 97 patients positive for Malassezia elements, namely, yeast cells and short hyphae in microscopic examination, were included in the study. All samples were inoculated in plates containing modified Dixon's medium. However, only 44 of the patients (45.4%) showed Malassezia spp. in culture. Malassezia globosa (47.7%) was the most commonly isolated species followed by Malassezia furfur (36.4%) and Malassezia slooffiae (15.9%). Mixed Malassezia species were not isolated. In conclusion, M. globosa was found to be the predominant PV isolate in Adana, Turkey.     

Prevalence of pityriasis versicolor in a group of Italian pregnant women

BACKGROUND: Although a predisposing role of pregnancy to Malassezia infections is referred, data on the prevalence of pityriasis versicolor (PV) in pregnant women are not available in literature. OBJECTIVE: To investigate the frequency of PV during pregnancy, 60 pregnant women were clinically and microscopically investigated during and after pregnancy. RESULTS: Fifty-two women completed all visits; three women were affected by PV at first or third trimester of pregnancy, and none at 6 months after delivery. Colonization due to Malassezia yeasts was very significantly (P < 0.01) or significantly increased (P < 0.05) at the third trimester and 6 months after delivery, respectively. No variation was observed between the end of pregnancy and the postpartum (P > 0.05). CONCLUSION: Frequency of PV during pregnancy (5.7%) does not seem different from that reported in general population living in temperate climates (2-5%). However, higher degree of colonization by Malassezia resulted at the end of pregnancy and postpartum.     

花斑癣患者血清中抗糠秕马拉色菌IgG、IgM、IgA抗体的检测及其意义

目的：探讨机体体液免疫在花斑癣发病中的作用和意义。方法：以糠秕马拉色菌（Ｍ．ｆｕｒｆｕｒ）整菌（ＷＭＦ）为抗原,用间接酶联免疫吸附试验（ＥＬＩＳＡ）方法,检测６８例花斑癣患者和４１例正常人血清中的抗ＷＭＦ抗体。结果：正常人血清中存在高滴度的抗ＷＭＦ抗体,花斑癣患者血清中抗ＷＭＦＩｇＧ抗体明显低于正常对照组（Ｐ〈０．０１）,男性患者血清中ＩｇＧ抗体低于女性患者（Ｐ〈０．０１）,病程１年以上者血清中特异的ＩｇＧ抗体低于病程不到１年者（Ｐ〈０．０１）。结论：机体血清抗Ｍ．ｆｕｒｆｕｒ抗体可能是人体内天然抗体,且特异的ＩｇＧ抗体具有保护作用。支持花斑癣的发病与免疫缺陷有关。     

Distribution of Malassezia species in pityriasis versicolor and seborrhoeic dermatitis in Greece. Typing of the major pityriasis versicolor isolate M. globosa

BACKGROUND: The expansion of the genus Malassezia has generated interest in the epidemiological investigation of the distribution of new species in a range of dermatoses, on which variable results have been reported from different geographical regions. No data are thus far available from South-east Europe (Greece). OBJECTIVES: To study the distribution of Malassezia species in pityriasis versicolor (PV) and seborrhoeic dermatitis (SD) and to investigate whether polymorphisms in the internal transcribed spacer (ITS) 1 region facilitate detection of M. globosa and M. sympodialis subtypes. METHODS: In total, 109 patients with PV and SD and positive Malassezia cultures were included in the study. Age, gender, primary/recurrent episode, disease extent and clinical form of PV were recorded. ITS 1 polymorphisms of M. globosa and M. sympodialis type and clinical strains were investigated by polymerase chain reaction (PCR)-single-strand conformational polymorphism (SSCP) analysis. RESULTS: Malassezia globosa was the prevalent species isolated from PV and SD either alone (77% and 39%, respectively) or in combination (13% and 18%, respectively) with other Malassezia species. The pigmented form of PV was strongly correlated with the female gender. PCR-SSCP differentiated five subgroups of M. globosa with one being associated with extensive clinical disease. All M. sympodialis isolates displayed a homogeneous ITS 1 PCR-SSCP profile. CONCLUSIONS: Malassezia species isolation rates were in agreement with those reported from South-west Europe. PCR-SSCP of the ITS 1 is useful for highlighting prospective clinical implications of M. globosa subtypes.     

花斑糠疹与马拉色菌毛囊炎相关危险因素和致病菌分析

目的 研究花斑糠疹和马拉色菌毛囊炎的相关危险因素和致病菌特点,并比较其差异。方法 收集我院临床花斑糠疹和马拉色菌毛囊炎患者,均以1：1设置病例对照组,调查发病相关因素,采用SPSS16.0软件进行单因素和多因素Logstic回归分析。培养阳性菌株采用形态学和生理生化学方法鉴定到菌种,比较菌种分布。结果 共收集到163例花斑糠疹和132马拉色菌毛囊炎患者。单因素回归分析显示与花斑糠疹发病相关的因素有多汗和油性皮肤,与马拉色菌毛囊炎发病相关的因素有男性、潮湿环境、多汗、油性皮肤、刺激性食物、甜腻食物。多因素回归分析显示花斑糠疹的危险因素有多汗和油性皮肤,马拉色菌毛囊炎的危险因素有多汗、油性皮肤、男性和甜腻性食物。两种疾病致病菌均以合轴马拉色菌为优势菌,但糠秕马拉色菌在毛囊炎中占较高比例。结论 多汗和油性皮肤是花斑糠疹和马拉色菌毛囊炎共同的危险因素,而男性、甜腻性食物为马拉色菌毛囊炎独有的危险因素,两种疾病致病分布也存在统计学差异。     

从花斑癣患者的皮损区及非皮损区分离和鉴定马拉色菌

目的 研究花斑癣患者皮损区及非皮损区马拉色菌菌种构成;不同解剖部位、皮损颜色及各菌种的分布情况;患者病情和年龄与菌种构成的关系。方法 用无菌胶带粘取113例花斑癣患者皮损区及非皮损区共629个部位的皮屑,分别接种于含菜子油培养基中分离马拉色菌,用生理生化及形态学方法鉴定菌种。结果 皮损区与相对应的非皮损区马拉色菌分离阳性率无差别,非皮损区额部和胸背部分离阳性率高于上、下肢。共分离到565株马拉色菌,鉴定出合轴马拉色菌(44.78%)、糠秕马拉色菌(32.94%)、球形马拉色菌(11.68%)、钝形马拉色菌(5.84%)及限制马拉色菌(4.76%)共5个种,有27处(5.01%)同时分离到两种菌。皮损区与非皮损区菌种构成无明显差别,限制马拉色菌主要从额部分离出。菌种构成与皮损面积无关,但与皮损颜色和患者年龄有关。皮损颜色与病程无关。结论 花斑癣患者皮损区与非皮损区马拉色菌分离阳性率和菌种构成基本一致,与病情无关,而不同解剖部位、皮损类型及年龄患者的菌种构成有一定差异。     

Humoral immunity to Malassezia furfur serovars A, B and C in patients with pityriasis versicolor, seborrheic dermatitis and controls

Abstract This study examined the humoral immune responses to Malassezia furfur serovars A, B and C of 10 patients with pityriasis versicolor, 10 patients with seborrheic dermatitis and 20 age- and sex-matched controls. A transferable solid-phase ELISA was used to determine titres of total Igs, IgM, IgA and IgG specific to M. furfur serovars A, B and C. The results demonstrated that patients with seborrheic dermatitis had a significantly higher litre of total Igs to serovar A than patients with pityriasis versicolor; and that patients with seborrheic dermatitis had a significantly higher litre of IgA to serovar C than patients with pityriasis versicolor. The litres of total Igs for controls and patienls with seborrheic dermatitis were significantly lower to serovar B than to serovar C. A modified TSP ELISA was used to determine the titres of the IgG subclasses. Titres of IgG _1,3,4 to serovar B were significantly higher in seborrheic dermatitis patients than pityriasis versicolor patients and litres of IgG₃, to serovar A were significantly higher in seborrheic dermatitis patients than pityriasis versicolor patients. However, despite the differences between the patient groups, none of these results was significantly different to those of controls. Thus, this study did not demonstrate any differences in humoral immunity of patients suffering from Malassezia-associated dermatoses when compared to normal controls. These results may suggest that the humoral immune response to M. furfur is not related to the pathogenesis of Malassezia-associated dermatoses, but simply to the carriage of M. furfur on the skin.     

马拉色菌与花斑癣色素改变的相关性初探

目的探讨马拉色菌与花斑癣皮疹色素改变及色氨酸产色三者之间的关系.方法从花斑癣患者皮损分离马拉色菌株,采用国际通用的生化鉴定方法鉴定,然后在不同浓度L-色氨酸的培养基上培养7 d,观察产色反应.结果每个菌种均有产色反应阳性和阴性菌株,产色反应阳性菌株更易引起皮损色素沉着(P＜0.005),且产色反应阳性标本颜色按色氨酸浓度递减而变淡.结论菌株的产色反应与马拉色菌的种属分类无必然的联系,色氨酸参与了马拉色菌产色反应.     

Oral fluconazole in the treatment of tinea versicolor

This study was designed to assess the efficacy, tolerability, and safety of oral fluconazole given at 300 mg once weekly for two weeks in the treatment of tinea versicolor. Enrolled into the study were 44 subjects with tinea versicolor, provisionally confirmed by the detection of fungal hyphae in KOH wet mounts and Wood's lamp examination. Four subjects were classified as dropouts because no information was obtained from them after the baseline visit. Subjects were treated for two weeks orally with fluconazole 300 mg weekly and followed at the 1st, 2nd, 4th and 12th weeks of treatment. The study included 40 subjects (26 males and 14 females, mean age 29 years, range 19-48 years). At the week 4 visit, 30 (75%) patients showed a complete cure and 31 (77.5%) patients showed mycologic cure. Ten (25%) patients had no significant response to therapy. At the final follow-up visit (week 12), none of the patients showing complete or mycologic cures exhibited a recurrence. No adverse effects were observed in any of the patients treated. We believe that, due to the low incidence of side effects, shorter treatment duration, and increased adaptation of the patients, fluconazole can be used in the treatment of tinea versicolor with confidence.     

马拉色菌相关疾病诊疗指南(2008版）

中华医学会皮肤性病学分会真菌学组及国内相关知名专家经过反复讨论和修改,制定了真菌性皮肤病诊治指南系列,将陆续刊出供国内同行参考.参加指南制定的专家为:金学洙、冉玉平、李若瑜、李春阳、刘维达、郑岳臣、席丽艳、温海、赖维.     

Pityriasis rotunda mimicking tinea cruris/corporis and erythrasma in an Indian patient

Pityriasis rotunda is a rare disease characterized by perfectly round to oval, sharply defined, scaly, hypo/hyperpigmented patches of variable number and size located mainly over the trunk and proximal extremities. More than 95% of the reported cases in medical literature are from three countries/ethnic populations, namely Japan, South Africa (Bantu), and Italy (Sardinian islanders). To the best of my knowledge, no patient with the characteristic clinico-pathologic features has been reported from the Indian subcontinent. I report a 44-year-old man with eighteen pityriasis rotunda patches, persistent for nearly 20 years. The lesions in the groin and axillae closely resembled erythrasma and tinea, and he had received treatment for these conditions several times in the past. Histopathology of the skin biopsy showed thinning of the epidermis with a thinned-out granular layer and a sparse lymphomononuclear infiltrate in the dermis. A review of literature suggests that there are two subsets of the disease. The type I subset is comprised of pityriasis rotunda associated with systemic illness and is seen in Black or Oriental patients with no family history of the disease. The lesions tend to subside on treatment of the underlying illness. The type II subset patients are Caucasians as well as Blacks and Orientals with no underlying systemic illness. Familial occurrence is possible; lesions tend to be persistent and unresponsive to therapy.     

伊曲康唑巩固疗法降低花斑癣复发率的临床研究

目的:探讨一种能够降低花斑癣复发率的有效治疗方案。方法:将初诊的花斑癣患者按就诊时间分为两组,均口服伊曲康唑0.2g,每日1次,连续服药7d。7d后对照组停药观察,试验组则继续服用伊曲康唑,每月口服0.2g1次,共6个月。两组患者皆每月复诊1次,共6次。结果:试验组99例患者复发率为1.01%,治愈率为85.86%。对照组95例患者复发率为17.89%,治愈率为64.21%。经卡方检验两组患者的复发率及治愈率相比,差异均有极显著性(χ2=16.4195,P=0.0001和χ2=12.2013,P=0.0005)。结论:巩固治疗方案能在近期内降低花斑癣复发率,同时提高花斑癣的治愈率。     

Cell-mediated immunity to the mycelial phase of Malassezia spp. in patients with pityriasis versicolor and controls

BACKGROUND: Malassezia is the aetiological agent of pityriasis versicolor. The mycelial phase of the organism predominates in lesions of pityriasis versicolor. OBJECTIVES: To evaluate the cell-mediated immune (CMI) response to the mycelial phase of Malassezia in patients with this disease, which has not previously been studied. METHODS: The CMI status of 12 patients with pityriasis versicolor and 12 age- and sex-matched controls to mycelial antigen(s) of the organism was examined. The responses to the mycelial form of three strains of the organism were assessed using lymphocyte transformation and leucocyte migration inhibition assays. RESULTS: The transformation responses of the lymphocytes from both patients and controls gave transformation indices < or = 3, although the responses of lymphocytes from patients with pityriasis versicolor to the mycelial form of Malassezia strains were generally higher than those of the controls. In the leucocyte migration inhibition assay, leucocytes from patients with pityriasis versicolor and controls responded to the mycelial antigens of three different Malassezia strains; however, there was no significant difference in leucocyte response between patients with pityriasis versicolor and controls. CONCLUSIONS: Patients with pityriasis versicolor do not therefore have a CMI deficiency to Malassezia mycelial antigens but fail to generate a protective CMI response to mycelial antigens over and above that of control individuals during active disease.     

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.     

Prevalence of pityriasis versicolor in young Italian sailors

BACKGROUND: Pityriasis versicolor is a superficial fungal disease with a world-wide distribution, but there are few available studies on its prevalence in the general population. OBJECTIVES: To assess the prevalence of pityriasis versicolor in a representative sample of young Italian sailors, evaluating the influence of habits and risk factors in the affected individuals. METHODS: Young cadets (n = 1024: 975 men and 49 women, mean age 22 years) of the Italian Navy Petty Officers' School in Taranto were consecutively examined by the same observer. The diagnosis of pityriasis versicolor was based on clinical picture and/or Wood's lamp examination. All the subjects filled in a questionnaire about sport practice, swimming pool attendance, marching, presence of hyperhidrosis and a positive clinical history of pityriasis versicolor in the past. The affected individuals were also asked if they were aware of their skin lesions. Differences between answers of affected and unaffected subjects were tested by Fisher's exact P-value test, and odds ratios were calculated. RESULTS: Pityriasis versicolor was diagnosed in 22 subjects (2.1%), all men, of whom 15 (68%) were not aware of their condition. No statistical association was found between active pityriasis versicolor and sport practice, swimming pool attendance, marching or presence of hyperhidrosis. A significant association [odds ratio 8.7 (95% confidence interval 3.3-21.5); Fisher's exact P-value test P < 0.01] was documented between active pityriasis versicolor and a previous clinical history of pityriasis versicolor. CONCLUSIONS: The prevalence of pityriasis versicolor in this sample of young Italian sailors was not high, in agreement with the available surveys performed in the general population in temperate climates. Many affected subjects were not aware of their condition. The only important factor associated with pityriasis versicolor was a previous history of pityriasis versicolor. This observation could confirm the hypothesis that constitutional factors, e.g. seborrhoea and chemical constitution of sebum, may play a crucial role in temperate climates, leading to relapsing forms of this superficial mycosis.