Seborrhoeic dermatitis and Pityrosporum ovale: a cultural and immunological study

Seborrhoeic dermatitis is associated with Pityrosporum ovale, but the exact role of the organism is not clarified. In order to study this connection we have investigated 30 patients with seborrhoeic dermatitis with quantitative culture for P. ovale, serum IgG antibodies against P. ovale and lipid measurements. We compared the patients with 60 healthy individuals and found no significant difference in the number of P. ovale or serum antibodies. The lipid content on the skin was significantly higher in the patient group (p = 0.0001). There was no difference in the number of P. ovale in lesions compared to healthy skin in the patient group. This study support our theory that an abnormal reaction in the skin to P. ovale causes the inflammation and the number of P. ovale is of minor importance.     

Pityrosporum infection in an infant with lesions resembling erythema annulare centrifugum

Erythematous, scaling patches over the face, torso, and extremities developed in a 2-month-old female infant. The facial lesions enlarged and became confluent, while the torso and leg lesions enlarged and assumed an annular configuration. Spores of Pityrosporum ovale and Pityrosporum orbiculare were found in large numbers in potassium hydroxide preparations from these lesions, a finding confirmed by culture. Clotrimazole ointment was applied, and the lesions resolved within one week, leaving depigmentation. The findings in this case and those of erythema gyratum atrophicans transiens neonatale resembled each other except for the demonstration of Pityrosporum spores. We assume that the disorder in our patient may represent superficial gyrate erythema (erythema annulare centrifugum) induced by Pityrosporum spores.     

Quantitative Culture of Pityrosporon Orbiculare

The author describes for the first time a method to culture Pityrosporon orbiculare quantitatively. Different nonionic detergents were studied for their in vitro effect to minimize aggregation of P. orbiculare. Triton X-100 0.1% had only a slight inhibitory effect when the organism was held less than 2 hours. A critical point in quantitative culturing of P. orbiculare seems to be the medium. With this medium, solitary colonies and optimal growth are achieved. No statistically significant differences were found in quantitative cultures from lesions and normal skin in patients with tinea versicolor, but this was observed when quantitative cultures from lesions and normal skin in patients with tinea versicolor were compared with healthy controls.     

Seborrheic dermatitis and malignancy. An investigation of the skin flora

The skin flora of patients with disseminated malignant disease and seborrheic dermatitis has been investigated and compared with controls as well as with otherwise healthy patients suffering from seborrheic dermatitis. Although significant differences were detected in both bacterial and yeast counts between different sites on the body, no significant qualitative or quantitative differences were found between the three groups of subjects. Whereas abnormalities of the skin flora have been described in seriously ill patients and in individuals subjected to occlusion, we were unable to demonstrate any changes in skin flora in patients with malignant disease and seborrheic dermatitis. Our results do not support the view that increased numbers of Pityrosporum yeasts are important in the pathogenesis of seborrheic dermatitis.     

含菜子油培养基对花斑癣致病真菌的培养研究

本文采用含菜子油的葡萄糖一蛋白陈一酵母浸膏一单硬脂酸甘油酯-琼脂培养基,接种花斑癣皮损鳞屑133例,成功地培养出pityrosporum orbiculare或(和)p.ovale,阳性率达.0.23%.并将其阳性率、菌落平均生长天数、孢子形态和菌丝比例与含芝麻油、橄榄油的相同培养基比较,证明菜子油(或芝麻油)可代替橄榄油.镜检的214例标本中,有35例见到菌丝(占16,36%).对皮肤上皮细胞与菌丝的关系和取材季节气温对培养菌显微形态的影响进行了讨论.     

圆形/卵形糠秕孢子菌:80例正常人皮肤带菌情况

本文报告80例正常人皮肤的圆形糠秕孢子菌(Pityrosporum orbiculure, P.orb)或(和)卵形糠秕孢子菌(P.ovale,P.ov)的带菌情况.将用皮肤擦洗的方法收集的标本接种在含菜子油的培养基中,有34例(42.5%)培养出p.orb或(和)P.ov.阳性者中的最小和最大年龄分别为13和71岁.发现正常人所带菌的活力较花斑癣病人低,且不同个体之间差异较大,菌落多少与孢子的形态有关.     

Use of topical lithium succinate in the treatment of seborrhoeic dermatitis.

Twenty-one patients with seborrhoeic dermatitis were included in an open trial of lithium succinate ointment (LSO) for a total duration of 8 weeks. The same clinician made assessments of the severity of redness, scaling, greasiness and overall clinical impression of the condition every 2 weeks. Because the results appeared to be satisfactory, we decided to perform a double-blind, placebo-controlled trial of LSO. Thirty patients with seborrhoeic dermatitis were included. The results also demonstrated the beneficial effect of LSO. A significantly higher number of patients treated with LSO showed remission or marked improvement compared with placebo. The main adverse events demonstrated consisted of minor transient skin irritation and/or stinging sensation. Studying the in vivo inhibitory effect of LSO on the growth of Pityrosporum revealed that Pityrosporum did not significantly have its growth inhibited by lithium. Topical lithium succinate appears to be a safe and an effective treatment for seborrhoeic dermatitis. The product presumably acts as an anti-inflammatory agent.     

Staphylococci of the normal human skin flora

Summary 352 strains of Staphylococci of the normal human skin flora were sampled from one volunteer by single scrabbing in a ca. 3 cm² measuring area. They were biotyped by the scheme of Pelzer et al. (1973)—a modified Baird-Parker-Scheme (1963)— and the resistance to antibiotics was investigated by the method of Bauer et al. (1966).All the nine biotypes of Staphylococci were found in variable quantities. It seems problematic to call one biotype as the main type. Morphologically identical colonies of Staphylococci from the indigenous flora of the human skin were not identical in their biotypes as previously described by Pelzer (1976).Only the investigation of all Staphylococci colonies from the culture plate can evaluate all biotypes of Staphylococci of the normal human skin flora, and can give the right quantitative correlation. Staphylococci were found to be sensitive and resistant up to four antibiotics, and one biotype did not show one type of antibiogram.     

Tinea corporis with acute inflammation caused by Trichophyton tonsurans

A 13-year-old Japanese boy presented with acute skin inflammation on the extremities. He belonged to a judo club of a junior high school in which club tinea capitis and tinea corporis seemed to be prevalent. Vesicles and pustules appeared on his right forearm and right leg. They increased in numbers and formed annular lesions. Pruritic erythema appeared surrounding these lesions. Direct microscopic examination of the lesions detected hyphae, and culture for the fungi yielded yellowish colonies. The result of culture from pustules revealed Staphylococcus aureus. At first, a topical antifungal drug and systemic antibiotics seemed to cure annular lesions, but pustules arose again. A large surrounding erythema was cured by topical treatment with a steroid agent. A biopsy specimen from a pustule showed hyphae of fungi within a hair shaft and in the bulb. The restriction fragment length polymorphism in the internal transcribed spacer regions of the ribosomal gene (polymerase chain reaction restriction fragment length polymorphism) revealed a banding pattern compatible with Trichophyton tonsurans. Treatment with systemic itraconazole was begun and lesions disappeared immediately. Systemic antifungal therapy was needed in our case. Tinea corporis with inflammation necessitates systemic antifungal therapy.     

A Clinical,Microbiological, and Histopathologic Study of Trichostasis Spinulosa

Trichostasis spinulosa (TSS) is a relatively common follicular disorder that can occur on the face and trunk, especially in the interscapular area. Its cause remains unclear. We examined clinically 30 patients with TSS and follicular materials extracted from each patient were examined microscopically. Bacterial culture and skin biopsy were done in 12 and 10 patients, respectively. Periodic acid Schiff (PAS) and Brown-Brenn Gram stain were used for detection of pityrosporum (malassezia) and bacteria. The interscapular area (14/30), nose (8/30), and cheek (4/30) were common sites of TSS. Pityrosporum and bacteria in the extracted follicular material were found at the rates of 82.6% and 73.3%, respectively. In histologic examination, follicular hyperkeratosis and numerous vellus hairs enveloped within keratotic sheath were common features. Pityrosporum and bacteria were found at the rate of 70% in biopsied specimens on PAS and Brown-Brenn Gram stain. In bacterial culture, Propionibacterium acne was most commonly identified in 75% (9 out of 12 patients). Pityrosporum and bacteria, especially Propionibacterium acne, were commonly found in the extracted follicular material and biopsied specimens. Thus, they may be related to the induction of follicular hyperkeratosis with retention of vellus hairs, and we suggest that these microorganisms may be one of the possible etiologic factors of TSS.     

An immunologic and cultural study of Pityrosporum folliculitis

In patients with Pityrosporum folliculitis the mean serum antibody titer against Pityrosporum orbiculare was significantly higher than in healthy control subjects (p less than 0.01). The mean number of P. orbiculare organisms per square centimeter cultured from normal-looking skin in patients was not significantly higher than the number cultured from normal-looking skin in control subjects. Results of prick tests against P. orbiculare extract were negative or weak, indicating that patients with Pityrosporum folliculitis had no type I hypersensitivity against P. orbiculare. Immunohistochemical staining of skin lesions showed perivascular dermal cell infiltrates near the hair follicles dominated by anti-Leu 3a-reactive T lymphocytes. Human lymphocyte antigens with the DR locus, but not those with the DQ locus, on keratinocytes were observed in one case.     

Seborrhoeic dermatitis and Pityrosporum (Malassezia) folliculitis: characterization of inflammatory cells and mediators in the skin by immunohistochemistry

BACKGROUND: The fact that Pityrosporum ovale plays a part in seborrhoeic dermatitis is well established but the mechanism of this relationship has not been established. OBJECTIVES: To compare the number and type of inflammatory cells and mediators in skin biopsies from normal and lesional skin from the trunk and scalp in patients with seborrhoeic dermatitis, Pityrosporum (Malassezia) folliculitis and in normal skin from healthy controls. METHODS: The skin biopsies were stained using the labelled Streptavidin-biotin METHOD: The following markers were studied: CD4, CD8, CD68, HLA-DR, NK1, CD16, C1q, C3c, IgG, CD54 (ICAM-1), interleukin (IL) -1alpha, IL-1beta, IL-2, IL-4, IL-6, IL-10, IL-12, tumour necrosis factor-alpha and interferon-gamma. RESULTS: HLA-DR+ cells were seen in the highest number, and were higher in lesional skin compared with normal skin from both patients and healthy volunteers. ICAM-1 expression was also increased in lesional skin. C1q and the interleukins showed an increased cellular and intercellular staining in patients compared with healthy controls and the intercellular staining was often more intense in lesions compared with non-lesional skin. Staining was often more intense when Malassezia (Pityrosporum ovale) yeast cells were present. CONCLUSIONS: An increase in NK1+ and CD16+ cells in combination with complement activation indicates that an irritant non-immunogenic stimulation of the immune system is important. The result with the interleukins showed both an increase in the production of inflammatory interleukins as well as in the regulatory interleukins for both TH1 and TH2 cells. Similarities to the immune response described for Candida albicans infections indicate the role of Malassezia in the skin response in seborrhoeic dermatitis and Pityrosporum folliculitis.     

An immunological study in patients with seborrhoeic dermatitis

The humoral and cellular immune-status was studied in 30 patients with seborrhoeic dermatitis. Increased frequencies of natural killer cells were found in 46% of patients. Furthermore, subnormal mitogen stimulation responses were demonstrated in 13 patients, whereas two individuals were found to have very high numbers of activated T lymphocytes in peripheral blood. Higher-than-normal total serum IgG and IgA was observed in 14 and 11 patients, respectively. For nine of 12 patients with skin lesions, dermal perivascular cell infiltrates were seen. The majority of the infiltrating cells reacted with anti-CD4 antibodies. HLA-DR-expressing keratinocytes were found in two biopsies. The study suggests that patients with seborrhoeic dermatitis may have depressed T-cell function. This could have a bearing on their susceptibility to the Pityrosporum ovale-associated dermatitis. The very high frequencies of activated T cells observed in the peripheral blood of two otherwise healthy seborrhoeic individuals suggests that intermittent systemic immune activation may occur. Seborrhoeic dermatitis is a common skin disease. It can be diagnosed by its characteristic red to yellow-brown lesions covered with greasy scales distributed in areas with a high number of sebaceous glands, such as the scalp, face and upper trunk. There is an association between seborrhoeic dermatitis and the lipophilic yeast Pityrosporum ovale but its exact aetiological role is not known. The yeast is a member of the normal cutaneous flora but also the aetiological agent of pityriasis versicolor and Pityrosporum folliculitis. P. ovale can activate complement via the direct and alternative pathways. This may play some part in the induction of inflammation.(ABSTRACT TRUNCATED AT 250 WORDS)     

A simple method for the study of scale pattern and effects of a moisturizer--qualitative and quantitative evaluation by D-Squame tape compared with parameters of epidermal hydration

A new tape (D-Squame tape) made for scale pattern assessments was used to study epidermal effects of an oil-in-water emulsion applied at random to forearm skin of 16 volunteers. The contralateral forearm served as an untreated control. The emulsion was applied twice daily for 7 days. Tapes were assessed visually in a medical viewer, and a special system for measurement of optical transmission of the tapes was established. Visual evaluation showed (Day 7) an altered pattern in nine volunteers with an absence of flakes on the treated side, which was not seen on the control side. The optical transmission of the tapes from the 16 volunteers was significantly increased in samples from the test side (P less than 0.001). One week after cessation of treatment the transmission was still increased (P less than 0.02), and one volunteer presented an altered scale pattern according to visual grading. Measurements of electrical conductance and capacitance, both parameters of epidermal hydration, gave similar results, i.e., increased values on Day 7 and increased conductance 1 week later. Thus, the epidermal effects of the emulsion were protracted. Evaluation of the tape method showed this to be reproducible and valid. The method is easy to use and suited for qualitative and quantitative evaluation of variations in the scale pattern of human skin.     

Comparative Study of Staphylococcal Flora on the Skin Surface of Atopic Dermatitis Patients and Healthy Subjects

Bacterial samples were obtained from the facial and forearm skin of atopic dermatitis (AD) patients and healthy subjects in humid summer weather. Staphylococcus (Staph) species bacteria were selectively sampled by a plate-contact technique using mannitol salt medium-coated film. Staph species were isolated from the film after the number of colonies was counted, and the species were determined by the API-Staph system and coagulase test. Large numbers of S. aureus were isolated in the samples from the facial skin of patients with severe dermatitis, as previously reported. The number of S. aureus colonies in the samples from the forearm skin of the patients was significantly greater than from the healthy subjects; the mean and standard deviation of colony forming units per 10 cm², expressed as log₁₀ value, were 1.64 ± 0.96 for patients and 0.02 ± 0.07 for healthy subjects (p<0.01). One hundred and seventeen strains were isolated, and their sensitivities to ten antibiotics were tested. Ten of the strains were resistant to some antibiotics; all of these were isolated from patients. Penicillin type antibiotics had weak effects, but cephem type had strong effects. The number of S. aureus colonies isolated in this study was compared with the number isolated during the winter, in our previous study, in order to identify seasonal variations. The only significant seasonal difference was on the forearm skin of the AD patients, which had significantly more S. aureus colonies (p<0.01) in this study. There were no significant seasonal differences in S. aureus numbers on the facial skin of patients or healthy subjects.     

Conformability and irritancy of adhesive tapes on the skin

The relationship between the conformability of adhesive tape, the mechanical property of the adhesive tape not to interfere with skin movement, and irritation of the skin was investigated. In order to assess the conformability of adhesive tape to the skin, a uniaxial method employing film strips connected to a strain gauge was used to measure the elastic properly of the skin, with or without application of various elastic tapes. The tension loaded on the strain gauge was measured while the skin was extended by 15% of its original length in a direction across the humeral axis on the flexor side of the upper right arm. The most elastic adhesive tape showed the best conformity to the skin. The same adhesive tapes were applied on the flexor side of both upper arms so that the tape held a piece of sanitary cotton in place for 24 h. Dermal irritation was not so remarkable in the skin under the inner part of the tapes. On the other hand, the skin reaction was much more severe on the skin under the edge portion of the applied tape which showed poor conformability to the skin. These findings seemed to indicate that the skin reaction was caused by localized distortion of the skin under the edge portion of the applied tapes, during movement of the underlying muscle. Actually, the distortion of the skin surface was great in the areas immediately outside the edge of the applied tape. In conclusion, adhesive tape conformable to skin movement reduced localized distortion of the skin during application, resulting in low irritation at the edge of the applied tape.     

Pityrosporum and seborrheic keratosis: an association

Seborrheic keratoses (SK) are one of the most common benign tumors of the skin. Studies have suggested that human papillomavirus or a benign clonal proliferation of epidermal cells is involved in the pathogenesis of some SK's, however, this issue remains to be resolved. Pityrosporum ovale has been implicated in the pathogenesis of seborrheic dermatitis, however, its potential role in association with SK's has not been evaluated as evidenced by the fact that there are no publications in the English-language literature regarding this issue. We observed a common occurrence of Pityrosporum organisms in the stratum corneum of SK on routine histopathologic sections and decided to investigate whether there was an association between these two common entities. We found that in a majority of the SK studied Pityrosporum was present, which was significantly different from controls (verruca vulgaris and basal cell carcinoma).     

Idiopathic eruptive macular pigmentation with papillomatosis: Report of nine cases

Nine patients, seven males and two females aged 6-14 years, presented with extensive, asymptomatic, brown-black macules and mildly elevated, pigmented lesions of a few months' duration. The sites affected were the face, trunk and proximal extremities. The skin lesions were discrete and individual lesions were less than 2 cm in size. The clinical diagnoses rendered by the referring physicians were lichen planus pigmentosus, urticaria pigmentosa, erythema dyschromicum perstans and postinflammatory hyperpigmentation. Histology in all nine cases showed papillomatosis of the dermis with prominent pigmentation of the basal layer (pigmented papillomatosis) without any significant dermal inflammation. Two cases had spores of Pityrosporum ovale in the thickened horny layer, one of which also had, in addition, bacterial colonies in the stratum corneum. The pigmentation resolved on its own over several months. This presentation is similar to the previously described idiopathic eruptive macular pigmentation with the additional histological finding of papillomatosis that is being described for the first time and may be nosologically related to acanthosis nigricans and confluent and reticulate papillomatosis.     

Properties of pressure-sensitive adhesive tapes with soft adhesives to human skin and their mechanism

BACKGROUND/PURPOSE: The use of soft adhesives in the manufacture of pressure-sensitive adhesive tapes has recently increased. The dermal peeling force of adhesive tapes with soft adhesives was studied. METHODS: Four kinds of adhesive tapes with adhesives of different softness were made, by adding varying amounts of isopropyl myristate as a softener. The tapes were applied on the flexor side of the forearm of six healthy male volunteers. The dermal peeling force, the amount of stripped corneocytes, the level of pain when the tapes were removed and the degree of penetration of adhesives into the sulcus cutis (skin furrows) were evaluated at 1 and 24 h after application of the tapes. Furthermore, a skin model panel (a sulcus cutis and crista cutis model panel) and a crista cutis model panel were constructed from a general stainless-steel panel, and the peeling force of the tapes against the model panels was measured. RESULTS AND CONCLUSION: As the softness of adhesives increased, the peeling force against a general stainless-steel panel with a flat surface decreased, although the peeling force against human skin did not significantly change. The amount of stripped corneocytes on the removed tapes and the level of pain when the tapes were removed decreased with the increase in softness of the adhesives. These results suggest that adhesive tapes with soft adhesives that contain isopropyl myristate as a softener are suitable for the skin. Furthermore, the degree of penetration of adhesive into the sulcus cutis increased as the softness of adhesives increased. Upon evaluation of the peeling force against the model panels, as the softness of adhesives increased, there was a slight decrease in the peeling force against the skin model panel, while there was a remarkable decrease in the peeling force against the crista cutis model panel. These results suggest that the lack of change in the dermal peeling force as the softness of adhesives increased was caused by penetration of soft adhesive into the sulcus cutis, and that the decrease in the amount of stripped corneocytes was caused by a decrease in the peeling force against the crista cutis, which consists of corneocytes mainly removed by the tapes.