Miconazole Treatment of Pityriasis Versicolor A Review

Data are presented from seventeen studies (304 patients) on the topical treatment of pityriasis versicolor with the substituted imidazole compound miconazole. The results indicate that miconazole is a very efficacious and well tolerated drug in this condition.

Zusammenfassung

Daten über die topische Behandlung der Pityriasis versicolor mit dem substituierten Imidazol-Derivat Miconazol wurden aus siebzehn Studien (304 Patienten) zusammen-gestellt und verglichen. Es ergibt sich aus diesen Daten, daß Miconazol für diese Krank-heit ein hoch wirksames und gut verträgliches Arzneimittel ist.     

Pityriasis versicolor in school children in Cross River State of Nigeria

Out of 2,353 primary school children aged 4-16 years in Cross River State of Nigeria examined, 88 (3.7%) showed lesions mycologically proven to be pityriasis versicolor. Incidence was highest (6.3%) in children aged 12-16. Lesions were much more common on the face than on other sites.     

Phospholipase activity in Malassezia furfur pathogenic strains

Summary. The lipophilic dimorphic yeast Malassezia furfur is a common skin commensal and the aetiological agent of pityriasis versicolor. A source of lipids is essential for its growth, and there are already demonstrations of in vitro lipase and lipoxygenase production. In eight wild strains, isolated from patients with pityriasis versicolor, we showed a phospholipase activity using a medium containing egg yolk emulsion as the only source of lipids; in this medium M. furfur grows and produces a phospholipase zone. Adding manganese sulphate, an unspecific inhibitor of phospholipase activity, M. furfur does not grow, because the lipophilic fungus cannot utilize the egg yolk as a source of fatty acids. Adding Tween 60 to the same medium, M. furfur also grows in presence of manganese sulphate.
Zusammenfassung. Die dimorphe Hefe Malassezia furfur ist ein verbreiteter Hautkommensale und das ätiologische Agens der Pityriasis versicolor. Eine Liquidquelle ist für ihr Wachstum essentiell. Lipase- und Lipoxygenase-Aktivität wurde in vitro bereits nachgewiesen. In acht Wildstämmen, isoliert von Patienten mit Pityriasis versicolor, wurde nunmehr Phospholipase-Aktivität mittels Eigelbemulsion als einziger Lipidquelle nachgewiesen. In diesem Medium wächst M. furfur und produziert eine Phospholipase-Zone. Bei Zusatz von Mangansulfat, einem unspezifischen Hemmer der Phospholipase-Aktivität, wächst M. furfur nicht, da der lipophile Pilz Eigelb als Fettsäurenquelle nicht nutzen kann. Bei Zusatz von Tween 60 zum gleichen Medium wächst M. furfur auch in Gegenwart von Mangansulfat.     

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.     

Glycine as a regulator of tryptophan‐dependent pigment synthesis in Malassezia furfur

The effects of the addition of different amino nitrogens on growth, morphology and secondary metabolism of Malassezia furfur were investigated. After primary culture on Dixon agar, M. furfur CBS 1878 was transferred into a fluid medium together with the nitrogen sources, glycine (Gly) or tryptophan (Trp), or a combination of both. Growth was measured by means of a direct cell counting method and pigment synthesis was photometrically assessed. Addition of glycine resulted in an exponential increase in biomass, but not in pigment production. Tryptophan as the sole nitrogen source caused distinct brown staining of the medium, without increasing biomass. Simultaneous equimolar addition of both amino acids resulted in an initial increase in biomass as a sign of preferential metabolism of glycine, followed by a growth plateau and pigment production which, caused by higher biomass, occurred more rapidly than after addition of tryptophan alone. The yeast‐cell morphology changed from round to oval. Addition of glycine to the tryptophan‐containing liquid culture stopped pigment formation with simultaneous growth induction. These in vitro on‐off phenomena depending on the nitrogen source might be significant in the pathogenesis of pityriasis versicolor: hyperhidrosis followed by preferential consumption of individual nitrogen sources such as glycine with exponential growth and thereafter transamination of tryptophan and TRP‐dependent pigment synthesis.     

Zur Morphologie der Malassezia-assoziierten Erkrankungen

Zusammenfassung. Die morphologischen Untersuchungen geben Auskunft über das Vorkommen, die Struktur und die Topik des Mikroorganismus Malassezia furfur an der Hautoberfläche und vermitteln Einblicke in die Begleiterscheinungen am Makroorganismus bei Pityriasis versicolor, Malassezia -Follikulitis und seborrhoischem Ekzem. Aus morphologischer Sicht lassen sich die Malassezia -assoziierten Dermatosen zwei unter-schiedlichen Krankheitsgruppen zuordnen. Eine Gruppe ist von zahlreichen, im Stratum corneum adhärenten Mikroorganismen geprägt (Beispiel: Pityriasis versicolor); die andere Gruppe ist von einer Entzün-dungsreaktion gekennzeichnet (Beispiel: seborrhoisches Ekzem), die Pilzzellen lassen sich hierbei in der Horn-schicht mikromorphologisch im allgemeinen nicht nachweisen, sie können jedoch in den Foliikelostien wie an der gesunden Haut vorkommen.
Summary. Fine-structural investigations were done with surface material and slides of pityriasis versicolor, Malassezia -folliculitis and seborrheic eczema. Aspects of the microorganism Malassezia furfur , such as its presence, its distribution on the skin surface, and its shape, and changes in the host skin tissue, such as the structure of the horny layer and signs of an inflammation were registered. Two main types of Malassezia -associated dermatoses were defined. One type is characterized by a considerable number of microorganisms, adhering to regular cells of the horny layer (exemplified by pityriasis versicolor), the other type is characterized by signs of an inflammation and a very low number of visible fungal cells (exemplified by seborrheic eczema).     

Tinea capitis in South Indian Families: Tinea capitis in südindischen Familien

Summary: Intrafamilial incidence of tinea capitis in 26 families was studied in Madras and was found to vary from 3.6 % to 80.0%. Usually the incidence was higher in noninflammatory types caused by Trichophyton violaceum infection than those with inflammatory lesions or kerion. Poor socioeconomic and hygienic background was found in most of the families studied. The commonest agent involved was T. violaceum, in 68.6%. The other species were T. tonsurans (21.6 Vo), T. rubrum (6%) and T. simii (3.8%). Findings reveal that tinea capitis and or T. violaceum infection are endemic in Madras, South India.
Zusammenfassung: Das intrafamiliäre Vorkommen von Tinea capitis wurde bei 26 Familien in Madras untersucht. Der intrafamiliäre Befall betrug dabei zwischen 3,6 und 85,7%. Gewöhnlich war der Befall innerhalb einer Familie bei den nicht entzündlichen Formen, wie sie durch Trichophyton violaceum hervorgerufen werden, größer als bei den entzündlichen oder Kerion-Formen. Ein geringer sozio-ökonomi-scher und hygienischer Standard wurde bei den meisten untersuchten Familien ge-funden. Der häufigste Erreger bei dieser Untersuchung war Trichophyton violaceum mit 68,6%. Weitere Arten waren T. tonsurans (21,6%), T. rubrum (6%) und T. simii (3,8%). Die Befunde zeigen, daß die Tinea capitis bzw. Trichophyton viola-ceum-Infektionen in Madras, Südindien, endemisch sind.     

Differentiation of Malassezia furfur and Malassezia sympodialis by glycine utilization

The genus Malassezia has been revised to include six lipophilic species and one nonlipophilic species. These Malassezia species have been investigated to differentiate their morphological and physiological characteristics. However, assimilation of amino acids as a nitrogen source by these species was not well elucidated. In the present study, isolates of Malassezia species were examined with a glycine medium (containing 7-266 mmol glycine, 7.4 mmol KH(2)PO(4), 4.1 mmol MgSO(4)7H(2)O, 29.6 mmol thiamine, 0.5% Tween-80 and 2% agar) and a modified Dixon glycine medium (0.6% peptone, 3.6% malt extract, 2% ox-bile, 1% Tween-40, 0.2% glycerol, 0.2% oleic acid, 7 mmol glycine and 2% agar). All M. furfur isolates developed on the glycine medium, assimilating glycine at concentrations of at least 7 mmol l(-1). However, the other six Malassezia species were unable to grow on the glycine medium. Also, many colonies of M. furfur grew rapidly, within 2-3 days on the modified Dixon glycine medium, although the other six species showed slow and poor development. From these results, it was suggested that M. furfur might be able to utilize glycine as a single nitrogen source, which the other Malassezia species could not. Therefore, glycine medium was recommended for the differentiation of M. furfur from other species of Malassezia.     

Malassezia furfur colonization of neonates in an intensive care unit

We studied Malassezia furfur colonization of neonates in the neonatal intensive care unit (NICU) and found that the rate was astonishingly high as compared to the previous studies. In very low birth weight (less than 1,000 g) infants we recorded a colonization rate of 80%, and 4% infants with a birth weight greater than 2,000 g. Under 10 day's hospitalization the rate was 11%, and it was 70% after 20 days spent in the unit. Among the infants with the birth weight less than 1,700 g, antibiotic therapy was recorded as a significant risk factor for colonization. In the infants with a greater birth weight, the colonization rate was independent from the risk factors studied. M. furfur colonization could not be linked with occurrence of any symptoms of signs recorded and colonization by M. furfur was so common in NICU that the predictive value of surveillance cultures is poor.     

Tinea pedis in children

Tinea pedis is a superficial mycosis, unusual in children. Epidemiological and clinical data regarding cases of tinea pedis observed in children over a period of 20 years are discussed and some explanation given for the conditions which predisposed children to the infection. Clinical features are variable and similar to adults. Bullous lesions are more frequently seen in children. Most of the cases were seen in children over 10 years of age. Males are more often affected with tinea pedis: this is particularly true for 10 to 13 year-old children. As in adults, Trichophyton rubrum is the most frequently isolated etiological agent.     

Association between Malassezia furfur colonization and seborrhoeic dermatitis in AIDS patients

A total of 180 HIV-positive patients were assessed for seborrhoeic dermatitis (SD) and colonization with Malassezia species. Diseased skin of patients with seborrhoeic dermatitis were sampled selectively for Malassezia. In patients without SD, uninvolved skin was sampled. The prevalence of SD was 19%. Of the 34 SD patients, 16 were positive for Malassezia. Of the 146 patients without SD, only 27 were culture positive for Malassezia. Analysis of the largest HIV-positive patient population studied thus far yielded only a weak correlation between SD and Malassezia colonization.     

Tinea capitis in Northern Nigeria Tinea capitis in Nord Nigeria

Summary: Patients with tinea capitis constituted 2.48% of all new dermatologcal cases seen in the period of over 4 years in two out-patient dermatological clinics in Northern Nigeria. Tinea capitis constituted 31 % of all dermatophytoses seen in that period and outnumbered fungal infections of glabrous skin, feet and nails. Dermatophytes were isolated from 181 out of 441 specimens. Fourteen different species were cultured, but 5 of them constituted 84% of all isolated. T. schoenleinii was the most frequent isolates (35%). M. audouinii, T. soudanense, T. mentagrophytes and T. tonsurans caused 17%, 12%, 10, and 10% of infections, respectively. T. tonsurans, T. venucosum, T. gallinae, T. megninii, M. vanbreuseghemii and E. floccosum were isolated for the first time from scalp lesions in Nigeria. T. schoenleinii, T. soudanense and T. mentagrophytes occurred almost exclusively in islamic rural Hausa-Fulani and in students of Koranic schools. M. audouinii showed a less ethnically restricted pattern and M. canis infections occurred only in town-dwellers from tribes other than the Hausa-Fulani. The standard of patients' hygiene and nutrition appears to be an important factor in determining the morphology of scalp infection since all 7 patients with favus-like scarring alopecia caused by dermatophytes other than T. schoenleinii were malnourished and hygienically neglected Koranic students. A thorough review of previous reports on tinea capitis from Nigeria is presented. Zusammenfassung: Von allen neuen Fällen, die in zwei dermatologischen Ambulatorien in Nord-Nigeria über einem Zeitraum von über 4 Jahren hinweg untersucht wurden, stellten die Patienten mit Tinea capitis einen Anteil von 2,48%. 31% aller in diesem Zeitraum gefundenen Dermatophytosen waren Fälle von Tinea capitis, dies übertraf den Anteil der mykotischen Infektionen an unbehaarter Haut, Füßen und Nägeln. Aus 181 von 441 untersuchten Proben konnten Dermatophyten isoliert werden. 14 verschiedene Spezies wurden angezüchtet, davon waren 5 an 84 % der Fälle beteiligt. T. schoenleinii wurde mit 35 % am häufigsten isoliert. M. audouinii, T. soudanense, T. mentagrophytes und T. tonsurans verursachten jeweils 17%, 12%, 10% und 10% der Infektionen. T. tonsurans, T. verrucosum, T. gallinae, T. megninii M. vanbreuseghemii und E. floccosum wurden zum ersten Mal von Kopfhautläsionen in Nigeria isoliert. T. schoenleinii, T. soudanense und T. mentagrophytes kamen fast auschließlich bei islamischen Dorfbewohnern der Stämme Haussa und Fulani und bei Koran-Schülern vor. M. audouinii war weniger an die Stammeszugehörigkeit der Patienten gebunden und M. canis-Infektionen kamen nur bei Stadtbwohnern vor, die nicht zu den Haussa oder Fulani gehörten. Persönliche Hygiene und Ernähnmgszustand der Patienten scheinen wesentlichen Einfluß auf die Morphologie der Kopfhautinfektionen zu haben, denn alle 7 Patienten mit Favusähnlicher vernarbender Alopozie, die von anderen Dermatophyten als T. schoenleinii verursacht war, waren schlecht ernährte und hygienisch vernachässigte Koran-Schüler. Es wird ein eingehender Überblick früherer Arbeiten über Tinea capitis in Nigeria gegeben.     

Differentially expressed genes associated with tryptophan‐dependent pigment synthesis in Malassezia furfur– a comparison with the recently published genome of Malassezia globosa

Malassezia (M.) furfur, a commensal organism found on the human skin, produces a wide range of pigments and fluorochromes when cultured with tryptophan as a sole nitrogen source. Some compounds of this pigment metabolism may provide an explanation for clinical characteristics of pityriasis versicolor (PV), a frequent skin disease in humans characterised by long‐lasting pigmentary changes. Malassezia globosa is currently regarded as the causative agent of PV, but tryptophan‐dependent pigment production has not yet been demonstrated in this species. In a previous study, we identified M. furfur genes that were differentially expressed 3 and 5 h, respectively, after induction of tryptophan‐dependent pigment production. The recent publication of the genome of M. globosa prompted us to check the M. furfur sequences for homologues in M. globosa. The 3‐h pool contained 79 sequences and the 5‐h pool contained 91 sequences. A translated vs. translated BLAST search resulted in 62 sequences (78%) of the 3‐h pool and 61 sequences (67%) of the 5‐h pool showing similarity to a sequence from M. globosa. It appears that M. globosa possesses homologues to most of the genes that are differentially expressed during pigment production in M. furfur.     

Tinea capitis in School Children in Eastern Nigeria/Tinea capitis bei Schulkindern in Ost-Nigeria

Summary: A survey of tinea capitis was carried out during the period 1974–1977 in 3, 478 primary school children aged 4–13 years and comprising 1, 868 males and 1610 females in Anambra State in Eastern Nigeria. A total of 303 (8.7%) mycologicaliy proven cases of tinea capitis were detected. Incidence was significantly higher in young children (10.5%) aged 4–8 years than in older children (6.0%) aged 9–13 years. Males (9.0%) were more commonly affected than the females (73%). Microsporum audouinii was the commonest etiological agent (483%) followed next by Trichophyton soudanense (26.6%) and T. tonsurans (15.2%). Other dermatophytes occasionally represented were M. ferrugineum (3.4%), T. violaceum (3.7%), T. yaoundei (1.2%), T. mentagrophytes (0.9%) and T. schoenleinii (0.6%). Investigation of scalp carriage of dermatophytes showed that approximately 9% of children without any clinical signs of tinea capitis harbour dermatophytes in their scalp hair. The significance of these findings is discussed in relation to relative distribution of different species of dermatophytes in Nigeria and other countries in Africa. A detailed study of the morphological characters of the isolates showed considerable variation in microscopical features of M. audouinii and T. soudanense. Zusammenfassung: In den Jahren 1974 bis 1977 wurden im Staat Anambra in Ost-Nigeria 3478 Schulkinder im Alter von 4 bis 13 Jahren, darunter 1868 männliche und 1610 weibliche Kinder, untersucht Insgesamt wurden 303 (8,7%) einer nachgewiesenen Tinea capitis entdeckt. Bei jungen Kindern im Alter von 4–8 Jahren war die Inzidenz mit 10,5% höher als bei älteren Kindern im Alter von 9–13 Jahren mit 6%. Männliche Kinder waren mit 9,0% häufiger betroffen als weibliche Kinder (73%). Der häufigste Erreger war Microsporum audouinii (483%). Es folgten Trichophyton soudanense (26,6%) und T. tonsurans (15,2%). Andere Dermatophyten traten nur gelegentlich auf: M. ferrugineum (3,4%), T. violaceum (3,7%), T. yaoundei (1,2%), T. mentagrophytes (0,9%) und T. schoenleinii (0,6%). Die Untersuchung der Kopfhaut von klinisch erscheinungsfreien Kindern zeigte, daß bei etwa 9% dieser Kinder Dermatophyten von der Kopfhaut isoliert werden konnten. Die Bedeutung dieser Ergebnisse wird auch unter dem Gesichtspunkt der unterschiedlichen Verteilung der verschiedenen Dermatophyten in Nigeria und in anderen afrikanischen Ländern diskutiert. Eine eingehende Untersuchung der morphologischen Charakteristika der isolierten Pilze zeigte beträchtliche Variationen in der Mikromorphologie von M. audouinii and T. soudanense.     

Identification of Malassezia species from pityriasis versicolor in Indonesia and its relationship with clinical characteristics

Pityriasis versicolor (PV) is a chronic superficial fungal disease caused by Malassezia spp. The incidence is as high as 30–40% in tropical climates. Previous studies indicate that the geographic factor has influence on the main species isolated from PV. Our aim was to identify Malassezia spp. from PV patients in Indonesia and their correlation to clinical characteristics. Isolates of Malassezia were collected from 98 PV patients (62 males and 36 females). Identification was based on morphological observation and biochemical evaluation. Leeming Notman agar was used as isolation culture medium. The biochemical evaluation consisted of specimen culture onto Sabouraud dextrose agar, Cremophor EL, Esculin, Dixon's agar at 37 °C and catalase reaction. The isolates found were Malassezia furfur (42.9%), M. sympodialis (27.5%), M. globosa (13.3%), M. slooffiae (7.7%), M. obtusa (7.7%) and M. restricta (2.2%), and 7.14% specimens were unidentified. There was no statistically significant association between Malassezia spp. and demographic characteristics and clinical characteristics of the patients. Unlike reports from temperate climate countries, this study in Indonesia found M. furfur as the most frequently isolated Malassezia spp. in PV patients.     

The detergent scrub method for quantitative determination of Malassezia furfur on chest and back skin: comparative evaluation of three different media

The quantitative determination of Malassezia furfur on normal human skin has been considered as difficult until recently. During the last years, however, several different media have been described which facilitate the quantification of M. furfur. As the efficacy of these media is still controversial, three different media were compared analyzing the chest and back of 20 healthy young adult volunteers. The highest counts of colony-forming units (CFU) per cm2 were found using a medium containing whole fat cow's milk as a major ingredient. At the chest the mean count read was 259, at the back 322. The corresponding figures related to other media were markedly lower (P less than 0.001). Hence, the use of the milk-containing medium for cultivation of M. furfur seems advisable for therapeutic trials.     

Malassezia yeast species isolated from Iranian patients with pityriasis versicolor in a prospective study

The goal of this study was to determine the prevalence of Malassezia species in pityriasis versicolor lesions and to examine if the range of species varies with patients characteristics such as: age, sex and family history and also clinical findings such as site and number of the lesions. In a prospective study from July 2006 to July 2007, the patients with a clinical diagnosis of pityriasis versicolor (n = 166) were asked to participate in the study. A total of 116 patients had positive culture for Malassezia species: M. globosa was found in 52 (31.3%) cases, M. furfur in 34 (20.5%) cases, M. pachydermatis in 12 (7.2%) cases, M. restricta in 12 (7.2%) cases, M. slooffiae in 6 (3.6%) cases. According to our data, M. globosa is the main species causing pityriasis versicolor, M. furfur was found to be the second‐most frequent species. M. sympodialis and M. obtusa were not found in any case, and in 30.2% of patient’s Malassezia culture was negative.     

Syndrome of Carteaud and Gougerot -Case Report:Confluent and reticulate papillomatosis

Summary: A case of confluent and reticulate papillomatosis (Carteaud and Gougerot) in a 25 year old man is reported in whom Malassezia furfur was found in the lesions. Tolnaftate was partially successful in treatment.
Zusammenfassung: Ein Fall einer Papillomatosis confluens et reticulata von Carteaud und Gougerot wird berichtet. Bei einem 25jährigen Mann konnte Malassezia furfur in den Herden nachgewiesen werden. Eine Behandlung mit Tolnaftat war teilweise erfolgreich.     

A case of pityriasis versicolor atrophicans

A case of pityriasis versicolor atrophicans caused by Malassezia globosa is reported in a 49-year-old woman. Diagnosis was based on direct microscopic examination and culture. Differential diagnosis was performed with respect to other skin diseases manifesting with cutaneous atrophy.