Predisposing factors on the surface of the skin in persons with pityriasis versicolor

This is a report on biochemical and physiological examinations carried out on 20 test persons who in the last 2 years had contacted and completely recovered from pityriasis versicolor and on 25 control persons of corresponding age and sex. The tests on the skin surface of the patients with pityriasis versicolor show, when compared with the corresponding control group, the following significant results: 1. Significantly more amino acids could be extracted from the skin of the pityriasis versicolor patients than from the skin of the control persons. 2. A significantly shorter alkali neutralisation time was to be found in the pityriasis versicolor patients than in the control persons. 3. The degree of water spreading on the skin was found to be significantly reduced in the pityriasis versicolor patients when compared with the control persons. It is probable that these results point to important predisposing factors for pityriasis versicolor.     

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.     

Disruption of barrier function in dermatophytosis and pityriasis versicolor

Dermatophytes have the ability to form molecular attachments to keratin and use it as a source of nutrients, colonizing keratinized tissues, including the stratum corneum of the skin. Malassezia species also affect the stratum corneum of the skin. Therefore, dermatophytosis and pityriasis versicolor of the skin are thought to be important factors of profound changes in skin barrier structure and function. We aimed to describe the changes in transepidermal water loss (TEWL), stratum corneum hydration, and skin pH in the lesions of the dermatophytosis and pityriasis versicolor. Thirty-six patients with dermatophytosis (14 with tinea cruris, 13 with tinea corporis and nine with tinea pedis or tinea manus) and 11 patients with pityriasis versicolor were included in this study. TEWL, stratum corneum conductance and skin pH were determined by biophysical methods to examine whether our patients exhibited changes in barrier function. Dermatophytosis and pityriasis versicolor except tinea pedis and tinea manus showed highly significant increase in TEWL compared with adjacent infection-free skin. Hydration was significantly reduced in lesional skin compared with adjacent infection-free skin. From this study, infections with dermatophytes and Malassezia species on the body can alter biophysical properties of the skin, especially the function of stratum corneum as a barrier to water loss. On the contrary, infections with dermatophytes on the palms and soles little affect the barrier function of the skin.     

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.     

Skin Characteristics in Patients with Pityriasis Versicolor Using Non-Invasive Method, MPA5

Background

Skin pigmentary changes of pityriasis versicolor may occur as either hyperpigmented or hypopigmented lesions, depending on the outcome of interactions between Malassezia yeasts and the skin, such as lipoperoxidation process, stimulus of inflammatory cell to melanocytes, and increased thickness of keratin layer.

Objective

To investigate skin characteristic factors that enhance the susceptibility to Malassezia yeasts and provoke different color changes of pityriasis versicolor patients.

Methods

To clarify these factors, we investigated the skin characteristics of pityriasis versicolor patients, using a non-invasive method known as MPA 5® (Courage and Khazaka, Germany). A total of 90 normal healthy subjects and 30 pityriasis versicolor patients were included in this study.

Results

Both hyperpigmented and hypopigmented pityriasis versicolor skin lesions showed higher humidity, increased sebum excretion rate and increased transepidermal water loss (TEWL) values than normal healthy subjects. But no significant difference of specific Malassezia yeasts species between hyperpigmented and hypopigmented skin lesions was evident.

Conclusion

These results indicate that higher humidity and increased sebum level provide a better growing environment of Malassezia yeasts in the skin, leading to the assumption that interaction between Malassezia yeasts and skin barrier materials makes disruption of skin barrier causing increased TEWL.     

Lipoxygenase activity of Pityrosporum in vitro and in vivo

Lipid peroxidation has been investigated both in cultures of Pityrosporum supplemented with different lipid classes and in skin surface lipids from patients affected with pityriasis versicolor. Thin-layer chromatography (TLC) and 2 spectrophotometric methods were used: the indirect thiobarbituric acid test and the direct N,N-diethyl-1,4-phenylene-diammonium sulfate (DEPD) test. The coupling of the DEPD test with the TLC technique performed by different eluent systems allowed the detection of the specific lipoperoxides deriving from the oxidation of the different lipid classes. In the cultures, Pityrosporum was capable of peroxidating not only unsaturated free fatty acids, but also unsaturated triglycerides, cholesterol, and squalene. A similar lipid peroxidation was observed in patients with pityriasis versicolor in skin lipids from areas positive for fungal hyphae and spores and fluorescent under the UV lamp (366 nm). The lipoperoxide values were significantly higher (p less than 0.05) than in skin lipids from normal controls. Hyphae and spore-negative areas of patients with pityriasis versicolor, whether apparently normal or achromic, showed no evidence of a significant lipid peroxidation and neither did skin areas of patients with pityriasis alba. Though further investigations are necessary, it seems reasonable to suggest, in analogy with other biologic systems, that the presence in skin lipids of a significant amount of highly reactive and cytotoxic lipoperoxides may play a role in the pathogenesis of skin alterations in pityriasis versicolor, including damage to melanocytes and resulting achromia.     

The carriage of Malassezia furfur serovars A, B and C in patients with pityriasis versicolor, seborrhoeic dermatitis and controls

The aetiological role of Malassezia furfur in various dermatoses is controversial. The role of the three serovars of M. furfur in Malassezia-associated diseases has not been investigated. This study measured population densities of M. furfur serovars A. Band C. propionibacteria and Micrococcaceae on the chest, back, forehead, left and right cheeks of 10 patients with pityriasis versicolor, and 10 age- and sexmatched controls: and 10 patients with seborrhoeic dermatitis, and 10 age- and sex-matched controls. The population densities of M. furfur. propionibacteria and Micrococcaceae did not vary at a given site between patients and the corresponding control subjects. Malassezia furfu serovar A was found to be the predominant isolate on the chest and back of all four groups. but there was no difference in the distribution of serovars on the forehead and cheeks. No serovar was specifically associated with lesional skin in either disease. Thus, this data indicated that there was no difference in either the total population density of M. furfur or the distribution of serovars on lesional skin compared with control skin in either pityriasis versicolor or seborrhoeic dermatitis.     

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.     

Comparative study of ketoconazole versus selenium sulphide shampoo in pityriasis versicolor

Forty patients suffering from pityriasis versicolor were treated with either 2% ketoconazole shampoo (20 patients) or 2.5% selenium sulphide shampoo (20 patients), once a week for three weeks. On global assessment after one month of start of therapy, 19 (95%) out of 20 patients treated with ketoconazole shampoo were cured while one case had mild residual disease. In selenium sulphide shampoo group, 17 (85%) out of 20 patients were cured, one had mild residual disease and two had considerable residual disease. No significant difference was observed in the response rates in the two groups. Relapse occurred in one patient of ketoconazole group and two patients of selenium sulphide group during the follow-up period of three months.     

Cell-mediated immunity to Malassezia furfur in patients with seborrhoeic dermatitis and pityriasis versicolor

The lymphocyte transformation response to Malassezia furfur, Candida albicans, phytohaemagglutinin, concanavlin A and tuberculin purified protein derivative of 12 patients with pityriasis versicolor, 15 patients with seborrhoeic dermatitis and matched controls, was studied. Patients with pityriasis versicolor showed a significantly lower response to M. furfur than patients with seborrhoeic dermatitis and controls.     

Tinea versicolor mimicking pityriasis rubra pilaris

Tinea versicolor is a common noninvasive cutaneous fungal disease. We recount a case of tinea versicolor that mimicked type I (classic adult) pityriasis rubra pilaris. A 54-year-old white man reported a 20-year history of a recurrent pruritic eruption that had marginally improved with use of selenium sulfide shampoo and treatment with oral antihistamines. Results of a skin examination revealed erythematous plaques; islands of spared skin; and follicular erythematous keratotic papules on the trunk, shoulders, and upper arms. A lesion was scraped to obtain skin scales for potassium hydroxide staining. Examination of the stained samples revealed the characteristic "spaghetti and meatballs," confirming the diagnosis.     

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。     

Itraconazole in the treatment of superficial mycoses—a double-blind study vs. placebo

Ninety-four patients with dermatophytosis and 16 patients with pityriasis versicolor were assigned under double-blind conditions to oral itraconazole (100 mg once daily) or placebo. The medication consisted of two capsules, each containing 50 mg of active substance, or placebo and was given for 15 or 30 days in patients with dermatophytosis and for 15 days in patients with pityriasis versicolor. Patients with pityriasis versicolor who had not responded at the end of the double-blind period were treated on an open basis with itraconazole (100 mg once daily) for 15 days. In the treatment of dermatophyte infections for 30 days, both clinical response and mycological cure were significantly superior in the itraconazole group compared with placebo. Oral administration of itraconazole (100 mg once daily) was also highly efficacious in the treatment of pityriasis versicolor. None of the placebo patients was clinically or mycologically cured at the end of the double-blind phase compared to seven out of eight itraconazole patients. All placebo patients who entered the open phase responded to itraconazole treatment. Three itraconazole-treated patients and nine placebo-treated patients reported 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.     

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.     

花斑癣、马拉色菌毛囊炎、脂溢性皮炎马拉色菌诱发因素分析

目的调查昆明地区花斑癣、马拉色菌毛囊炎、脂溢性皮炎马拉色菌诱发因素,并比较三种疾病的诱发因素有无差异。方法收集花斑癣、马拉色菌毛囊炎、脂溢性皮炎(头皮屑)的病例,用自制的调查表对入选病例进行诱发因素调查,比较诱发因素在三种疾病间有无差异。结果共收集158例病例,男104例,女54例,平均年龄29.4岁,多汗、油性皮肤患者所占比例均超过60%,系统或局部使用糖皮质激素是马拉色菌毛囊炎的危险因素。结论马拉色菌感染好发于男性青壮年,多汗者易发生花斑癣,油性皮肤及使用糖皮质激素易发生马拉色菌毛囊炎。     

The associated diseases with leprosy

The prevalence of cutaneous, medical and surgical disorders was studied in 846 leprosy patients. Common cutaneous disorders among leprosy patients were pityriasis versicolor, tinea, pyodermas, warts, acquired ichthyosis, scabies, pediculosis and callosities. Only pityriasis versicolor had higher incidence when compared to general population. Common medical diseases were tuberculosis, infective hepatitis and diabetes mellitus. The epidemiological importance of their co-existence with leprosy is discussed and relevant literature of other diseases found to be frequently associated with leprosy is reviewed.     

PITYRIASIS VEESICOLOR: A CLINICAL AND MYCOLOGICAL INVESTIGATION

SUMMARY. Twenty-five patients with pityriasis versicolor have been studied clinically and mycologically and the hospital records of a further 62 patients have been analysed. The sex ratio for the whole series was 3 males to 2 females, the age of onset was usually in the early twenties. Nearly all cases in the Cambridge area start in the warmer months of the year. Conjugal cases are reported but a genetic factor in susceptibility is also accepted. Attention is drawn to the extent of the lesions on the limbs and flexural involvement in association with excessive sweating is shown to be common. Pityrosporum orbiculare was cultured from the lesions of 25 of 27 patients and its presence was also detected on uninvolved skin. The evidence for the identity of P. orbiculare and Malassezia furfur is reviewed briefly and the analogy is drawn with yeast/mycelium transition in candidiasis. The ecology of P. orbiculare/M. furfur in pityriasis versicolor is discussed in the light of the results presented.     

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。     

Management of Seborrheic Dermatitis and Pityriasis Versicolor

Pityriasis (tinea) versicolor and seborrheic dermatitis are two very common skin diseases. Pityriasis versicolor is a chronic superficial fungal disease usually located on the upper trunk, neck, or upper arms. In pityriasis versicolor, the lipophilic yeast Malassezia (also know as Pityrosporum ovale or P. orbiculare) changes from the blastospore form to the mycelial form under the influence of predisposing factors. The most important exogenous factors are high temperatures and a high relative humidity which probably explain why pityriasis versicolor is more common in the tropics. The most important endogenous factors are greasy skin, hyperhidrosis, hereditary factors, corticosteroid treatment and immunodeficiency. There are many ways of treating pityriasis versicolor topically. Options include propylene glycol, ketoconazole shampoo, zinc pyrithione shampoo, ciclopiroxamine, selenium sulfide, and topical antifungals. In difficult cases, short term treatment with fluconazole or itraconazole is effective and well tolerated. To avoid recurrence a prophylactic treatment regimen is mandatory. Seborrheic dermatitis is characterized by red scaly lesions predominantly located on the scalp, face and upper trunk. There are now many studies indicating that Malassezia plays an important role in this condition. Even a normal number of Malassezia will start an inflammatory reaction. Mild corticosteroids are effective in the treatment of seborrheic dermatitis. However, the disease recurs quickly, often within just a few days. Antifungal therapy is effective in the treatment of seborrheic dermatitis and, because it reduces the number of Malassezia, the time to recurrence is increased compared with treatment with corticosteroids. Antifungal therapy should be the primary treatment of this disease.