An update on pityrosporum folliculitis in Singapore from a single tertiary care dermatological centre

INTRODUCTIONPityrosporum folliculitis (PF) is a common skin condition that can be easily misdiagnosed, especially by non-dermatologists. While the initial diagnosis is often made clinically, skin microscopy may help to confirm the same. However, there is scant literature regarding the clinical epidemiology of PF. To our knowledge, in Singapore, only one prior epidemiological study was performed in 1987. Through the present study, we aimed to provide an update regarding the epidemiology, diagnosis and treatment of patients with PF in Singapore.METHODSWe performed a retrospective review of patients with clinical presentations compatible with PF who presented to the dermatology clinic at the National University Hospital, Singapore, between 1 January 2011 and 31 December 2015. The medical records of patients identified as having clinical presentations that resembled PF were reviewed via written and electronic databases. Information regarding the demographics and clinical presentation of the patients was collected.RESULTSOf the 375 patients identified, 214 (57.1%) were confirmed as having PF based on Gram-stain microscopy. Most (35.0%) of these 214 patients were aged between 21 and 30 years, with a male-to-female ratio of 3:1. The lesions predominantly occurred on the trunk and the back. The majority of patients presented with symptoms that lasted more than one month. 128 (59.8%) patients received oral antifungal treatment, whereas 82 (38.3%) patients were treated with topical antifungal treatment alone.CONCLUSIONA typical Singapore patient with PF is a young man aged 21–30 years, with erythematous follicular papules or pustules over the trunk and the back.     

Pityrosporum folliculitis: renal transplantation case report

Pityrosporum folliculitis is caused by the fungus Pityrosporum ovale. It is characterized by the presence of pruriginous follicular papulae and papulae-pustules in face, upper part of the trunk, and upper limb root. It is more prevailing in places with hot and humid climates. Its incidence can be associated with either immunosuppressive or chemotherapy states secondary to pathologies. We report herewith a case of pityrosporum folliculitis in a patient who had previously underwent kidney transplantation and these result of the itraconazol therapeutics given.     

久治不愈的痤疮样皮损与圆形糠秕孢子菌感染关系初步研究

目的 探讨按痤疮久治不愈的痤疮样皮损与圆形糠秕孢子菌（P.orb）感染的关系。方法 对33例该类患者进行毛囊内容物镜检、真菌培养、病理检查及抗真菌治疗。结果 22例（66．7％）患者阳性；P.orb阳性患者皮损数目与孢子数目存在相关性；16例P.orb阳性患者经抗真菌治疗，3例（18．7％）痊愈、6例（37．5％）显效。结论试验提示痤疮样皮损按痤疮久治不愈时，P.orb感染可能是重要原因之一。     

难治性寻常型痤疮合并糠秕孢子菌及螨虫感染的临床观察

目的：观察难治性寻常型痤疮合并糠秕孢子菌，螨虫感染情况及加用针对特殊病原体治疗疗效。方法：取104例难治性寻常型痤疮炎性皮损内容物涂片。复方刚果红当色，检查糠秕孢子菌，螨虫，在常规痤疮治疗基础上结合针对所合并的特殊病原体进行综合治疗。结果：104例患者中糠秕孢子菌阳性者38例，螨虫阳性者30例，两者均阳性者6例，总阳性率71．1％。治愈34例，显效25例，有效40例，无效5例，总有效率95．2％，结论：提示合并糠秕孢子菌，螨虫感染是难治性寻常型痤疮的重要病因之一。     

圆形糠秕孢子菌(Pityrosporum Orbicularis)的培养及超微结构研究

本文报告由花斑癣患者皮屑处取材培养,成功地产生圆形糠秕孢子菌菌落,经光镜、电镜的超微观察及间接免疫荧光等检查证实,本菌菌体呈瓶状芽生,菌体内部具有特征性的螺旋状结构。再试用含20种氨基酸细胞培养液(1640)对圆形糠秕孢子菌进行培养,产生出菌丝型,这在国内外尚属首次报告。有关本菌抗原性等问题,有待今后深入研究。     

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.     

痤疮病程与圆形糠秕孢子菌感染关系的初步探讨

目的 :探讨痤疮病程与圆形糠秕孢子菌 (P orb)感染的关系。方法 :按病程分组对 1 1 3例该类患者进行皮损内容物镜检、真菌培养、病理检查及抗真菌治疗。结果 :Ⅰ组 2 3例 ( 63 9% )患者阳性 ,Ⅱ组 1 7例 ( 4 0 5 % )阳性 ,Ⅲ组 4例 ( 1 6% )阳性。Ⅰ组明显高于Ⅱ、Ⅲ组 ( χ2 =4 2 5 ,P <0 0 5和 χ2 =1 3 71 ,P <0 0 0 1 ) ,)Ⅱ组明显高于Ⅲ组 ( χ2 =4 3 6,P <0 0 5 )。结论 :痤疮病程越长 ,糠秕孢子菌感染的可能性越大。     

糠秕孢子菌性毛囊炎32例临床分析

目的总结糠秕孢子菌性毛囊炎诊断治疗经验。方法对32例糠秕孢子菌性毛囊炎发病的相关因素、临床表现、实验室检查、治疗方法进行分析评价。结果经6周治疗观察痊愈20例,显效8例,好转3例,无效1例,基本无不良反应。结论糠秕孢子菌性毛囊炎易被误诊、漏诊应提高警惕,治疗时应积极治疗原发病及祛除诱发因素,抗真菌药外用效果不明显时,宜同时口服。     

Oral itraconazole for the treatment of seborrhoeic dermatitis: an open, noncomparative trial

BACKGROUND: Seborrhoeic dermatitis is an inflammatory cutaneous disorder in which the colonization of the affected area by Malassezia has been proved to play a key role. OBJECTIVE: To perform a noncomparative open clinical study with oral itraconazole capsule (200 mg/day x 7 days) and consecutive usage 200 mg/day for the first 2 days of the following 2 months in patients with seborrhoeic dermatitis. METHODS: Twenty-nine patients were enrolled to determine the efficacy and safety of oral itraconazole. The patients were evaluated according to itching, burning, erythema, desquamation and seborrhoea, each scored on a 0-4 scale on days 15 (T15), 30 (T30), 60 (T 60) and 90 (T90). Itraconazole capsule 100 mg was given twice a day for 1 week and then, after a 3-week interval, patients used itraconazole capsule 200 mg/day for the first 2 days of the following 2 months. The clinical response was graded as markedly effective, effective, moderate or ineffective. RESULTS: A clinical improvement (evaluated as markedly effective or effective) was observed in 23 patients (83%) at T15, 21 (76%) at T30, 20 (72%) at T60 and 17 (61%) at T90. At baseline, the mean +/- SD total clinical scores were 10.44 +/- 2.45, 1.98 +/- 0.5, 2.97 +/- 1.12, 3.15 +/- 1.74 and 3.30 +/- 1.90 at T0, T15, T30, T60 and T90, respectively. Compared with baseline values, itraconazole capsule significantly reduced the mean +/- SD total score as well as individual erythema and desquamation (Wilcoxon's signed test-two tailed) (P < 0.0001). No drug-related systemic adverse event was observed during the study. CONCLUSIONS: Seborrhoeic dermatitis shows marked reduction in inflammation when treated with itraconazole. The anti-inflammatory activity of oral itraconazole and efficacy on Malessezia suggests that itraconazole capsule will be first oral treatment option in future in severe seborrhoeic dermatitis.     

糠秕孢子菌毛囊炎物理治疗的疗效观察

目的：观察3种物理疗法对糠秕孢子菌毛囊炎的治疗效果。方法：186例患者均内服伊曲康唑200mg/d，连用7d。同时分3组采用冷冻、窄频中波紫外线（UVB）照射和特定电磁波（TDP）照射法。隔日一次的治疗，7次为一疗程。结果：冷冻组有效率92．2％，UVB组83．1，TDP组84．1％。结论：3种物理疗法均提高了糠秕孢子菌毛囊炎的治愈率，而且安全有效，以冷冻治疗更佳，值得使用推广。