Dermacase. Pityriasis versicolor

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Cutaneous manifestations of systemic diseases

Many aspects of dermatologic diagnosis are either of importance or interest to the nondermatologist, and there are many excellent textbooks available for guidance. This article focuses on four categories of conditions that are the source of frequent queries from the primary care setting: (1) common skin diseases that frequently mimic systemic illness, (2) common skin diseases that have important systemic associations, (3) common systemic diseases that have prominent cutaneous findings, and (4) the seldom seen but frequently raised concerns regarding cutaneous signs of internal malignancy.

[Pityriasis versicolor in children: a retrospective study of 164 cases]

INTRODUCTION

Pityriasis versicolor is a superficial mycosis uncommonly reported in children. It occurs frequently in warm humid climates. Clinical diagnosis can be confirmed by mycology examination of a biopsy sample or a patch-test. The aim of our work was to assess the frequency of pityriasis versicolor in children in our region and ascertain the contribution of the cutaneous patch test and its diagnostic specificity.

PATIENTS AND METHODS

A retrospective analysis was conducted in patients meeting the following inclusion criteria over a 5-year period: age < 14 years, clinical presentation compatible with pityriasis versicolor, a positive patch-test. Age, sex, clinical features and favoring factors were recorded for all patients. Patch tests were performed in a control group of age-matched children with eczema or vitiligo.

RESULTS

Pityriasis versicolor was diagnosed in 1,379 cases during the study period including 164 children (11.8 p. 100). Age varied from 5 months to 14 years (mean 11 years), with a slight female predominance. Facial lesions were the most frequent (n = 78; 47.5 p. 100), preferentially on the forehead (n = 53; 68 p. 100). An achromic and hypochromic aspect predominated (n = 118; 72 p. 100). The adhesive tape tests were negative in all controls.

DISCUSSION

Pityriasis versicolor is exceptional in children in our region. The adhesive tape test provides a specific diagnostic tool. Preferential facial localization and predominant achromic and hypochromic aspect are characteristic of childhood pityriasis versicolor in our region. These 2 features are also reported in the literature. Childhood cases suggests the pathogenic factors involved in pityriasis versicolor should be reconsidered. Pityriasis versicolor should be included in the differential diagnosis of childhood hypopigmentation of the face.

The epidemiology of pityriasis versicolor in Malawi, Africa

During a total population survey in 1988 and 1989 in Karonga district, northern Malawi, 4915/61735 (8.0%) people examined were found to have extensive pityriasis versicolor (PV). An additional 6085 people (9.9%) were diagnosed as having mild disease. The highest prevalence rates of extensive and mild PV were found among subjects aged 15-24 years. In this age group between 20% and 25% of people had extensive PV. Rates were generally higher among males than among females. PV was rarely found in prepubertal subjects.

[Superficial mucocutaneous mycosis]

Superficial mycosis are very common. The frequency in France is 10 to 15% of the population. The reason for the high incidence of this disease is the change of the moral values, rise in promiscuity and increase sports activities. The agents responsible are divided in four groups. Dermatophytes involve keratin of the skin, hairs and nails but never the mucous membranes. They can cause glabrous skin lesion, tinea corporis, tinea capitis or onychomycosis. Yeast are divided in two groups: the candidiasis and Malassezia furfur, the etiologic agent of pityriasis versicolor. Oral mucosa candidiasis is very common in HIV infected patients.

Diagnosis and treatment of tinea versicolor

Tinea versicolor (pityriasis versicolor) is a common superficial fungal infection of the stratum corneum. Caused by the fungus Malassezia furfur, this chronically recurring disease is most prevalent in the tropics but is also common in temperate climates. Treatments are available and cure rates are high, although recurrences are common. Traditional topical agents such as selenium sulfide are effective, but recurrence following treatment with these agents is likely and often rapid. Currently, therapeutic interest is focused on synthetic "-azole" antifungal drugs, which interfere with the sterol metabolism of the infectious agent. Ketoconazole, an imidazole, has been used for years both orally and topically with great success, although it has not been approved by the Food and Drug Administration for the indication of tinea versicolor. Newer derivatives, such as fluconazole and itraconazole, have recently been introduced. Side effects associated with these triazoles tend to be minor and low in incidence. Except for ketoconazole, oral antifungals carry a low risk of hepatotoxicity.

A single method to stain Malassezia furfur and Corynebacterium minutissimum in scales

The scales are collected by pressing small pieces of scotch tape (about 4 cm length and 2 cm width) onto the lesions and following withdrawal the furfuraceous scales will remain on the glue side. These pieces are then immersed for some minutes in lactophenol-cotton blue stain. Following absorption of the stain the scales are washed in current water to remove the excess of blue stain, dried with filter paper, dehydrated via passage in two bottles containing absolute alcohol and then placed in xylene in a centrifugation tube. The xylene dissolves the scotch tape glue and the scales fall free in the tube. After centrifugation and decantation the scales concentrated on the bottom of the tube are collected with a platinum-loop, placed in Canada balsam on a microscopy slide and closed with a cover slip. The preparations are then ready to be submitted to microscopic examination. Other stains may also be used instead of lactophenol-cotton blue. This method is simple, easily performed, and offers good conditions to study these fungi as well as being useful for the diagnosis of the diseases that they cause.

The superficial mycoses

The various agents of the superficial mycoses have been recognized for more than a century as causes of mild diseases affecting humankind. Two of these, Malassezia furfur and Trichosporon beigelii, are ubiquitous organisms now known to be opportunistic pathogens in susceptible patient populations. The clinical manifestation, pathogenesis, and treatment of the common skin presentation of these and the other superficial mycoses are reviewed.

Yeast infections

Yeasts are unicellular fungi that reproduce by the process of budding in which daughter cells are produced from parents by outpouching of the cell membrane and wall, migration of cytoplasm into the new structure thus formed, and then separation from the parent cell. Yeasts that are pathogenic in humans range in size from 2 to 12 microns in diameter; most, therefore, can be engulfed by phagocytic cells. These pathogens include many of the best known of pathogenic fungi, such as the Candida species, Cryptococcus neoformans, and the lipophilic yeasts of the genus Malassezia.

Tinea versicolor of the scalp

BACKGROUND

Tinea versicolor (TV) is commonly described on the trunk without giving attention to involvement of the scalp. We examined cases with dandruff with and without TV on the body to see how frequent Malassezia furfur (M. furfur) is present in dandruff scales.

METHODS

A total of 80 patients were examined mycologically using KOH preparation for the presence of M. furfur in dandruff scales.

RESULTS

M. furfur was found in dandruff scales in 7 out of 20 men with TV (35%) and 5 out of 20 women with TV (25%), whereas it was absent in another 40 cases without clinical lesions of TV on the body.

CONCLUSIONS

Attention must be paid to TV of the hairy scalp. Cases of dandruff, especially those accompanied with TV of the body, must be examined for the presence of M. furfur because of its prognostic significance. Positive cases should be treated accordingly.

Pityriasis versicolor in a newborn

Pityriasis versicolor is a superficial mycosis that rarely afflicts children. We present a case in a 2-month-old male baby in good health, with hyper- and hypopigmented macules located in the cervical region and on the scalp, face and chest. Moreover, we report our record of cases in infancy and the predisposing factors.

Superficial fungal infections in the tropics

Cutaneous dermatophyte infections are limited to the superficial layers of the epidermis. Tropical and subtropical regions of the world provide warm and humid climates and therefore a favorable environment for organisms causing superficial dermatophyte infections. This article deals with cutaneous dermatophyte infections, with particular emphasis on those occurring in tropical regions of the world. History, causative organisms, diagnosis, and treatment are discussed.

Tinea versicolor and visceral leishmaniasis

BACKGROUND

Visceral leishmaniasis (VL) is endemic in several areas in the Sudan. The disease is associated with depressed cellular immunity. Tinea versicolor is a normal commensal of the skin which can become pathogenic particularly in patients with depressed cell-mediated immunity. Patients with VL have a high prevalence of tinea versicolor.

METHODS

One hundred and thirty patients with parasitologic confirmation of VL were screened for tinea versicolor infection. In the suspected cases the diagnosis was made by demonstrating the fungal hyphae and spores in skin scrapings. All patients were treated with sodium stibogluconate.

RESULTS

Of the 130 patients with VL, 10.8% were found to have severe tinea versicolor. The fungal infection developed or became worse with the start of VL. After successful treatment of VL, the tinea lesions disappeared completely or decreased in severity.

CONCLUSIONS

Depressed cell-mediated immunity that is a feature of VL is the probable underlying cause for fungal infection. Tinea infection during the course of VL is to be distinguished from lesions of post-kala-azar dermal leishmaniasis.

Albert's solution versus potassium hydroxide solution in the diagnosis of tinea versicolor

BACKGROUND

The diagnosis of tinea versicolor can usually be made by clinical examination. Either potassium hydroxide (KOH) or Wood's light fluorescence are used to corroborate the diagnosis. Albert's solution has been reported as a method of visualizing dermatophytes. We compared Albert's solution to KOH in the diagnostic evaluation of tinea versicolor.

METHODS

Twenty patients with clinical tinea versicolor were examined for the presence of hyphae and/or spores utilizing Albert's solution or KOH (20%) with dimethyl sulfoxide.

RESULTS

All patients were positive for hyphae and/or spores by both methods. Preparations with Alberts' stains were faster and easier to read.

CONCLUSIONS

Albert's solution is an alternate method to stain for fungal elements in patients with tinea versicolor.