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.

Pityriasis versicolor

The lipophilic yeast Pityrosporum ovale is both a member of the normal human cutaneous flora in adults and the etiological agent of pityriasis versicolor. Pityriasis versicolor develops under the influence of predisposing factors. The presence of these factors are also the reason for the high rate of recurrence seen in pityriasis versicolor and for its chronicity. There are numerous ways of treating pityriasis versicolor topically and systemically. Propylene glycol 50% in water is effective and cheap, but the imidazoles and the older antidandruff shampoos as well as two new antifungals: ciclopiroxolamine and terbinafine are also effective topically. However, short-term oral treatment with ketoconazole, itraconazole or fluconazole are very effective and the risk for side effects minimized with short treatment regiments. The patient compliance is also higher with oral treatment. The recurrence rate is very high, and to avoid this a prophylactic treatment schedule (eg, ketoconazole) one 200 mg tablet on three consecutive days every month or a single dose of 400 mg every month are effective.

Analyses of skin surface lipid in patients with microbially associated skin disease

The composition of the total skin surface lipid, free fatty acids and fatty acid of triglyceride was used in discriminant analyses to classify patients with severe acne vulgaris (AV), pityriasis versicolor (PV), seborrhoeic dermatitis (SD) and atopic dermatitis (AD). It was not possible to discriminate between the PV and SD patients but all the lipid groups gave a satisfactory separation between AV, PV + SD and AD patients. A similar separation was obtained when the sex of the patient was studied but not when both sex and disease were taken into account. The results suggest that there are fundamental differences in the composition of skin lipid between patients with microbially associated diseases, but the precise role of the organisms has not been ascertained.

[Pityriasis versicolor--modern views on etiology, pathogenesis and therapy]

Pityriasis versicolor (Tinea versicolor) is a superficial chronic fungal infection caused by Pityrisporum species which are normal "inhabitants" of the cutaneous flora. The morphologic changes from yeast to mycelial hypha form are important in the development of clinical lesions. The onset and course of the disease are under the influence of genetic factors, age, sex, climate, local environmental factors, malnutrition, pregnancy, oral contraceptives, corticosteroid and immunosuppressive treatment. They favorize transformation of saphrophytic to pathogenic form, and are the cause of recurrences and chronicity of the disease. The ultrastructural and immunologic studies which are carried out today would significantly contribute to a better understanding of pathogenesis of the disease. The disease is limited to seborrheic areas of the skin and commonly has three clinical forms: papulosquamous, follicular and inverse. This can make great problems in differential diagnosis. In the treatment of these patients it should be kept in mind that Pityriasis versicolor is not a primary contagious disease and that conversion of Pityrisporum depends on the predisposing factors. Numerous medicaments with local and systemic effect which are used nowaday in the treatment and prevention of pityriasis are reported. Way of application, doses, duration of therapy, advantages and disadvantages are given in detail.

Office dermatologic testing: the KOH preparation

A potassium hydroxide preparation is used to confirm the diagnosis of a superficial fungal skin infection. Adding black or blue-black ink to the potassium hydroxide solution highlights fungal organisms and distinguishes them from surrounding cellular debris.

Pityriasis versicolor in the pediatric age

Pityriasis versicolor (PV) is a superficial mycosis, theoretically unusual in children. Epidemiologic and clinical data for children with PV over 11 years was collected. Some explanations are given for the conditions that favored this mycotic infection in children. This study confirms that the face is a usual site of PV in children, in contrast to its rarity as a site in adults. Clinical features are variable and similar to adults. Both sexes are equally affected. The family history is often positive for PV.

Tinea versicolor. A practical guide for primary care physicians

The characteristic pigmentary changes in tinea versicolor are easy to distinguish from dermatophyte infections of the skin. When specific identification is needed, the diagnosis can be confirmed microscopically with a potassium hydroxide preparation or Polysciences Multiple Stain. Tinea versicolor responds readily to topical therapy or oral ketoconazole, but recurrences are common.

Pityriasis (tinea) versicolor in infancy

Pityriasis (tinea) versicolor is a common disorder of adults. We cared for five infants (four males and one female) with the disease. Diagnosis was confirmed by potassium hydroxide preparation demonstrating the filaments of Malassezia furfur and/or Pityrosporum orbiculare, the yeast form. Three patients had lesions in the neonatal period. The mother of one baby had pityriasis versicolor. Two patients were siblings. One baby had associated atopic dermatitis and two had a positive family history of atopy.

[Pityriasis versicolor pseudoatrophicans. A case description]

We report on a pseudoatrophic manifestation of tinea versicolor. A 32-year-old female patient, who had suffered from typical spotty lesions of tinea versicolor for 12 years, now additionally developed pseudoatrophic lesions within a few weeks. Complete remission of these lesions after local antimycotic therapy as well as mycological and histopathological findings confirmed the diagnosis of pseudoatrophic tinea versicolor.

Fungal infections in children

Fungal infections of the skin represent a relatively common problem in pediatric dermatology. Although fungal infections of the feet, nails, and groin are uncommon in the pediatric age group, fungal infections of the scalp are very common and must be diagnosed early because they may lead to permanent hair loss if left untreated. Perhaps the most significant change in fungal infections in children has occurred in tinea capitis, including the causative agent and the type of infection this organism may produce; these factors are focused upon in this article. Also discussed are infections caused by the yeast organisms Candida albicans and Pityrosporum orbiculare, as well as the deep mycoses, specifically chromoblastomycosis and cutaneous aspergillosis.

[Pityriasis versicolor due to Malassezia ovalis]

In a randomly collected series of 175 cases of pityriasis versicolor in residents of the central-northern part of Venezuela, 13% of the patients were infected with ovoid unicellular units of the causal fungus (Malassezia ovalis) and 87% with globous unicellular units in the scales (M. furfur). Only globous unicellular units (Pityrosporum orbiculare) were seen outside the active lesions and in these, after the successful treatment with ketoconazole. The median age of 40 'ovalis' patients was 37.5 years; the same in 40 'furfur' patients was 24.5 years. The median age at the moment of discovering the first lesions among 'ovalis' patients was 31; among 'furfur' patients this was 20 years. There were 16 male patients among the 'ovalis' and 24 among the 'furfur' groups of 40. The topographic distribution of the lesions varied according to the type of the invader. M. ovalis prevailed on the trunk below the waist-line and on the limbs, mainly on buttocks and upper legs. M. furfur prevailed on the chest, neck, face and upper limbs. The hypothesis is offered that the ovoid agent of pityriasis versicolor preferentially occupies the less sweating and sebum-producing parts of the body in older (and drier) persons than the globous type does.

1% sulconazole cream v 2% miconazole cream in the treatment of tinea versicolor. A double-blind, multicenter study

Sulconazole nitrate, a new imidazole derivative, was formulated at 1% concentration in a cream vehicle and compared with 2% miconazole nitrate cream in the treatment of tinea versicolor in a double-blind, multicenter, randomized, parallel clinical trial. At baseline, all of the 192 patients enrolled had a positive potassium hydroxide (KOH) preparation; itching was reported by 48% of the patients. The medications were applied twice daily for three weeks. Of 181 patients analyzed for efficacy at the end of the treatment trial, 93% of sulconazole-treated patients and 87% of miconazole-treated patients had become KOH negative. The complete clearing of tinea versicolor lesions occurred in 89% of sulconazole-treated patients and 82% of miconazole-treated patients. Both drugs were well tolerated with no systemic reactions reported. Drug-related adverse cutaneous reactions, predominantly transient itching, were reported in eight patients receiving sulconazole and in four patients receiving miconazole.