Tinea versicolor

A study of the pattern of dermatoses in adolescent patients in South India

BACKGROUND

Adolescence describes the age group between 10 and 19 years. This is the transitional stage of physical and physiological human development generally occurring between puberty and adulthood. Hormonal changes occurring during puberty result in various physical and psychological changes, affecting their social relationship. At this stage, external appearance is of immense concern to them. As such, any dermatological condition can extremely affect their psychological status. This study was conducted to give an insight on the various dermatological conditions of the adolescent age groups and their incidence.

METHODS

Study design: Descriptive study - Cross-sectional study. Three hundred patients between the ages of 10 and 19 years, attending the tertiary care center in South India, were included in the study. A detailed history, clinical examination, and appropriate laboratory investigations were carried out.

RESULTS

Out of 300 patients, females (52.7%) more commonly presented with dermatoses than males (47.3%). Most of the 300 patients belonged to the age group of 17-19 years (50.33%). Infections/infestations (39%) were the most predominant dermatoses followed by acne (17.67%), eczema (9.67%), insect bite reactions (IBRs) (7%), keratinization disorders (6.67%), polymorphic light eruptions (PLEs) (4.33%), urticaria (4.33%), and pigmentary disorders (4.33%).

CONCLUSION

This study gives an insight of various dermatological conditions among the adolescent age groups. Females more commonly presented with dermatoses. The most common dermatoses were infections. Since very few studies regarding dermatoses in adolescents are available in the literature, this study is distinctive in this regard.

Pityriasis versicolor: a review of pharmacological treatment options

Pityriasis versicolor is a common disorder of the skin, which is characterised by scaly hypo- or hyperpigmented lesions on the body. The lipophilic yeast, Malassezia, is considered to be the aetiological agent of this disease. A number of treatment options, both topical and systemic, have been shown to be effective. A critical evaluation of treatment options is presented.

Fehlendes granulozytares Infiltrat bei der Pityriasis versicolor - ein Hinweis fur eine spezifische antiinflammatorische Aktivitat des Erregers? Missing granulocytic infiltrate in pityriasis versicolor - indication of specific anti-inflammatory activity of the pathogen?

The yeast Malassezia furfur is a part of the resident flora of human skin. It causes various diseases such as pityriasis versicolor, which hardly shows signs of inflammation despite marked clinical symptoms (e.g. hypopigmentation). The pathophysiology related morphological picture might give a clue to this phenomenon. As a part of the literature data are controversial, the present study compared the inflammatory infiltrate of pityriasis versicolor with that of tinea corporis in 40 human skin preparations each from diagnostic specimens. All preparations were stained with HE and PAS. Neutrophilic granulocytes were counted in the HE stain, and hyphae and spores in the PAS stain. The number of counted cells was related to the size of the respective area and the values were compared between pityriasis and tinea corporis. Significantly, more neutrophilic granulocytes were found with tinea corporis (P > 0.01), while they were virtually not demonstrable with pityriasis versicolor. It is surprising that fungal load in the stratum corneum is significantly higher with pityriasis versicolor (P > 0.01). Obviously the immune response involving neutrophilic granulocytes does not occur despite high bacterial load. This might be explained by reduced immunogenicity because of high content of lipids in the cell membrane. Furthermore, pityriarubins that are produced during tryptophan metabolism might be involved, which, in a stimulus-dependent manner, can suppress the ROS production of neutrophilic granulocytes in vivo.

Superficial fungal infections

Superficial fungal infections arise from a pathogen that is restricted to the stratum corneum, with little or no tissue reaction. In this Seminar, three types of infection will be covered: tinea versicolor, piedra, and tinea nigra. Tinea versicolor is common worldwide and is caused by Malassezia spp, which are human saprophytes that sometimes switch from yeast to pathogenic mycelial form. Malassezia furfur, Malassezia globosa, and Malassezia sympodialis are most closely linked to tinea versicolor. White and black piedra are both common in tropical regions of the world; white piedra is also endemic in temperate climates. Black piedra is caused by Piedraia hortae; white piedra is due to pathogenic species of the Trichosporon genus. Tinea nigra is also common in tropical areas and has been confused with melanoma.

Pityriasis versicolor on the groin mimicking erythrasma. Fallbericht. Eine Erythrasma nachahmende Pityriasis versicolor in der Leistengegend

Pityriasis versicolor (PV) is a widespread dermatomycosis caused by yeasts. Erythrasma is a superficial bacterial skin disease affecting the major folds of the body, particularly the groin. We report the case of a 45-year-old man, affected by PV, exclusively localized in the inguinal folds and in the inner surface of the thighs, characterized by lesions clinically reproducing erythrasma. The authors underline the possibility that PV mimics erythrasma and vice versa, especially in those countries in which both diseases are quite common, and stress the importance of performing a simple mycological examination to avoid gross diagnostic and therapeutic errors.

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.

Case report. Pityriasis versicolor mimicking Pityriasis rotunda

Pityriasis versicolor is a common dermatomycosis, occurring throughout the world, characterized by irregular, slightly scaly patches, varying in color from red/light brown to white. Pityriasis rotunda, on the other hand, is an uncommon disease, reported in specific ethnic groups, and characterized by perfectly round or oval patches of varying color, with a scaly surface. The histologic pattern is that of ichthyosis vulgaris. We report here the case of a male patient, aged 31, from Sardinia (Italy), affected by Pityriasis versicolor mimicking Pityriasis rotunda. Mycological examination allowed us to formulate the correct diagnosis, and ensuing treatment with antifungal drugs was entirely successful. The authors, while pointing out the rarity of this case, stress the possibility that Pityriasis versicolor mimics Pityriasis rotunda and vice-versa, especially in those countries in which the two diseases are endemic. More widespread recourse to microscopic examination can help avoid the risk of mistaken diagnosis and consequent incorrect treatment.

Comparative efficacy of ketoconazole and fluconazole in the treatment of pityriasis versicolor: a one year follow-up study

Pityriasis versicolor can be treated by a single or multiple dosage regime of ketoconazole as well as by fluconazole. The therapeutic efficacy of these two drugs has not been compared. One hundred and eighty patients with moderate to extensive pityriasis versicolor confirmed by KOH and Wood's lamp examination were randomly assigned to one of the four oral antifungal regimes: Ketoconazole 400 mg single dose (Category I), Ketoconazole 200 mg daily for 10 days (Category II), Fluconazole 400 mg single dose (Category III) or Fluconazole 150 mg per week for 4 weeks (Category IV). Follow up was done at 2 and 4 weeks and then at 3, 6 and 12 months after the treatment in each group. KOH and Wood's lamp examinations were repeated each time. After four weeks of treatment, clinical cure was observed in 66.6% (Category I), 73.3% (Category II), 80% (Category III) and 59.9% (Category IV) of patients. Mycological cure after four weeks of treatment was observed in 53.3% (Category I), 73.3% (Category II), 82.2% (Category III) and 64.4% (Category IV) of patients. After twelve months of follow-up, maximum relapses were observed with Category I. No relapse was seen in Category III patients. The time period of relapse varied from three to ten months. In conclusion, single dose 400 mg oral fluconazole provided the best clinical as well as mycological cure rate with no relapse during twelve months of follow-up.

Superficial fungal infection of the skin. Where and how it appears help determine therapy

Superficial fungal infections of the skin are a common presentation in clinical practice. Any skin surface, the mucous membranes, nail plates, and nail beds can be affected. Tinea pedis is the most common fungal infection and may affect up to 70% of the adult population worldwide. Ubiquitous candidal organisms are found in the oral flora of many healthy persons and result in infection in the presence of certain host factors or immunodeficiency disorders. Onychomycosis has had an increasing incidence worldwide, and it now accounts for almost half of all nail disorders. These and many other infections can have varying presentations as well as features that resemble nonfungal disorders. Therefore, it is important that primary care physicians are familiar with the many cutaneous fungal infections and their differential diagnosis to ensure that appropriate therapy is selected.

Ketoconazole 2% shampoo in the treatment of tinea versicolor: a multicenter, randomized, double-blind, placebo-controlled trial

BACKGROUND

Tinea versicolor is a common superficial fungal infection caused by a lipophilic yeast. This chronically recurring opportunistic infection is especially prevalent in tropical and semitropical regions. The topical short-term application of ketoconazole 2% shampoo may provide effective and safe therapy for tinea versicolor.

OBJECTIVE

The purpose of this study was to evaluate the efficacy and safety of a single application (1 day) versus three daily applications (3 days) of ketoconazole 2% shampoo versus placebo shampoo in the treatment of mycologically confirmed tinea versicolor.

METHODS

Three hundred twelve patients were included in the primary analyses for this 31-day study. Global evaluation scores were measured on days 10 and 31 with a 5-point scale (1 = healed to 5 = worsening), and a cellophane tape test was done at baseline and days 3, 10, and 31. Efficacy was assessed by clinical response, defined as both a global evaluation score of 1 (healed) and a negative cellophane tape test on day 31. Signs and symptoms of tinea versicolor (scaling, itching, erythema, hypopigmentation, hyperpigmentation) also were evaluated at baseline, day 10, and day 31 with a 4-point scale (0 = absent to 3 = severe).

RESULTS

Both regimens of ketoconazole shampoo were significantly (P < .001) more effective than placebo for rate of clinical response, global evaluation scores, and mycologic outcomes (cellophane tape test). The clinical response rates at day 31 were 73%, 69%, and 5% for the 3-day ketoconazole, 1-day ketoconazole, and placebo groups, respectively. The difference in the efficacy of the two ketoconazole treatment regimens was not statistically significant. There were no significant differences between any of the treatment groups in the number of patients who experienced adverse events. No serious adverse events occurred and no patient withdrew from the trial prematurely because of an adverse event.

CONCLUSION

Ketoconazole 2% shampoo, used as a single application or daily for 3 days, is safe and highly effective in the treatment of tinea versicolor.