Studies on the yeast flora in patients suffering from psoriasis capillitii or seborrhoic dermatitis of the scalp

Oral candidiasis in patients with psoriasis: correlation of oral examination and cytopathological evaluation with psoriasis disease severity and treatment

BACKGROUND

Infections are known to trigger and exacerbate psoriasis. Although oral candidiasis is often clinically diagnosed, it is not always confirmed by laboratory tests such as oral cytopathology.

OBJECTIVES

The aims of this study were to determine the prevalence of oral candidiasis in patients with psoriasis through clinical and cytopathological diagnosis and to investigate the association between oral candidiasis and psoriasis with regards to the severity of the clinical presentation and the type of treatment for psoriasis.

METHODS

A total of 140 patients with psoriasis and 140 healthy control subjects received an oral examination. Scrapings of the tongue were also obtained for a cytopathological examination.

RESULTS

The oral examination and the results of the cytopathological smear revealed 37 (26%) cases of candidiasis in the patients with psoriasis and no cases of candidiasis in the healthy control subjects. There was no correlation between the type of psoriasis treatment and the presence of oral candidiasis (P = .616). There was a statistically significant association (P = .033) between the clinical severity of psoriasis and the presence of Candida.

LIMITATIONS

This study was limited by the small number of subjects and the lack of follow-up to determine the development of psoriasis after treatment for oral candidiasis.

CONCLUSIONS

The presence of oral candidiasis is higher in patients with psoriasis and it is associated with disease severity. This increased presence of oral candidiasis was apparent despite any type of treatment for the psoriasis. Cytopathology to rule out oral candidiasis should be used in the routine medical workup of patients with psoriasis.

Oral Candida colonization and candidiasis in patients with psoriasis

OBJECTIVES

The objective of this study was to investigate oral Candida colonization and candidosis in a group of patients with psoriasis and controls.

STUDY DESIGN

A total of 100 patients with psoriasis and matched controls underwent the concentrated oral rinse test for Candida isolation. Candida species were identified by the VITEK 2 Identification System. Categorical variables were evaluated using the χ(2) test. The median Candida count was compared using the Mann-Whitney U test.

RESULTS

Oral candidiasis was diagnosed in 3% of the patients with psoriasis. The Candida count and prevalence were significantly higher in the patients with psoriasis compared with controls (69% vs 44%, P < .001), but with no relationship to the severity or treatment of psoriasis. Oral Candida was significantly higher in late-onset (at age ≥30 years) compared with early-onset psoriasis (at age <30 years).

CONCLUSIONS

Patients with psoriasis have increased oral Candida colonization and candidiasis. Further studies are needed to clarify the predisposing factor(s) for oral Candida in patients with psoriasis.

Prevalence of Candida on the tongue and intertriginous areas of psoriatic and atopic dermatitis patients

Data in the literature regarding the prevalence of Candida in psoriatic and atopic dermatitis patients are controversial. We conducted a prospective study to determine the prevalence of Candida on the tongue, axillae and groin of psoriatic patients when compared with atopic dermatitis patients and normal controls. During the period 2003-2005, data were collected from 100 psoriatic patients, 100 patients with atopic dermatitis and 100 normal controls. Fungal test specimens for Candida were collected from the axillae, groin and tongue of each patient. There was no increase in the prevalence of Candida in intertriginous area of either psoriatic or atopic dermatitis patients. However, the prevalence of Candida on the tongue was significantly higher in psoriatic patients (32%) compared with atopic dermatitis (18%) (P = 0.024) and higher, although not significantly, than in normal controls (21%) (P = 0.08). Our study did not reveal higher prevalence of Candida in the axillae and groin of either psoriatic or atopic dermatitis patients. There was a higher prevalence of Candida on the tongue of psoriatic patients. The Candida of the tongue was asymptomatic and did not correlate with age, gender, type of psoriasis or severity of the disease, therefore we conclude that this is clinically irrelevant.

Triggering psoriasis: the role of infections and medications

Psoriasis can be provoked or exacerbated by a variety of different environmental factors, particularly infections and drugs. Strong evidence exists for the induction of guttate psoriasis by a preceding tonsillar Streptococcus pyogenes infection, whereas disease exacerbation has been linked with skin and/or gut colonization by Staphylococcus aureus, Malassezia, and Candida albicans. The role, if any, of viruses (papillomaviruses, HIV, and endogenous retroviruses) present in lesional skin is at present unknown. The use of various drugs, such as lithium, beta-blockers, antimalarial agents, nonsteroidal anti-inflammatory drugs, and angiotensin-converting enzyme inhibitors, has also been associated with induction or worsening of disease in psoriatic patients.

Fecal fungal flora of pediatric healthy volunteers and immunosuppressed patients

Most hematogenous candidiasis originates from endogeneous host flora. Fungal flora of gastrointestinal system are important source of infection especially in immunosupressed patients. The purpose of this study was to investigate the fecal fungal flora of pediatric patients with hematologic malignancy or disorders and to compare the results with healthy volunteers. For this purpose, fungal etiological agents were investigated retrospectively in stool samples of 80 patients followed in Bone marrow transplantation and Hematology-Oncology units. The diagnosis of patients were as follows: 26 acute myelogeneous leukemia, 19 acute lymphocytic leukemia, 5 lymphoma, 3 chronic myelogeneous leukemia, 2 solid tumor, 4 neuroblastoma and 21 hematologic disorders. In patients, totally 102 fungal growth was detected and 42 (41.2%) C. albicans and 51 (50%) non-albicans Candida species and 9 (8.8%) yeast other than Candida and mould was isolated. The results were compared prospectively with growth in stool samples of 61 healthy children. C. albicans was detected in 16 (43.2%) and non-albicans Candida species in 15 (40.5%) and yeasts other than Candida and mould in 6 (16.2%) of 37 fungal growth in controls. Non-albicans Candida species growth was found significantly higher and C. glabrata was more prevelant in patients than in controls (p < 0.001).

Faecal fungal flora in healthy volunteers and inpatients

The faecal fungal flora was analysed in healthy volunteers and inpatients. Self-obtained stool swabs from volunteers (n = 228) and inpatient stool-samples (n = 34) were cultured on Inhibitory-Mould-Agar plates. All yeast isolates were identified. Fungi were detected in 51.8% of volunteers; the majority (88.1%) had single species. The prevalence increased steadily with age. Candida albicans was detected in 62.7%, non-albicans Candida species in 22.0%, yeasts--other than Candida in 20.3% and moulds in 8.5% of volunteers with fungi. No gender-related differences were noted in the prevalence or types of yeast. Candida glabrata and C. krusei were detected in adults only. Intra-household species-similarity (excluding C. albicans) was noted in seven of 31 (22.6%) households with fungi in two or more members. Inpatients had higher prevalence of yeast (88.2%) with a single species in the majority (73.3%). Yeasts other than Candida were less common in inpatients (3.3%; P = 0.013) whereas C. glabrata was significantly more prevalent (33.3 versus 2.5%; P < 0.001). This study delineates the faecal fungal flora in volunteers and inpatients. Most subjects harbour a single species that may be shared with other households. The prevalence is somewhat higher in adults and the types of yeast may vary with age. Finally, C. glabrata appears to be acquired nosocomially.

Incidence of Candida in psoriasis--a study on the fungal flora of psoriatic patients

The presence of Candida albicans and other Candida species in saliva and faeces of 50 psoriatic patients compared with a control group of 50 healthy donors was examined quantitatively. The quantity of Candida in saliva and faeces of the psoriatics proved to be significantly higher than in the controls. Candida was detected in 78% of the saliva samples of the psoriatics but in only 50% of the controls, and in the faeces samples in 72% of the psoriatics, but in only 46% of the controls. Qualitative analysis revealed a predominance of Candida albicans (saliva, 77%; faeces, 64%) and Candida rugosa (saliva, 28%; faeces, 28%). We did not find a correlation between the severity of the psoriasis according to the Psoriasis Area and Severity Index and the amount of Candida in the saliva or in the faeces. Our results reinforce the hypothesis that C. albicans is one of the triggers to both exacerbation and persistence of psoriasis. We propose that in psoriatics with a significant quantity of Candida in faeces, an antifungal treatment should be considered as an adjuvant treatment of psoriasis.

Systemic aspects of psoriasis. An integrative model based on intestinal etiology

Psoriasis can best be understood from a multifactorial approach that recognizes the systemic aspects of the disorder. Among the various factors thought to be involved in the etiology and pathogenesis of psoriasis, bowel pathology has assumed a noteworthy position in the literature. This article reviews the psoriasis/bowel connection with regard to abnormal bowel structure and physiology in psoriasis patients. Clinical implications of bowel involvement in psoriasis are discussed within the framework of an integrative medicine model that emphasizes natural therapeutics for addressing the systemic aspects of the illness.

Limited effect of refined carbohydrate dietary supplementation on colonization of the gastrointestinal tract of healthy subjects by Candida albicans

BACKGROUND

Infections due to Candida albicans occur readily in situations in which ample glucose is available. In mice, dietary refined carbohydrate supplementation leads to higher rates of Candida growth in the gastrointestinal tract and favors mucosal invasion.

OBJECTIVE

The modulating properties of dietary carbohydrate supplementation on colonization of the human gastrointestinal tract by C. albicans were evaluated.

DESIGN

A 2-step study was conducted in 28 healthy volunteers. First, we determined the subjects' habitual uptake of refined carbohydrates and correlated these data with the C. albicans blastoconidia concentration in the mouth washes and feces of subjects with no intervention. Second, we compared C. albicans counts in the specimens before, during, and after a high-sugar diet.

RESULTS

No correlation between C. albicans counts in the specimens and the habitual uptake of refined carbohydrates was observed. A high-sugar diet did not increase the frequency of C. albicans-positive samples, the number of subjects positive for C. albicans in the mouth washes, or the concentration of candidal blastoconidia in the samples of the 28 subjects. However, in selected subjects with elevated counts of oral C. albicans, we observed an increase in fecal C. albicans counts in response to the diet.

CONCLUSIONS

The effect of adding a high amount of refined carbohydrates to the diet of healthy human subjects has a limited influence on Candida colonization. Follow-up studies should define whether selected patient groups might benefit from dietary restriction of refined carbohydrates.

[Mycoses in patients with psoriasis or atopic dermatitis]

Both, psoriasis and atopic dermatitis are multifactorial diseases with an unknown pathogenesis. To elucidate the influence of fungal infections in the onset or recurrence of those inflammatory skin disease we determined the frequencies of Candida and dermatophyte infections of the skin and orointestinal tract concomitantly seen in patients with psoriasis or atopic dermatitis. We analyzed the files of more than 40,000 in-patients of the Department of Dermatology, Kiel. Sex- and age-adjusted relative risk were calculated. The results demonstrate that patients with psoriasis (N = 3006) presented with a decreased rate of tinea. This was significant for tinea corporis (RR = 0.13, p < 0.01). Candida infections of the skin were seen more often in psoriasis patients compared to controls. Differentiating between Type I (early onset) and Type II (late onset) psoriasis only Type I psoriasis patients presented with decreased dermatophyte infections and increased Candida colonization of the intestinum. However, patients with Type II psoriasis demonstrated an increased rate of candidosis cutis and candidosis oris as compared to controls. Patients with atopic dermatitis (N = 1808) displayed a decreased overall incidence of tinea and Candida infections. Furthermore, in patients with atopic dermatitis a Candida colonization of the orointestinal tract was found elevated (RR = 1.51, p < 0.01), whereas tinea corporis (RR = 0.24, p < 0.01) and candidosis cutis (RR = 0.30, p < 0.001) was found decreased compared to controls. Our results show that the influence of fungal infections on the two skin diseases investigated is not as strong as often considered. The increased relative risk in patients with atopic dermatitis to present with Candida colonization in the digestive tract or vice versa may contribute to the pathogenesis of atopic dermatitis.

[Mucocutaneous candidiasis in patients with skin diseases]

We investigated skin diseases associated with mucocutaneous Candida infection by analyzing the clinical records of 44695 in-patients of the department of dermatology of Kiel. For more than eighty skin diseases the relative risk (RR) was calculated by age-and sex-adjusting methods. 1996 patients demonstrated a mucocutaneous candidosis, 14.8% of them being hospitalized because of extensive Candida infection. In patients with dermatomyositis, bullous pemphigus, tinea inguinalis, and condylomata acuminata a Candida infection was observed more than threefold than expected. Furthermore, patients with urticaria, folliculitis, and bullous pemphigoid demonstrated candidosis more than twice as often as control patients. In addition, patients with erysipelas, acne, psoriasis, and atopic dermatitis showed a candidosis significantly more often (RR between 1.3 and 1.6). Some internistic maladies were investigated, too. In patients presenting with diabetes mellitus, heart-insufficiency, hypertension, chronic tonsillitis, and urinary tract infection a mucocutaneous Candida infection was significantly increased.