Uncommon cases of pityriasis versicolor

Malassezia may play a role in several dermatoses. It is responsible for foliculitis and mainly for pityriasis versicolor. Pityriasis versicolor is the most known dermatitis because of its clinical aspects and frequently for its poor response to the therapy, mainly in chronic forms. The clinical aspects of uncommon and rare forms of pityriasis versicolor have been reported. The data related to the patients observed in the last thirty years in Siena are reported. In addition, a study was carried out in Pisa by Professor F. Mancianti to identify species of Malassezia isolated in 37 patients.     

江西地区花斑癣患者马拉色菌菌种分析

目的了解江西地区花斑癣患者马拉色菌菌种分布情况。比较传统吐温试验和改良吐温试验。方法对141例临床典型、真菌镜检阳性的花斑癣患者,采用Leeming和Notman培养基培养皮屑。以标准菌株为对照,按形态学和生理生化特点进行分类,分析马拉色菌菌种构成情况。同时比较传统吐温试验和改良吐温试验优缺点。结果培养到95株马拉色菌,分离出5个菌种:合轴马拉色菌62株,糠秕马拉色菌17株,球形马拉色菌9株,钝形马拉色菌6株,限制马拉色菌1株。结论合轴马拉色菌占有明显优势(65.26%)。改良吐温试验易于操作、费时短,尤其适合多标本的流行病学调查研究,值得推广。     

Isolation of Malassezia globosa and M. sympodialis from patients with pityriasis versicolor in Spain

Pityriasis versicolor is a superficial infection of the stratum corneum by several yeast species formerly collectively named Malassezia furfur. The genus Malassezia has been recently enlarged with new species. With the exception of M. pachydermatis, the remaining six species have an absolute requirement in vitro for supplementation of long-chain fatty acids in media. These lipophilic yeasts comprise six species: M. furfur, M. globosa, M. obtusa, M. restricta, M. slooffiae and M. sympodialis. The aim of this study was to establish whether there was any association between the various species of Malassezia and pityriasis versicolor lesions. Thus, we studied the isolates from 79 patients with pityriasis versicolor, both from lesions and from apparently healthy skin close to the visible lesions. In pityriasis versicolor lesions, the species most frequently isolated was M. globosa (90%), followed by M. sympodialis (41%). Almost all isolates (99%) belonged to one of these two species. The most frequent pattern was M. globosa as the sole species (58% of cases), although the association with M. sympodialis was also frequent (30%). These results confirmed M. globosa as the main agent of pityriasis versicolor and M. sympodialis as the second agent in importance. Malassezia globosa was found to be a species with high levels of esterase and lipase enzymes of probable importance in their pathogenicity. This revised version was published online in June 2006 with corrections to the Cover Date.     

Contribution to the study of dermatomycosis in Catalonia

We report the results of a study which aim was the mycological identification of specimens coming from patients included in a clinical trial. A total of 445 specimens from patients with clinical diagnosis of dermatomicosis were processed during 8 months (138 pityriasis versicolor, 28 cutaneous candidosis and 279 dermatophytosis). A 48% of pityriasis versicolor cultures were positive for Malassezia furfur, 50% of candidosis cultures were positive for yeasts and 67% of dermatophytosis cultures were positive for dermatophytes. According to our results Candida albicans was the principal causative agent for cutaneous candidosis and Trichophyton mentagrophytes and Trichophyton rubrum were the most frequent isolated species causing dermatophytosis.     

Skin diseases associated with Malassezia species in humans. Clinical features and diagnostic criteria

Malassezia yeasts not only cause the well known pityriasis versicolor and folliculitis, but also play an important role in other skin diseases, including seborrheic dermatitis and atopic dermatitis. The presence of Malassezia yeasts may be confirmed by direct microscopic examination and cultures of skin scrapings. In pityriasis versicolor the direct microscopic examination is the rapidest and surest test for confirming the clinical diagnosis. The preparation will show a cluster of globose budding spores with thick or double wall and short hyphae. For detecting Malassezia in the other diseases the cultures is preferable. Culture is useful both for confirming the clinical diagnosis and for epidemiological investigations. The identification of the Malassezia species is not easy. The microscopic observation of the colony direct towards the identification of Malassezia species, but it is not enough to identify the colonies definitely. Several biochemical tests are necessary for a precise identification, such as catalase reaction, growth on media without lipid sources, ability to utilize hydrophilic emulsifiers as sole lipid source, esculin test, tryptophan test.     

822例浅部真菌病及其致病菌种分析

目的分析新疆乌鲁木齐市浅部真菌病病原菌的流行趋势。方法对2006年1月～2013年12月就诊于我院皮肤科门诊、有典型临床表现、真菌镜检及培养均阳性的822例患者进行致病病种及菌种分析。使用SPSS17．0统计软件对于结果进行统计分析。结果822例患者包括8个病种：体癣214例（26．0％）,足癣131例（15．9％）,头癣128例（15．6％）,甲真菌病125例（15．2％）,股癣119例（14．5％）,手癣54例（6．6％）,皮肤念珠菌病38例（4．6％）,花斑糠疹13例（1．6％）。菌种分布以须癣毛癣菌为首位,336株（40．9％）,其次为红色毛癣菌共239株（29．1％）,犬小孢子菌68株（8．3％）,铁锈色小孢子菌48株（5．8％）,念珠菌38株（4．6％）,断发毛癣菌33株（4．0％）,许兰黄癣菌23株（2．8％）,马拉色菌13株（1．6％）,疣状毛癣菌9株（1．1％）,紫色毛癣菌7株（0．9％）,支顶孢霉菌4株（0．5％）,曲霉、絮状表皮癣菌各2株（各0．2％）。统计学分析显示：不同性别足癣、股癣、甲真菌病及花斑糠疹构成比有统计学意义（P〈0．05）,除体癣及花斑糠疹外,本组其他浅部真菌病的分布在年龄方面有着明显的差别（P〈O．05）。结论乌鲁木齐市浅部真菌病发病率排在前3位的依次为体癣、足癣、头癣,致病病原菌以毛癣菌为主,须癣毛癣菌为首位致病菌,其次为红色毛癣菌。足癣及甲真菌病好发于女性,而股癣及花斑糠疹好发于男性。除体癣及花斑糠疹外,不同年龄段浅部真菌病分布有明显差异,其中头癣主要好发于青少年。     

Genotyping by RAPD-PCR analyses of Malassezia furfur strains from pityriasis versicolor and seborrhoeic dermatitis patients

Malassezia furfur is lypophilic yeast commonly associate with dermatological disorders. In the present work, we described the isolation of 47 M. furfur strains from three groups of patients: pityriasis versicolor (21 isolates), seborrhoeic dermatitis (15 isolates) and seborrhoeic dermatitis of the HIV positive patients (11 isolates). To investigate the identity of the strains at molecular level, DNA genomic of M. furfur strains were prepared and used to RAPD-PCR analyses. RAPD assay were carried out using two decamer primers and bands pattern generated were analyzed by an Unweighted Pair-Group Method (UPGMA). Dendrogram established a distinct differentiation between M. furfur isolates from pityriasis versicolor and seborrhoeic dermatitis patients with or without AIDS. We concluded that RAPD typing presented a high discriminatory power between strains studied in this work and can be applied in epidemiological investigation of skin disease causing by M. furfur.     

伊曲康唑联合外用药物治疗花斑糠疹临床研究

目的探讨伊曲康唑胶囊联合1%盐酸布替萘芬乳膏和2%酮康唑洗剂治疗花斑糠疹的疗效及不良反应。方法入选患者按单双日分为两组,两组均口服伊曲康唑0.2g,1次/d,连续7d,同时外用1%盐酸布替萘芬乳膏,1次/d,连续14d,对照组停药观察,试验组同时使用2%酮康唑洗剂洗浴,每周2次,连用3个月。分别于治疗前、治疗后1、3、6、12个月评价疗效。结果试验组114例患者3个月时痊愈率78.1%,6个月时痊愈率90.4%,对照组125例患者3个月时痊愈率72.8%,6个月时痊愈率75.2%,12个月后试验组复发率1.8%,对照组为18.4%。结论伊曲康唑胶囊短时口服联合外用布替萘芬和酮康唑洗剂洗浴疗效较好,安全性高,使用方便,可大大降低花斑糠疹的复发率。     

Species of Malassezia associated with various dermatoses and healthy skin in the Mexican population

At the present, eight Malassezia species have been described and their distribution in normal skin and in several skin diseases appears variable. The aim of the present study was to determine the frequency and distribution of Malassezia species in patients with psoriasis, seborrhoeic dermatitis and pityriasis versicolor attended in a Hospital from Mexico City, in addition to a healthy individual group. Scales of abnormal and healthy skin were grown in modified Dixon agar and the species identification was performed by macroscopic and microscopic features; by catalase and urease reaction; growth at 32, 37 and 40 degrees C; and Tween 20, 40, 60 and 80 assimilation. The cultures from 63 persons were included: forty six patients (20 psoriasis, 15 seborrhoeic dermatitis, 11 pityriasis versicolor) and 17 healthy individuals (external auditory canal). A total of 96 isolates were obtained. The more frequently isolated species were: M. sympodialis (38.2%) and M. furfur (26.5%) in psoriasis; M. sympodialis (38.5%) and M. slooffiae (34.6%) in seborrhoeic dermatitis; M. globosa (46.7%) and M. sympodialis (26.7%) in pityriasis versicolor; and M. restricta (47.6%) and M. globosa (23.8%) in normal skin. The number of isolates, the species diversity and association were higher in the patients group than in the healthy individuals group.     

Isolation of dermatophytes,Candida species and systemic fungi from dermatologic specimens in Montréal, 1963 to 1973.

Of 10 057 specimens of scrapings from skin, nails and scalp examined for dermatophytes, yeasts, pityriasis versicolor and systemic mycoses between 1963 and 1973, 30.4 percent were positive for fungi. Skin produced the highest proportion (68.6 percent) of positive scrapings, scalp the lowest (4.2 percent). Trichophyton rubrum was the predominant species (23.6 percent); of lesser prevalence were Microsporum canis (9.3 percent), T. mentagrophytes (8.4 percent) and Epidermophyton floccosum (4.8 percent). Double infections were encountered on 102 occasions; T. rubrum and Candida parapsilosis were the most frequent cohabiting species. The introduction in 1966 of periodic acid-Schiff staining for routine examination of scrapings resulted in better diagnostic results, particularly in the case of culturally nonproductive specimens and cases of pityriasis versicolor. Blastomyces dermatitidis and Cryptococcus neoformans were isolated from two patients in the course of routine investigation for dermatophytes.     

Molecular Epidemiology of Malassezia globosa and Malassezia restricta in Sudanese Patients with Pityriasis Versicolor

Pityriasis versicolor is a superficial infection of the stratum corneum caused by Malassezia yeasts. The cutaneous Malassezia globosa and Malassezia restricta in Sudanese patients with pityriasis versicolor were elucidated using a molecular-based, culture-independent method and compared with that in healthy individuals. Scale samples were collected by applying an Opsite? transparent dressing to lesional and non-lesional sites on 29 Sudanese patients with pityriasis versicolor and 54 healthy individuals. Malassezia DNA was extracted directly from the samples. The overall level of colonization by Malassezia globosa and Malassezia restricta was analyzed by real-time PCR using a TaqMan probe. The overall level of colonization by Malassezia at the lesional sites was higher than that at the non-lesional sites for all body sites, including the face, neck, cheeks, and trunk (2.7- to 6.0-fold increase). Both M. globosa and M. restricta were detected in patients and healthy individuals. However, M. globosa predominated at lesional sites, whereas the level of colonization by both species was similar in healthy individuals.     

A study of pityriasis versicolor in Bangkok (Thailand)

A total of 410 cases of pityriasis versicolor were studied in the Division of Dermatology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, during January to December 1987. These comprised 1% of all skin disorders, while infection caused by fungus comprised 17%. Most persons infected with pityriasis versicolor were 12–21 years old (mean age 20 years) and 47% were male and 53% were female. The common sites of infection were back, arms, face and trunk. The colors of lesions found were white (83%), brown (7%), pink (6%) and ashy (4%). Both forms of M. furfur were isolated, the ovale form in 97% and the orbiculare form in 3% of cases. The colors of the lesions did not depend on the form of the organism. Mycological and immunological studies confirmed that the two forms were different stages in the complex developmental cycle of a single species.     

Taxonomy of Exophiala werneckii and its relationship to Microsporum mansonii

Study of the neotype culture of Exophiala werneckii (Cladosporium werneckii), as well as additional isolates, has shown that the yeast-like and hyphal conidiogenous cells are annellides. E. werneckii cannot be accommodated in Cladosporium, a genus characterized by catenulate holoblastic coanidia. E. werneckii and the dematiaceous hyphomycete that Castellani misidentified as Microsporum mansonii (Cladosporium mansonii) are two entirely different fungi. M. mansonii is considered to be a synonym of the Malassezia furfur since both names were used to describe in tissue the etiologic agent of pityriasis versicolor.     

Pityriasis Versicolor: Treatment Update

Purpose of Review

To address the latest treatments used for pityriasis versicolor and identify those that have proven to be effective in recent publications.

Recent Findings

Even though Malassezia spp. have shown resistance to antifungals, classical treatments continue to be effective, and other novelty therapies including light therapies have shown promising results in the treatment of this condition.

Summary

Pityriasis versicolor is a common superficial fungal infection of the skin. There are numerous and diverse topical and systemic therapeutic options that are successful for the treatment and prophylaxis of this mycosis. New substances that act against the fungus through other mechanisms of action different from those used until now are expected in the near future.

     

A clinical study of Pityriasis versicolor in Madras

One hundred subjects with extensive pityriasis versicolor determined clinically and confirmed by wet preparations (potassium hydroxide positive) were studied. Its incidence in relation to sex, seasons and age groups was analyzed. More than fifty patients sought medical advice on grounds of cosmetic handicap. The most pronounced clinical feature was to be found on the trunk. One case was Confluent and Reticulated Papillomatosis of Gugerot-Carteaud (CRP) (16). Among the factors of susceptibility, pulmonary tuberculosis (P.T.) emerged statistically significant.     

Pityriasis Versicolor: Clinical Spectrum and Diagnosis

Pityriasis versicolor (PV) is caused by the fungus Malassezia, especially by Malassezia globosa. The predisposing factors for PV are heat, humidity, hyperhidrosis, oral contraceptives, stress, application of oily preparations, and treatment with corticosteroids. PV is found mainly on the seborrheic areas of the trunk, shoulders, upper aspects of the arms, and neck, but it may spread to the face, scalp, submammary areas, axillae, groin, skin folds, and buttocks. It is characterized by hyperpigmented, hypopigmented, or erythematous (versicolor), round-to-oval, finely scaling, thin plaques. Other less frequent clinical variants are papular, atrophic, imbricata, and pityriasis rubra pilaris-like presentations. The diagnosis of PV is usually made clinically with the aid of Wood’s light or dermoscopy. Direct microscopic examination, culture, biopsy, and molecular studies are among the laboratory diagnostic methods. Topical therapy is the treatment of choice for most patients. Systemic imidazole therapy is usually reserved for widespread or resistant cases.     

Taxonomy of Malassezia furfur: state of the art

Malassezia furfur is a lipophilic yeast considered as a normal component of the human skin flora. Apart from pityriasis versicolor, M. furfur has been linked to several skin diseases such as seborrheic dermatitis, folliculitis or atopic dermatitis. Moreover, these yeasts have been reported as agent of invasive human diseases including pneumonia, catheter-associated sepsis and peritonitis. The existence of morphological, serological, metabolical, biochemical and karyotipical differences has been described among isolates of these yeasts. These observations gave arguments for a possible intraspecific division, and this hypothesis has been confirmed by the existence of six species within the formerly called M. furfur (lipid-dependent Malassezia strains): M. furfur, Malassezia sympodialis, Malassezia globosa, Malassezia obtusa, Malassezia restricta and Malassezia slooffiae.     

无锡地区293例儿童浅部真菌病临床分析

目的研究无锡地区儿童浅部真菌病的流行及病原菌特点。方法采用真菌镜检和含氯霉素(和含氯霉素及放线菌酮)的葡萄糖蛋白胨琼脂培养,根据菌落形态及其镜下形态鉴定菌种。结果 293例临床诊断患儿中,直接镜检阳性245例,阳性率83.6%,其中皮肤念珠菌病、足癣、头癣发病例数居前3位,分别为79例(32.2%)、50例(20.4%)和46例(18.8%),共175例,占总病例数的71.4%,其次分别为体癣、甲真菌病、手癣、股癣、花斑糠疹,分别为29例(11.8%)、13例(5.3%)、11例(4.5%)、10例(4.1%)、7例(2.9%)。随着年龄增长,患儿易患疾病有所差异,花斑糠疹0～2岁发病率最高;皮肤念珠菌病0～3岁发病率最高;头癣4～8岁发病率最高;体股癣、手、足癣9～15岁发病率最高。238例镜检阳性标本(7例花斑糠疹除外)共培养出致病菌145株,阳性率为60.9%,其中皮肤念珠菌病培养阳性率为70.9%,股癣70%,体癣51.7%,甲真菌病53.8%,头癣65.2%,足癣50%,手癣45.5%。在145株致病菌中,念珠菌属63例(43.45%),红色毛癣菌43例(29.7%),犬小孢子菌26例(17.93%),须癣毛癣菌4例(2.76%),紫色毛癣菌3例(2.07%),石膏样小孢子菌3例(2.07%),断发毛癣菌2例(1.38%),絮状表皮癣菌1例(0.69%)。结论本研究为无锡地区防治儿童浅部真菌病提供了依据。     

Activity of ajoene on dermatophytes, Candida albicans and Malassezia furfur.

The sensitivity in vitro of an isolate of Trichophyton rubrum and another of Trichophyton mentagrophytes to ajoene. This compound inhibited the growth of both isolates, showing an minimal inhibitory concentration (MIC) of 60 microg/ml and a minimal fungicidal concentration (MFC) of 75 microg/ml. In vivo, the ajoene cream at 0.4% used once a day and every five days in 38 patients (thirty dermatophytosis and eight Candida intertrigo cases) achieved a low percentage of cures (23.3% and 12.5%, respectively). However, an excellent clinic response was obtained in eight patients with pityriasis versicolor, with a cure in 87.5% of the cases.     

The tryptophan aminotransferase Tam1 catalyses the single biosynthetic step for tryptophan-dependent pigment synthesis in Ustilago maydis

Tryptophan is a precursor for many biologically active secondary metabolites. We have investigated the origin of indole pigments first described in the pityriasis versicolor-associated fungus Malassezia furfur . Some of the identified indole pigments have properties potentially explaining characteristics of the disease. As M. furfur is not amenable to genetic manipulation, we used Ustilago maydis to investigate the pathway leading to pigment production from tryptophan. We show by high-performance liquid chromatography, mass spectrometry and nuclear magnetic resonance analysis that the compounds produced by U. maydis include those putatively involved in the etiology of pityriasis versicolor. Using a reverse genetics approach, we demonstrate that the tryptophan aminotransferase Tam1 catalyses pigment biosynthesis by conversion of tryptophan into indolepyruvate. A forward genetics approach led to the identification of mutants incapable of producing the pigments. These mutants were affected in the sir1 gene, presumably encoding a sulphite reductase. In vitro experiments with purified Tam1 showed that 2-oxo 4-methylthio butanoate serves as a substrate linking tryptophan deamination to sulphur metabolism. We provide the first direct evidence that these indole pigments form spontaneously from indolepyruvate and tryptophan without any enzymatic activity. This suggests that compounds with a proposed function in M. furfur -associated disease consist of indolepyruvate-derived spontaneously generated metabolic by-products.