右腋下花斑糠疹误诊9年1例

患者女，28岁，因“右腋下反复红斑伴瘙痒9a”于2008年10月至中国医学科学院皮肤病医院就诊。患者于9a前无明显诱因右腋下出现指甲盖大小的红斑，无明显脱屑，轻度瘙痒。未予治疗，皮疹增多，融合成片状，夏重冬轻，出汗时症状加重，偶伴刺痛感。曾在外院查真菌直接镜检阳性，考虑为体癣，口服伊曲康唑0．1g，2次／d，服药1周症状好转后停药，1个月后病情反复；口服特比萘芬2周（具体剂量不详），无明显效果。     

伊曲康唑口服联合外用抗真菌药物治疗泛发性体癣的疗效观察

伊曲康唑口服治疗浅部真菌感染已在临床得到广泛应用并取得良好效果。我们在2009年3～9月,采用伊曲康唑口服联合外用抗真菌药治疗33例泛发性体癣患者,取得了满意的临床和真菌学疗效,现报道如下。     

伊曲康唑联合特比萘芬治疗孢子丝菌病1例

孢子丝菌病（sporotrichosis）是由申克孢子丝菌引起的一种亚急性或慢性真菌感染,本病易侵犯皮肤、皮下组织及其附近的淋巴管,当存在免疫缺陷时,可能出现播散型感染。最近我们用伊曲康唑联合特比萘芬治疗1例淋巴管型孢子丝菌病患者,报告如下。     

特比萘芬、伊曲康唑和氟康唑不良反应和药物相互作用评价

医生在应用特比萘芬、伊曲康唑或氟康唑治疗真菌病时,除了需要熟悉其药物的固有不良反应外,还应重视抗真菌药物和其他药物之间的相互作用,以确保患者用药安全有效。     

伊曲康唑和酮康唑香波治疗头癣26例临床疗效观察

目的 观察伊曲康唑间歇冲击疗法和外用酮康唑香波治疗头癣的疗效。方法 采用开放性研究方法,口服伊曲康唑,间歇冲击疗法为1次／d,连服7d,停21d为1疗程;同时酮康唑香波外用,每周2～3次,每次药物停留时间不少于5min。治疗过程中不剪发,不剃头。结果 治疗头癣26例,治愈25例。结论 伊曲康唑间歇冲击疗法与酮康唑香波外用为治疗头癣的有效方法之一。     

特比萘芬联合伊曲康唑治疗孢子丝菌病失败1例

伊曲康唑和特比萘芬治疗孢子丝菌病（sporo-trichosis）有效安全,目前已成为孢子丝菌病治疗指南中的推荐用药[1].但少数患者单用伊曲康唑或特比萘芬不能有效控制病情,研究显示两药分别联合碘化钾溶液或两药联合治疗皮肤型孢子丝菌病显示疗效增强2-6].最近,我们诊治1例由球形孢子丝菌引起的皮肤固定型孢子丝菌病患者,采用特比萘芬联合伊曲康唑治疗失败,之后经特比萘芬联合碘化钾溶液治疗才获得痊愈.鉴于该病例治疗过程的特殊性,我们对其分离菌株进行了一些相关的实验研究,现报道如下.     

伊曲康唑治疗胃部真菌感染1例

患者因患陈旧性心肌梗死、脑梗塞,长期服药致胃黏膜损伤,同时合并糖尿病,引发胃部真菌感染,经口服伊曲康唑200mg,2次／d,治疗3周后痊愈。     

伊曲康唑治疗花斑癣52例疗效观察

我们从1999年4月～2000年3月用伊曲康唑治疗花斑癣52例,获得满意疗效,现将结果报告如下 1材料与方法 1.1临床资料门诊选择经临床和真菌镜检确诊的花斑癣共52例.     

伊曲康唑治疗甲真菌病的疗效观察

本组于2000年3月～2005年6月对128例甲真菌病患者给予口服伊曲康唑胶囊（商品名：斯皮仁诺）治疗,采用间歇冲击疗法,治疗结果报告如下。 1 资料与方法 1．1 临床资料 128例患者均为门诊患者,男性73例,女性55例,年龄17～72岁,平均年龄36．5岁,病程2个月～45年。其中指甲真菌感染者32例（病甲48个）,趾甲真菌感染者72例（病甲377个）,指甲、趾甲均真菌感染者24例（病指甲35个,病趾甲103个）。近端甲下真菌病37例,远端甲下真菌病61例,白色甲下真菌病30例。其中32例伴有手癣,67例伴发足癣,19例伴发甲沟炎,2例伴有股癣。真菌直接镜检,镜下均可见菌丝及孢子。     

伊曲康唑联合特比萘芬治愈着色芽生菌病1例

报告1例由卡氏枝孢瓶霉引起的着色芽生菌病。患者男性,43岁,因右上臂局限性红色斑块性皮损5 a就诊。皮损组织病理为慢性炎性肉芽肿改变,可见硬壳细胞。真菌培养鉴定为卡氏枝孢瓶霉。给予伊曲康唑(200 mg/d)和特比萘芬(250 mg/d)联合治疗12周痊愈。     

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.     

Humoral immune response to Malassezia furfur in patients with pityriasis versicolor and seborrheic dermatitis

Humoral immune responses against exoantigen components of oval, elliptic and round yeast forms of Malassezia furfur were analysed by ELISA and Western blotting assays, using sera from patients with pityriasis versicolor (PV), seborrheic dermatitis (SD) and healthy adults (HA), as control. Sera from patients with SD showed IgG anti-oval M. furfur titers ranging from 1/400 to 1/6400 showing geometric mean (GM) of 1/1472, higher than those obtained with sera from patients with PV (1/200 to 1/6400, GM = 1/1239). Both patient groups showed mean titres statistically superior (p < 0.05) than those obtained from HA (GM = 1/229). Similar data were also obtained with the elliptic and round antigens. However, the anti-oval IgG mean titers from patients' sera were much higher than those obtained with elliptic or round antigenic components (p < 0.05). Anti-M. furfur IgM titers obtained from patient's sera with PV against all three exoantigens were statistically superior (p < 0.05) than HA group. Patients with SD showed IgM titers statistically superior (p < 0.05) only to oval yeasts of M. furfur. The IgA mean titers from patients' groups against the different morphological antigens were shown be slightly higher than those HA group. By Western blot, using rabbit anti-sera, the different antigenic components of M. furfur showed a close relationship mainly between oval and elliptic yeast cells antigens. The 70 kDa component of the M. furfur exoantigen of oval morphology was recognized by 84% of the PV patients' sera. On the other hand, SD patients' sera recognized 3 principal components of 70 kDa (100%), 65 kDa (67%) and 84 kDa (53%). These components may be considered immunological markers for PV and SD. Twenty-five percent of HA sera recognized the components of 65, 70 and 94 kDa. This investigation shows that M. furfur antigens can sensitize the host, mainly the oval yeast form of M. furfur with a very important specific IgG response in patients with SD and PV. This revised version was published online in June 2006 with corrections to the Cover Date.     

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.     

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.     

Identification of Malassezia species isolated from patients with extensive forms of pityriasis versicolor in Siena,Italy

BackgroundPityriasis versicolor (PV) is an infection caused by various species of Malassezia yeast. There is no agreement in the literature concerning the species of Malassezia and the demographic, clinical, and mycological data.AimsTo prospectively identify Malassezia species isolated from lesions of patients with extensive, long standing and recurrent forms of PV and to estimate the relationship between Malassezia species and the demographic and clinical data of the patients.MethodsAll patients with PV were enrolled over a four-year period. Malassezia species were isolated in cultures and identified by morphological features and physiological tests. In the last 2 years a PCR-based technique was used to confirm the species’ identification.ResultsA total of 74 patients (43 males and 31 females, mean age 39.5 years) were enrolled. Only one species was isolated in 45 patients, and more than one species were identified in the remaining 28 patients (38%). M. globosa was the most frequently isolated (60.3%) species. There was a significant association between the isolation of 2 or more species and the presence of at least one predisposing factor. In the last 29 cases, which were subjected to PCR, there were no differences in the identification of isolated species as compared to traditional methods.ConclusionsThe isolation of more than one species in a single lesion is not infrequent in PV and is related to the presence of one predisposing factor. The isolated species isolated were not influenced by demographic and clinical features. The traditional and more recent (PCR) procedures gave the same results in the isolated species.     

伊曲康唑联合全厚皮片移植术治愈着色芽生菌病1例

患者男,47岁.颈部皮损5a,皮损直接镜检可见多个棕色硬壳小体,皮损组织真菌培养为卡氏枝孢瓶霉,皮损组织病理PAS染色可见棕色厚壁孢子.诊断为着色芽生菌病,给予患者口服伊曲康唑胶囊治疗8个月,皮损形成瘢痕,之后采取全厚皮片移植术切除瘢痕,术后继续口服伊曲康唑治疗2个月,皮损痊愈.     

盐酸布替萘芬乳膏治疗体、股癣,手、足癣60例疗效观察

目的观察1%盐酸布替萘芬乳膏治疗60例浅部真菌病疗效。方法进行治疗前、后临床疗效和真菌疗效评价。结果临床疗效评价和真菌疗效评价,总有效率分别为96.67%和96.7%。结论1%盐酸布替萘芬乳膏治疗浅表真菌病疗效良好。     

Synergistic anticandidal activity of xanthorrhizol in combination with ketoconazole or amphotericin B

Candida species are responsible for the fourth most common nosocominal bloodstream infection. Xanthorrhizol, a sesquiterpene compound isolated from Curcuma xanthorrhiza Roxb. has been reported to have anticandidal activity. The aim of this study is to investigate the synergistic anticandidal effect of xanthorrhizol in combination with ketoconazole or amphotericin B against Candida albicans, Candida glabrata, Candida guilliermondii, Candida krusei, Candida parapsilosis , and Candida tropicalis . Mostly, xanthorrhizol in combination with ketoconazole or amphotericin B exhibited the synergistic anticandidal effects against all species of Candida tested. In combination with xanthorrhizol, the concentration of ketoconazole or amphotericin B for inhibiting the growth of the tested Candida species could be reduced by ≥50%. Time–kill curves showed that 1/2 minimum inhibitory concentration (MIC) dose of xanthorrhizol, amphotericin B, or ketoconazole alone against each of the six Candida species did not inhibit the growth of all Candida species tested. However, 1/2 MIC dose of xanthorrhizol in combination with 1/2 MIC dose of ketoconazole or 1/2 MIC dose of amphotericin B exhibited growth inhibition of all Candida species tested and reduced viable cells by several logs within 4 h. These results support the potential use of xanthorrhizol as an anticandidal agent, and it can be used complementarily with other conventional antifungal agents.     

口服特比萘芬联合外用联苯苄唑乳膏治疗足癣长期临床研究

目的 为足癣治疗提供较理想的方案.方法 盐酸特比萘芬250 mg,口服1次/d;1%联苯苄唑乳膏,外用1次/d.250例足癣患者随机入组.A组口服1周加外用1周,B组口服1周加外用2周,C组口服2周加外用1周,D组口服2周加外用2周,E组单独外用4周.在治疗结束时、治疗结束后4周、24周、40周、56周、72周时对各组的疗效、复发率进行评价.结果 在停药后第24周时,A、B、C、D组与E组疗效比较差异有统计学意义.在停药后第40周、56周、72周时,D组与A、B组疗效比较差异也出现统计学意义.在停药后24周、40周时,A、B、C、D组真菌学疗效与E组比较差异有统计学意义.在停药56周、72周时,D组与A、B组真菌学疗效比较差异也出现统计学意义.在停药40周时,A、B、C、D组与E组复发率比较差异有统计学意义.在停药56周、72周时,D组与A、B组复发率比较差异也出现统计学意义.结论 口服特比萘芬2周联合外用1%联苯苄唑乳膏2周治疗足癣的有效率和真菌学疗效最高,复发率最低.     

Antifungal effects of herbal essential oils alone and in combination with ketoconazole against Trichophyton spp

AIMS: To determine the effects of herbal essential oils on Trichophyton spp. growth and to evaluate the effects of Pelargonium graveolens oil and its main components citronellol and geraniol combined with ketoconazole against Trichophyton spp. METHODS AND RESULTS: Growth inhibition of six Trichophyton spp. by herbal essential oils was accessed and the combined effects of P. graveolens oil and its main components citronellol and geraniol were evaluated using a checkerboard microtitre assay against T. schoenleinii, T. erinacei and T. soudanense. The essential oil fraction of P. graveolens and its main components, geraniol and citronellol, exhibited strong synergism with ketoconazole against T. schoenleinii and T. soudanense, with fractional inhibitory concentration (FIC) indices in the range of 0.18-0.38. CONCLUSIONS: The antifungal effects of ketoconazole against Trichophyton spp. are enhanced significantly by administering it in combination with the essential oil fraction of P. graveolens or its main components, because of strong synergism, especially against T. soudanense and T. schoenleinii. SIGNIFICANCE AND IMPACT OF THE STUDY: The combination of ketoconazole and the essential oil fraction from P. graveolens or its main components for treatment of infections caused by Trichophyton species may reduce the minimum effective dose of ketoconazole, and thus minimize the side-effects of ketoconazole.