An update on pityrosporum folliculitis in Singapore from a single tertiary care dermatological centre

INTRODUCTION@#Pityrosporum folliculitis (PF) is a common skin condition that can be easily misdiagnosed, especially by non-dermatologists. While the initial diagnosis is often made clinically, skin microscopy may help to confirm the same. However, there is scant literature regarding the clinical epidemiology of PF. To our knowledge, in Singapore, only one prior epidemiological study was performed in 1987. Through the present study, we aimed to provide an update regarding the epidemiology, diagnosis and treatment of patients with PF in Singapore.@*METHODS@#We performed a retrospective review of patients with clinical presentations compatible with PF who presented to the dermatology clinic at the National University Hospital, Singapore, between 1 January 2011 and 31 December 2015. The medical records of patients identified as having clinical presentations that resembled PF were reviewed via written and electronic databases. Information regarding the demographics and clinical presentation of the patients was collected.@*RESULTS@#Of the 375 patients identified, 214 (57.1%) were confirmed as having PF based on Gram-stain microscopy. Most (35.0%) of these 214 patients were aged between 21 and 30 years, with a male-to-female ratio of 3:1. The lesions predominantly occurred on the trunk and the back. The majority of patients presented with symptoms that lasted more than one month. 128 (59.8%) patients received oral antifungal treatment, whereas 82 (38.3%) patients were treated with topical antifungal treatment alone.@*CONCLUSION@#A typical Singapore patient with PF is a young man aged 21-30 years, with erythematous follicular papules or pustules over the trunk and the back.

Prevalence of different Malassezia species in pityriasis versicolor in central India.

Background: In the last 10 years, different studies have shown interesting geographical variations in the prevalence of different Malassezia species in pityriasis versicolor. Aim: Identification of Malassezia species isolated from patients with pityriasis versicolor. Methods: In 100 patients with pityriasis versicolor, Malassezia species were identified by culture in Sabouraud's dextrose agar containing cycloheximide with olive oil overlay and modified Dixon agar and by doing biochemical tests (catalase reaction, assimilation of glycine, and Tween utilisation tests). Results: In 10 patients, 10% KOH smear was negative, while in 90 patients the smear showed characteristic "spaghetti and meatball" appearance. Of these 90 cases, growth was obtained on modified Dixon's agar in 87 cases. Fifty of the isolates (57.5%) were M. globosa, 15 (17.2%) were M. sympodialis, seven (8.0%) were suspected M. sympodialis, 6 (6.9%) each of the isolates were M. furfur and M. obtusa, and three (3.4%) isolates were M. restricta. Conclusion: M. globosa was the most common species, followed by M. sympodialis, M. furfur, M. obtusa, and M. restricta.

A Case of Head and Neck Dermatitis Treated with Itraconazole / 대한의진균학회지

Head and neck dermatitis is a variant of atopic dermatitis often seen in young adults. Pityrosporum is a normal skin commensal. Thus, its importance as a pathogen of atopic dermatitis was neglected in the past. It was found, however, that the treatment of head and neck dermatitis with an antifungal agent results in clinical improvement. At present, although the pathogenesis of atopic dermatitis has not yet been fully elucidated, Pityrosporum is considered one of the triggers of head and neck dermatitis. The case of an 18-year-old male who had a history of head and neck atopic dermatitis with erythematous xerotic patches accompanied by a yellowish colored crust and oozing on the facial area is reported herein. The lesion was treated with itraconazole monotherapy for four weeks, after which its condition improved.

The Relationship between Anti-Pityrosporum IgE Level and Clinical Manifestations in Atopic Dermatitis Patients with Head and Neck Dermatitis / 대한피부과학회지

BACKGROUND: Head and neck dermatitis is a variant of atopic dermatitis often seen in young adult. Though the pathogenesis of atopic dermatitis is still not well elucidated, Pityrosporum is considered to be one of the triggering factors for head and neck dermatitis. OBJECTIVE: We investigated the relationship between Pityrosporum infection and clinical features of head and neck dermatitis patients. METHODS: We evaluated anti-Pityrosporum IgE levels using RAST method in 68 outpatients with atopic dermatitis and other allergen specific antigens with MAST-CLA techniques. RESULTS: Among the 68 atopic dermatitis, 36 were diagnosed as atopic dermatitis with head and neck dermatitis and 24 out of 36 head and neck dermatitis patients showed RAST positive for Pityrosporum and the level of RAST was higher than atopic dermatitis patients without head and neck dermatitis with correlation coefficient (p<0.05). The severity of erythema and eczematous reaction was also correlated with the positivity of RAST with statistical significance (p<0.05). CONCLUSION: From these results, we speculate Pityrosporum can influence the severity and clinical manifestations in atopic dermatitis patients with head and neck dermatitis.

Determination of chemical structure of antifungal Pityrosporum orbiculare ingredient from Alpinia galanga Swartz in Vietnam

Greater galangal rhizomes have been used as medicinal herbs to treat pityriasis versicolor and other diseases. By using a premilinary examination from TLC and the antifungal activity against Pityrosporum orbiculare, a new component was extracted from rhizomes of Alpinia galanga Swartz in Vietnam. The chemical structure of this component was determined by GC-MS and 1H & 13C NMR. Galangal acetate was a colorless, pungent and oily liquid. It showed the antifungal activity against P. orbiculare with MIC = 0.25 ml/ml

Pityrosporum ovale Modulate the Pro-inflammatory Cytokines in Normal Human Keratinocyte / 대한피부과학회지

BACKGROUNDS: Pityrosporum (P.) ovale is a member of the cutaneous microflora, and is associated with several dermatologic diseases. Little is known about the mechanism by which P. ovale causes these dermatoses, but it has been supposed to be associated with immunologic response. The epidermis is largely composed of keratinocytes, and they not only play an important structural part in forming a physical barrier to microorganisms, but also are important functionally in mediating cutaneous immune reaction by secreting various cytokines. OBJECTIVES: There have been few studies on the interaction between fungi and keratinocytes, especially the effect of P. ovale on the production of cytokines by human keratinocytes. This study is to evaluate the effects of P. ovale on pro-inflammatory cytokines such as interleukin-1alpha (IL-1alpha), tumor necrosis factor-alpha(TNF-alpha), granulocyte-macrophage colony stimulating factor (GM-CSF) producted by human keratinocytes. METHODS: Normal human keratinocytes (NHK) from neonatal foreskin were suspended in culture medium with different concentrations of the P. ovale extract (0.01, 1, 10, 100microgram/ml). The production of IL-1alpha, TNF-alpha and GM-CSF after 24 hours treatment were semiquantitated by RT-PCR. Time-course changes of the cytokines were also observed until 72 hours (0, 6, 12, 24, 48, 72 hours). NHKs were treated with P. ovale culture supernatant (0.1, 0.2, 0.5, 1.0ml) for 24 hours, and the cytokines were measured by RT-PCR and ELISA. RESULTS: IL-1alpha and GM-CSF were increased by treatment with P. ovale extract as a dose-dependent manner. But TNF-alpha production was not affected by the treatement. The level of IL-1alpha was steadily increased with its maximum at 48 hours. The level of GM-CSF was increased for 48 hours and became decreased thereafter. NHKs treated with P. ovale culture supernatant showed the increase of IL-1alpha and GM-CSF synthesis as a dose-dependent manner. CONCLUSIONS: P. ovale induced the pro-inflammatory cytokines in normal keratinocytes, which is supposed to induce inflammatory response by the organism in the skin.

Malassezia(Pityrosporum) Infections of the Skin / 대한의진균학회지

The lipophilic yeast Pityrosporum ovale (Malassezia sp.) is a member of the normal human cutaneous flora in adults but also associated with several skin diseases. Treatment of P. ovale related diseases include topical and systemic antifungal therapy In pityriasis versicolor, under the influence of predisposing factors, P. ovale changes from the round blastospore form to the mycelial form. Pityriasis versicolor may be treated with topical treatment. However, with more extensive lesions, in patients with recurrence of the disease or patients not responding to topical therapy short term treatment with oral antifungal drugs is very effective. Recurrence is a great problem in pityriasis versicolor with a recurrence rate of 60% within 1 year. To avoid this oral ketoconazole 400mg once monthly or 200mg on 3 consecutive days every months have a documented effect. Pityrosporum folliculitis is a chronic disease characterized by pruritic follicular papules and pustules located primarily on the upper trunk, neck and upper arms. In direct microscopy clusters of round budding yeast cells are found. The same treatments used for pityriasis versicolor are effective in the treatment of Pityrosporum folliculitis. However, the treatment period has to be prolonged. With topical therapy 3 to 4 weeks of daily treatment and then prophylactic therapy once or twice weekly is often necessary to first clear the disease and then to avoid recurrence. However, due to the presence of P. ovale deep down in the follicle several patients will not be completely cleared with topical therapy and systemic therapy may be necessary. There are now many studies indicating that J9 ovale plays an important role in seborrheic dermatitis. Many of these are treatment studies showing a good effect of antimycotics parallelled by a reduction in number of organisms. Severe seborrheic dermatitis often difficult to treat is associated with AIDS. In peripheral blood from a high number of patients with seborrheic dermatitis we found an increase in number of natural killer T-cells and decreased PHA and Con-A stimulation. Secondary we found low serum IgG antibody titres in patients compared to controls. Other studies have found a reduced lymphocyte stimulation reaction when lymphocytes from patients with seborrheic dermatitis were stimulated with a P. ovale extract. Additionally, IL-2 and IFN gamma pruduction by lymphocytes from patients was markedly depressed and IL-10 sythesis were increased after stimulation with p. ovale extract. Several studies have clearly documented that antifungal therapy is very effective in the treatment of seborrheic dermatitis.

A case of Malassezia (Pityrosporum) Folliculitis Associated with Pityriasis(Tinea) Versicolor / 대한의진균학회지

We report a case of Malassezia folliculitis associated with pityriasis versicolor in a 16-year-old man. He had asymptomatic multiple erythematous papulopustular eruptions and scaly confluent hypopigmented maculas on the anterior chest for 2 months. The diagnosis of Malassezia folliculitis was established with the mycological and histological examinations from the specimen of papulopustules on the chest. Pityriasis versicolor was confirmed by KOH examination with the scales of the hypopigmented macules on the chest. Although the association of these two dermatoses is not common, they are generally accepted as being caused by the same organism of the genus Afafaffgfio, which has different pathogenic stages. In our case, both types of skin lesions were improved after 3 weeks of antifungal therapy with systemic itraconazole (200 mg/day) and topical 1% isoconazole nitrate cream.

Clinical Investigation and Distribution of Pityrosporum in Patients with Seborrheic Dermatitis of the Scalp / 대한피부과학회지

BACKGROUND: Seborrheic dermatitis is a very common chronic inflammatory disease. Previous studies suggested that, Pityrosporum, lipophilic fungi, may play an important role in the pathogenesis of the disease. OBJECTIVE: The purpose of this study was to investigate the disease clinically and mycologically for better understanding of the pathogenesis. METHODS: Two hundred and one new patient.s with seborrheic dermatitis of the scalp and 67 norrnal subjects were obs!,rved clinically by the dermatologist and studied stat,istically by questionnaires. A mycologic study of Pityrosporum was also performed by direct smear. RESULTS: Among a total of 201 patients wit,h seborrheic dermatitis, 72.6% had pityriasis sicca, 10.5% had pityr iasis steartoides and 16.9% had inflammatory seborrheic dermatitis. On clinical grading by the Kligman.. scale, grade III(slightly scaling) was the most common in the patients and 52.6% of the norma. subjects were below grade II (no scaling). Spores of Pityrosporum were observed in 76.7% of the patients and 91.5% of the normal subjects. The incidence of Pityrosporum was lower particularly in t,he patients with inflammatory seborrheic dermatitis t,han in other pa~tients groups. CONCLUSION: According to the results of the study, it, is difficult to conclude that Pityrosporum is a main causative ager t of seborrheic dermatitis. In addition, it is thought t.hat further studies of the role of Pityrosporum in seborrheic dermatitis are needed.

Clinical Investigation and Distribution of Pityrosporum in Patients with Seborrheic Dermatitis of the Scalp / 대한피부과학회지

BACKGROUND: Seborrheic dermatitis is a very common chronic inflammatory disease. Previous studies suggested that, Pityrosporum, lipophilic fungi, may play an important role in the pathogenesis of the disease. OBJECTIVE: The purpose of this study was to investigate the disease clinically and mycologically for better understanding of the pathogenesis. METHODS: Two hundred and one new patient.s with seborrheic dermatitis of the scalp and 67 norrnal subjects were obs!,rved clinically by the dermatologist and studied stat,istically by questionnaires. A mycologic study of Pityrosporum was also performed by direct smear. RESULTS: Among a total of 201 patients wit,h seborrheic dermatitis, 72.6% had pityriasis sicca, 10.5% had pityr iasis steartoides and 16.9% had inflammatory seborrheic dermatitis. On clinical grading by the Kligman.. scale, grade III(slightly scaling) was the most common in the patients and 52.6% of the norma. subjects were below grade II (no scaling). Spores of Pityrosporum were observed in 76.7% of the patients and 91.5% of the normal subjects. The incidence of Pityrosporum was lower particularly in t,he patients with inflammatory seborrheic dermatitis t,han in other pa~tients groups. CONCLUSION: According to the results of the study, it, is difficult to conclude that Pityrosporum is a main causative ager t of seborrheic dermatitis. In addition, it is thought t.hat further studies of the role of Pityrosporum in seborrheic dermatitis are needed.

The Study on Incidence of Pityrosporosis of the External Ear Canal between Normal Persons and Patients with Seborrheic Dermatitis / 대한피부과학회지

BACKGROUND: Pityrosporum yeast is a resident microflora of the normal skin and abundant in seborrheic dermatitis. In pathologic conditions, pityrosporum yeast is converted into hyphal form. Previous studies showed that this hyphal form could be found on clinically normal skin too. OBJECTIVES: We compared the incidence of Pityrosporum infection of the external ear canal in normal controls with that in patients with seborrheic dermatitis. METHODS: Seborrheic dermatitis, 258 subjects and normal person, 362 subjects were studied. Ear wax specimens were stained with 20% Parker ink-KOH(P-KOH) solution. The number of pityrosporal hyphae were graded according to hyphal index(1+ to 3+). RESULTS: The incidence of Pityrosporum infection of the external ear canal is 28.7% in patients with seborrheic dermatitis and 24.6% in normal controls, Amounts of pityrosporal hyphae are similar between two groups too. According to age group, incidence of PV of the external ear canal in patients with seborrheic dermatitis is statistically significantly higher than in normal controls. Female with seborrheic dermatitis have more Pityrosporum infection of the external ear canal than normal female controls. Pityrosporum infection of the external ear canal in patients with seborrheic dermatitis is prevalent in summer and spring in contrast to normal controls who have high incidence in spring. Among patients with Pityrosporum infection of the external ear canal, asymtomatic cases amount up to 70%. CONCLUSION: The results of this study showed that the incidence of Pityrosporum infection of the external ear canal in patients with seborrheic dermatitis and normal person is similar, but according to the age, sex and season, there were some differences between two groups.

Isolation of Pityrosporum ovale from a Patient with Onychomycosis: Clinical and Laboratory Investigation / 中华皮肤科杂志

Objective To isolate and observe Pityrosporum yeasts from a patient with onychomycosis. Methods The involved nail specimens were investigated by means of culture, pathological and scanning electron microscopic examination and 20% KOH preparation. Results Physical examination showed that each finger and toe nail appeared brownish black, rough and thick, some of the fore part of the nail plate detached from the nail bed. Fingernail specimen's culture results showed that Trichophyton rubrum grew on Sabouraud's dextrose agar and Pityrosporum ovale grew on the medium containing rapeseed oil. The pathological examination revealed P.ovale yeast involvement in the fissure of the nail plate. Under the scanning electron microscopy, a lot of P.ovale yeasts with characteristic collarette structure inserted in the nail tissue was noticed. In the 20% KOH preparations of nail incubated at 56℃for 1h and stained with Quink Parker ink, spores and hyphae were identified morphologically with P.ovale and T.rubrum respectively. The patient received intermittent pulse therapy with itraconazole, the color of the nails became much brighter 1 to 2 months after the fourth cycle of therapy, but no further improvement was observed afterwards. P.ovale and T.rubrum grew again 6 months after treatment when the clippings of the fingernail were cultured. Conclusion This is the first document of onychomycosis related with P.ovale in China.

The study of incidence and distribution of pityrospoum on clinically normal skin / 대한피부과학회지

BACKGROUND: Previous studies have suggested that pityrosporurr yeasts, normal resident flora of skin, may be important in the pathogenesis of dandruff seborrheic dermatitis and confluent and reticulated papillomatosis. OBJECTIVE: We investigated the incidence and distribution of pityiosorum yeasts on clinically normal skin as a more reasonable method for providing the basic data or proving the relationship of pityrosporum and pathogenesi, of the diseases. MEHTODS: A total of 350 subjects were studied. Skin scrapings were stained with 20% Parker ink-KOH(P-KOH) solution. The numbers of pityrosporum spores and hyphe per high power field( x 400) were counted and designated according to a new grading method using bacterial index(BI) of lepra bacilli. RESULTS: The incidence rates of pityrosporum orbiculare(p. orbiculare) and pityrosporum ovale(p. ovale) were 60-70% and 20-50% of subjects respectively on seborrheic area., The incidence of p. orbicilare was highter than that of p. ovale on all examined sites except for the iterior scalp. And pityrosporal hyphae was present on anteriand posterior scalp and earwax in 24-25% of subjects respectively. The incidence of pityrosporum was higher in summer than other seasons The incidence rate of p. orbiculare and hyphae in the group aged below 9 (except neonates) and above 60, were lower than that of other age groups. The inciderice rates and distribution of grades of pityrosporum of neonates were lower than those of older subjects. CONCLUSION: The results of this study showed that the incidence and distribution of pityrosporum spores were similar to previoureports and hyphal forms were found 25% approximately on clinically normal skin of the scalp and carwax. The significance of the presenet of pityosporal hyphae and the relationship between normal skin and pityrosporal hyphae are to be firther elucidated.

Statistical and mycologic studies on dandruff / 대한피부과학회지

BACKGROUND: Previous studies suggested that Pityrosporum may play an important role in the pathogenesis of dandruff. OBJECTIVE: Our purpose was to study the statistical and mycobgic findings of dandruff in normal subjects for better understanding of this condition. MEHTODS: Scales frorn the scalp of 384 students were studied stastistically by answer sheets and clinically by a dermatologist. Mycologic studies of Pityrosporum were also performed by direct smear, culture and inoculation to guinea pigs. RESULTS: There were 76.0% subjects with dandruff. Clinically grading the subjects by Kligrnan's scale, grade III and IV(mild caling) were the most. Dandruff developed commonly at the age of 14 to 16, and no seasonal change was observed. Spores of Pityrosporum were observed in all subjects by KOH microscopic examination with Cohens method, and the grading of the dandruff was not related with the number of the spores. In most subjects, P. orbiculare and P. ovae were found together. Positive culture colonies were observed in 93.7%. Inoculation of the cultured colonies to guinea pigs resulted in an experimental dermatitis. CONCLUSION: Our study shows that Pityrosporum may involve in the pathogenesis of dandruff; however, it is still unclear whether Pityrosporum is a main causative agent of dandruff.

Pityrosporum Folliculitis

Thirty-nine patients with pityrosporum folliculitis were investigated clinically and histopathologically. On clinical observation there were numerous, chronic, moderately itchy (64.1%), dome-shaped papules (89.7%) and pustules (66.7%). The most frequent sites of the lesions were the upper portion of the chest (76.9%) and back (56.4%). In biopsy specimens, abundant round and budding yeast cells were seen in a dilated hair follicle. The reptured follicle was observed in 19 specimen (48.7%). The accumulation on inflammatory cells were observed in or around the upper part of the follicle in all specimens. The effect of antimycotic treatment was excellent. After 4 weeks of treatment, 36 patients (92%) were cured and 3 (8%) had improved significantly. KOH/Parker Ink direct smear was done in 20 patients. Blue-colored round and budding yeast cells were observed under a light mcroscope in all patients. We suggest that pityrosporum folliculitis is a common disease of young and middle-aged Koreans.

CLINICAL AND LABORATORY RESEARCH ON BIFONAZOL FOR DERMATITS SEBORRHEICA CAPITIS / 重庆医科大学学报

1 8 casts of dermatitis seborrfceica capitis were topically treated with 1% Bifon- azol tincture. All the cases were cured clinically and of the cases turned negative in pathogen cultures. The MIC of Bifonazol to piturosponim ovale were tested in six strains isolated from dandruff.The MIC Bifonazol to Microsporum is 0.25-0.5/ml, slightly superior to Ketokon-azol and Micooazol.The results show that Bifonazol is a hopeful drug for dermatitis seborrheica capi tis and also support the theory that pitytosporem cvale is an opportunistic patogen for dermatitis seborrheica capitis

ETIOLOGICAL INVESTIGATION ON SEBORRHEIC DERMATITIS____THE RELATION BETWEEN PITYROSPORUM AND SEBORRHEIC DERMATITIS / 重庆医科大学学报

In this paper, we report that pityrosporum o biculare or/and pityrosporum ovale were cultivated from dandruff of 57 patients with seborrheic dermatitis. The posi-tivity rate was 94.7% in our series.The colony grows slowly and appears cream colour, yeastlike and oleophilic. It did not engender hyphae in Rice-Tween 80 medium and did not produce germ tubes in scrum culture. It could not grow and could not utilize carbohydrate in CHO assimilation test and was neither acidogenic nor aerogenous in fermentation test