Systematic review and meta-analysis on synthetic antifungal versus keratolytic agents for topical treatment of Pityriasis Versicolor

Background@#Pityriasis versicolor is a common fungal infection of the superficial skin layer caused by Malassezia furfur, a normal commensal in the skin. Keratolytic agents are popular, cheap, and readily available over-the-counter treatments for pityriasis versicolor. Conventional antifungal agents are more expensive, requiring prescription, and may induce resistant strains. However, evidence of their comparative safety and efficacy is still lacking. @*Objectives@#To assess the efficacy and safety of synthetic antifungals compared to keratolytic agents in the topical treatment of pityriasis versicolor through a systematic review.@*Methods@#We searched the following databases: MEDLINE (from 1966) through PubMed, CENTRAL (Issue 9 of 12, September 2021), EMBASE (from 1974), LILACS (from 1987); Herdin (from 1970), www.clinicaltrials.gov, www. isrctn.com, www.trialregister.nl. We contacted researchers in the field, hand searched relevant conference abstracts, and the Journal of the Philippine Dermatological Society 1992-2019. We included all randomized controlled trials involving patients with diagnosed active pityriasis versicolor where topical antifungal was compared with a topical keratolytic for treatment. Two review authors independently applied eligibility criteria, assessed risk of bias using the Cochrane collaboration tool, and extracted data from included studies. We used RevMan 5.3 to pool dichotomous outcomes using risk ratios (RR) and continuous outcomes using the mean difference (MD), using random-effects meta-analysis. We tested for statistical heterogeneity using both the Chi² test and the I² test. We presented results using forest plots with 95% confidence intervals. We planned to create a funnel plot to determine publication bias but were unable to due to few studies. A Summary of Findings table was created using GRADE profile software for the primary outcomes. @*Results@#We included 8 RCTs with a total of 617 participants that compared azole preparations (ketoconazole, bifonazole and econazole) versus keratolytic agents (selenium sulfide, adapalene, salicylic-benzoic acid). Pooled data showed that azoles did not significantly differ from keratolytic agents for clinical cure (RR 0.99, 0.88, 1.12; 4 RCTs, N=274, I2=55%; very low-quality evidence), and adverse events (0.59 [0.17, 2.06]; very low-quality evidence) based on 6 RCTs (N=536). There were two patients given a keratolytic agent (selenium sulfide shampoo) who had acute dermatitis and discontinued treatment. @*Conclusion@#It is uncertain whether topical azoles are as effective as keratolytic agents in clinical clearance and occurrence of adverse events in patients with pityriasis versicolor. A wider search of grey literature and local studies are warranted. Larger RCTs with low risk of bias are recommended.

The correct nomenclature of Zirelí sign in the propaedeutics of pityriasis versicolor (in memoriam)

Abstract Aiming at disclosing the semiotic method used in the diagnosis of pityriasis versicolor, the authors go through the history of the creation of Zirelí sign, describing the method, its usefulness and practicality in dermatological clinical practice, whether public or private, and to give credit to the author of this semiological maneuver, in memoriam.

Características clínico-epidemiológicas de los pacientes con pitiriasis versicolor en un centro de referencia de Colombia / Clinical-epidemiological characteristics of patients with tinea versicolor in a Colombian reference center

Resumen Objetivo: describir las características socio-demográficas, presentación clínica y condiciones extrínsecas que pueden favorecer el desarrollo de la pitiriasis versicolor. Material y métodos: estudio observacional descriptivo, de corte transversal y prospectivo, en el que se incluyeron pacientes con diagnóstico clínico y micológico de pitiriasis versicolor entre enero y diciembre de 2018, que asistieron al Hospital Universitario Centro Dermatológico Federico Lleras Acosta. Resultados: se incluyeron un total de 42 pacientes con diagnóstico de pitiriasis versicolor confirmado por examen directo, el 62% fueron hombres con una edad promedio de 33 años. La localización más común fue el tórax anterior (68%) y posterior (65%), en fototipos III y IV (78.5%), con una tonalidad hipocrómica. El 28% presentaron cuadros recurrentes, con síntomas hasta 7 años antes de la consulta. El signo de Besnier fue positivo en el 95% de los casos. El 64% refirió antecedente personal de hiperhidrosis y el 67% practicaba algún deporte como buceo, natación o gimnasia. Discusión: la identificación de las condiciones extrínsecas presentes esta población permite orientar medidas de prevención para evitar recurrencias de pitiriasis versicolor. Los viajes a lugares de clima cálido y la práctica de deportes son factores que favorecen el desarrollo de la micosis. En las formas clínicas atípicas se sugiere realizar siempre el examen micológico directo para confirmar el diagnóstico. El signo de Besnier es una maniobra útil para el diagnóstico clínico de la pitiriasis versicolor, particularmente cuando el acceso al examen directo es limitado.

Abstract Objective: to describe the sociodemographic aspects, clinical presentation and extrinsic conditions that may increase the risk of developing pityriasis versicolor. Materials and methods: a descriptive, cross-sectional and prospective observational study was conducted. Patients with clinical and mycological diagnosis of ptyriasis versicolor were included from january to december 2018 who attended to the Hospital Universitario Centro Dermatológico Federico Lleras Acosta. Results: a total of 42 patients were included in the study, all of them had confirmed mycological diagnosis of pityriasis versicolor. The most common location of the lesions was the anterior thorax (68%) and posterior thorax (65%), in III and IV phototypes (78.5%) with a hypochromic color. 28% had recurrent infection, with symptoms mean of 7 years before the consultation. The Besnier sign was positive in 95% of cases, 64% reported personal history of hyperhidrosis and 67% practiced some sports: diving, swimming and gymnastics. Discussion: recognizing extrinsic conditions that may increase the risk of developing pitiraisis versicolor in this population allows identifying control measures to prevent a relapse. The main factors involved in the development of pitiraisis versicolor were traveling to places with high temperatures and sport practice. In atypical clinical presentation it is mandatory to perform the mycological direct test to confirm the diagnosis. The Besnier sign is a useful method for the clinical diagnosis of pityriasis versicolor, particularly when access to direct examination is limited.

A triple-blind, randomized controlled trial on the efficacy and safety of 1.5% Carica papaya latex cream vs. 2% Ketoconazole cream in the treatment of pityriasis versicolor among Filipinos

Background@#Carica papaya latex has been found to have antifungal properties rendering an alternative treatment for fungal infections, i.e. pityriasis versicolor. It has remarkable mycelial inhibition, and static effect on fungal growth in cultures. Its keratolytic effect can remove diseased skin cells, and enhance drug penetration. Moreover, it is organic, locally available, and relatively inexpensive.@*Objective@#To compare the efficacy and safety of 1.5% Carica papaya latex cream vs. 2% ketoconazole cream in the treatment of pityriasis versicolor among Filipinos.@*Methods@#A single-center, parallel group, triple-blind, randomized controlled trial in the Dermatology out-patient clinic of Makati Medical Center was conducted. Sixty-four patients with pityriasis versicolor were randomly allocated to the two treatment groups, and received either 1.5% Carica papaya latex cream or 2% ketoconazole cream that they used twice daily for four weeks or until cured. The participants, researcher, and assessor were blinded to the treatment assignments. Therapeutic response was assessed at weeks 1, 2, 3 and 4 based on clinical and mycologic cure. Adverse events were identified. Patients’ assessment of their improvement was done at the end of the treatment.@*Results@#All 64 subjects in both treatment groups (100% in the Carica papaya and 100% in the ketoconazole group) achieved clinical and mycologic cure within the four-week study period. The adverse reactions noted (pruritus and erythema for Carica papaya latex cream, and pruritus for ketoconazole cream) were mild, did not cause disruption of daily activities, and spontaneously resolved.@*Conclusion@#1.5% Carica papaya latex cream is an effective and safe alternative treatment to the first line therapy, ketoconazole cream, for pityriasis versicolor.

Pityriasis versicolor, aspects épidémio-cliniques, facteurs associés et qualité de vie à Parakou (Bénin) en 2020

Le pityriasis versicolor (PV) est une pathologie cutanée fréquemment rencontrée en consultation dermatologique, surtout dans les pays à climat tropical. Une étude épidémio-clinique, s'intéressant aussi aux comorbidités associées et au retentissement de la maladie a été réalisée. Elle a concerné 118 patients venus consulter dans le service de Dermatologie-Vénérologie au Centre Hospitalier Universitaire Départemental Borgou-Alibori, Bénin. La population la plus touchée était les sujets jeunes avec une fréquence plus élevée chez les 20-30 ans (38,98%). L'âge moyen était de 27,03 ans avec une sex ratio à 1,40. Les antécédents familiaux de pityriasis versicolor ont été retrouvés chez 10 patients soit 8,47%. Comme facteurs favorisants, 57,62% utilisaient les laits corporels dépigmentants. La forme classique (20,37%) était majoritairement représentée. L'acné a été notée chez 19 patients (16,10%). La sérologie VIH était revenue positive chez 4 patients (5,55%) et le diabète a été diagnostiqué chez 3 patients (7,5%). Une altération de la qualité de vie des sujets (35,59%) a été retrouvée.

Pityriasis versicolor (PV) is a cutaneous pathology frequently encountered in dermatological consultations, especially in countries with a tropical climate. An epidemio-clinical study, also questioning the associated comorbidities and the repercussions of the disease, was carried out on 118 patients who came to the Dermatology-Venerology Department at the Borgou-Alibori Departmental University Hospital, Benin. The most affected population was young subjects with a higher frequency in the 20-30 years old (38.98%). The mean age was 27.03 years with a sex ratio of 1.40. Family history was found in 10 patients (8.47%). As contributing factors, 57.62% used depigmenting body milks. The classic form (20.37%) was predominantly represented. Acne was noted in 19 patients (16.10%). HIV serology was positive in 4 patients (5.55%) and diabetes was dignosed in 3 patients (7.5%). A slight alteration in the quality of life of the subjects (35.59%) was found.

Senna alata (akapulko) extract versus topical antifungals for treatment of superficial fungal skin infections: A systematic review and meta-analysis

@#<p style="text-align: justify;"><b>OBJECTIVE:</b> The study aimed to assess the efficacy and safety of Senna alata (akapulko) plant extracts compared with topical antifungals in the treatment of superficial fungal skin infections.</p><p style="text-align: justify;"><br /><b>METHODS:</b> A systematic review and meta-analysis of randomized controlled trials that studied patients with diagnosed cutaneous tinea or dermatophytosis (excluding hair and nail), tinea versicolor, or cutaneous candidiasis, via microscopy or culture, and compared the efficacy and safety of S. alata (akapulko) extract versus topical antifungals. Two authors independently screened titles and abstracts of merged search results from electronic databases (The Cochrane Skin Group Specialized Register, CENTRAL, MEDLINE, EMBASE (January 1990 to December 2011), Health Research and Development Information Network (HERDIN), and reference lists of articles), assessed eligibility, assessed the risk of bias using the domains in the Cochrane Risk Bias tool and collected data using a pretested Data extraction form (DEF). Meta-analyses were performed when feasible.</p><p style="text-align: justify;"><br /><b>RESULTS:</b> We included seven RCTs in the review. There is low certainty of evidence that S. alata 50% lotion is as efficacious as sodium thiosulfate 25% lotion (RR 0.91, 95% CI, 0.79 to 1.04; 4 RCTs, n=216; p=0.15; I2=52%) and high quality evidence that S. alata cream is as efficacious as ketoconazole (RR 0.95, 95% CI, 0.82 to 1.09; 1 RCT, n=40; p=0.44) and terbinafine cream (RR 0.93, 95% CI, 0.86 to 1.01; 1 RCT, n=150; p=0.09) in mycologic cure. For adverse effects, there is very low certainty of evidence of increased harm with S. alata 50% lotion compared to sodium thiosulfate 25% lotion (RR 1.26, 95% CI, 0.46, 3.44; 2 RCTs, n=120; p=0.65; I2=19%). Adverse effects were few and mild.</p><p style="text-align: justify;"><br /><b>CONCLUSION:</b> S. Alata 50% lotion may be as efficacious as sodium thiosulfate 25% lotion and is as efficacious as ketoconazole 2% and terbinafine 1% creams. There is insufficient evidence to compare the safety of S. alata 50% lotion with sodium thiosulfate 25% lotion.</p>

Systematic review and meta-analysis on Synthetic Antifungal versus Keratolytic Agents for Topical Treatment of Pityriasis Versicolor

Background@#Pityriasis versicolor is a common fungal infection of the superficial skin layer caused by Malassezia furfur, a normal commensal in the skin. Keratolytic agents are popular, cheap, and readily available over-the-counter treatments for pityriasis versicolor. Conventional antifungal agents are more expensive, requiring prescription, and may induce resistant strains. However, evidence of their comparative safety and efficacy is still lacking. @*Objectives@#To assess the efficacy and safety of synthetic antifungals compared to keratolytic agents in the topical treatment of pityriasis versicolor through a systematic review. @*Methods@#We searched the following databases: MEDLINE (from 1966) through PubMed, CENTRAL (Issue 9 of 12, September 2021), EMBASE (from 1974), LILACS (from 1987); Herdin (from 1970), www.clinicaltrials.gov, www. isrctn.com, www.trialregister.nl. We contacted researchers in the field, hand searched relevant conference abstracts, and the Journal of the Philippine Dermatological Society 1992-2019. We included all randomized controlled trials involving patients with diagnosed active pityriasis versicolor where topical antifungal was compared with a topical keratolytic for treatment. Two review authors independently applied eligibility criteria, assessed risk of bias using the Cochrane collaboration tool, and extracted data from included studies. We used RevMan 5.3 to pool dichotomous outcomes using risk ratios (RR) and continuous outcomes using the mean difference (MD), using random-effects meta-analysis. We tested for statistical heterogeneity using both the Chi² test and the I² test. We presented results using forest plots with 95% confidence intervals. We planned to create a funnel plot to determine publication bias but were unable to due to few studies. A Summary of Findings table was created using GRADE profile software for the primary outcomes. @*Results@#We included 8 RCTs with a total of 617 participants that compared azole preparations (ketoconazole, bifonazole and econazole) versus keratolytic agents (selenium sulfide, adapalene, salicylic-benzoic acid). Pooled data showed that azoles did not significantly differ from keratolytic agents for clinical cure (RR 0.99, 0.88, 1.12; 4 RCTs, N=274, I2=55%; very low-quality evidence), and adverse events (0.59 [0.17, 2.06]; very low-quality evidence) based on 6 RCTs (N=536). There were two patients given a keratolytic agent (selenium sulfide shampoo) who had acute dermatitis and discontinued treatment. @*Conclusion@#It is uncertain whether topical azoles are as effective as keratolytic agents in clinical clearance and occurrence of adverse events in patients with pityriasis versicolor. A wider search of grey literature and local studies are warranted. Larger RCTs with low risk of bias are recommended.

Especies de Malassezia causantes de pitiriasis versicolor en Paraguay / Malassezia species causative of pityriasis versicolor in Paraguay

Resumen Introducción: La pitiriasis versicolor es una patología frecuente en Paraguay; sin embargo, su epidemiologia es desconocida. Objetivo: Determinar la frecuencia de especies de Malassezia causantes de pitiriasis versicolor y las características epidemiológicas de la población. Materiales y Métodos: Se recolectaron muestras de pacientes con diagnóstico presuntivo de pitiriasis versicolor. El diagnóstico de laboratorio se realizó mediante examen en fresco y cultivo en agar Dixon modificado y agar cromogénico Chromagar Malassezia®, incubados a 32°C; y la identificación por las características macro y micromorfológicas, pruebas bioquímicas y fisiológicas. Resultados: Se incluyeron 102 pacientes (51% femenino), de 1 mes a 63 años de edad, predominando el grupo de 11 a 20 años (35,3%). La localización más frecuente fue el dorso (60,8%). Predominaron las formas hipocrómicas (48%). La especie más frecuente fue M. globosa (52,9%), seguida de M. furfur (24,5%), M. sympodialis (18,6%) y M. slooffiae (6,9%). Conclusiones: La epidemiología observada es similar a otros estudios sudamericanos, no hace distinción de sexo, se presenta predominantemente en la forma clínica hipocrómica y M. globosa aparece como principal responsable. Este es el primer reporte sobre las especies causantes de pitiriasis versicolor en Paraguay y las características de la población con esta patología.

Background: Pityriasis versicolor is a frequent pathology in Paraguay; however, its epidemiology is unknown. Aim: To determine the frequency of Malassezia species causing pityriasis versicolor and the epidemiological characteristics of the population. Methods: Samples from patients with a presumptive diagnosis of pityriasis versicolor were collected. Laboratory diagnosis was carried out by fresh examination and culture in modified Dixon agar and chromogenic Chromagar Malassezia®, incubated at 32° C, and identification by macro and micromorphological features, biochemical and physiological tests. Results: 102 patients were included (51% female) from 1 month to 63 years of age, the predominant age group was 11-20 years (35.3%). The most frequent location was on the back (60.8%). Hipocromic clinical forms (48%) predominated. The most frequent species was M. globosa (52.9%), followed by M. furfur (24.5%), M. sympodialis (18.6%) and M. slooffiae (6.9%). Conclusions: The observed epidemiology is similar to other South American studies, with no sex distinction, predominantly hypochromic clinical form and as primary responsible species appears M. globosa. This is the first report on species causing pityriasis versicolor in Paraguay and the characteristics of the affected population.

Systematic review and meta-analysis on oral azoles for the treatment of pityriasis versicolor

@#<p style="text-align: justify;"><strong>Background:</strong> Oral azole drugs are a second-line option for the treatment of pityriasis versicolor but evidence on their efficacy and safety is unclear. Objectives. To determine the efficacy and safety of oral azoles in the treatment of patients with pityriasis Versicolor.</p><p style="text-align: justify;"><strong>Methods</strong>: We searched MEDLINE, CENTRAL, EMBASE, LILACS, and HERDIN, from inception to the period between January to February 2014. We did not restrict the search by language or publication status. We included randomized controlled trials (RCTs) that compared the efficacy of oral azoles with placebo or no treatment, with topical agents, other oral azoles or dosing regimens in the treatment of pityriasis Versicolor, and that measured any of the pre-specified outcomes (mycologic cure, clinical cure, recurrence, duration to cure, time-to-cure, and quality of life). For adverse effects, we also included non-randomized studies (NRS). We used Cochrane methods to select studies, extract data, assess the risk of bias, pool studies, and calculate for treatment effects.</p><p style="text-align: justify;"><strong>Results:</strong> We included 38 RCTs (n=2894) and 56 NRS (n=3452). Overall, there were few pooled studies and evidence was low to moderate quality. Oral azoles were more effective than placebo (mycologic cure, RR 11.34, 95% CI 4.90, 26.28; 3 RCTs, n=131; I2=0%; low quality of evidence) and as effective as topical agents (mycologic cure, RR 1.02, 95% CI 0.86, 1.21; 4 RCTs, n=232; I2=60%; moderate quality of evidence).There were few adverse effects and were mostly minor and transient.</p><p style="text-align: justify;"><strong>Conclusions:</strong> Oral azoles may be more effective than placebo, and are probably as effective as topical agents in the treatment of PV. Triazoles are probably as effective as ketoconazole. Adverse effects were few, mostly minor, and transient.</p>

Systemic review and meta-analysis on oral azoles for the treatment of pityriasis versicolor

Background: Oral azole drugs are a second-line option for the treatment of pityriasis versicolor but evidence on their efficacy and safety is unclear.Objectives: To determine the efficacy and safety of oral azoles in the treatment of patients with pityriasis versicolor.Methods: We searched MEDLINE, CENTRAL, EMBASE, LILACS, and HERDIN, from inception to the period between January to February 2014. We did not restrict the search by language or publication status. We included randomized controlled trials (RCTs) that compared the efficacy of oral azoles with placebo or no treatment, with topical agents, other oral azoles or dosing regimens in the treatment of pityriasis versicolor, and that measured any of the pre-specified outcomes (mycologic cure, clinical cure, recurrence, duration to cure, timeto- cure, and quality of life). For adverse effects, we also included non-randomized studies (NRS). We used Cochrane methods to select studies, extract data, assess risk of bias, pool studies, and calculate for treatment effects.Results: We included 38 RCTs (n=2894) and 56 NRS (n=3452). Overall, there were few pooled studies and evidence was low to moderate quality.Oral azoles were more effective than placebo (mycologic cure, RR 11.34, 95% CI 4.90, 26.28; 3 RCTs, n=131; I2=0%; low quality of evidence) and as effective as topical agents (mycologic cure, RR 1.02, 95% CI 0.86, 1.21; 4 RCTs, n=232; I2=60%; moderate quality of evidence). There were few adverse effects and were mostly minor and transient.Conclusions: Oral azoles may be more effective than placebo, and are probably as effective as topical agents in the treatment of PV. Triazoles are probably as effective as ketoconazole. Adverse effects were few, mostly minor, and transient.

Aspects épidemiologiques et cliniques des mycoses superficielles en milieu hospitalier à Cotonou de 2005 à 2014

Introduction : Les mycoses superficielles sont fréquentes en zones tropicales et représentent le premier motif de consultation en dermatologie dans de nombreux pays africains. Matériel et méthodes : Une étude rétrospective, descriptive et analytique a été réalisée dans le service de Dermatologie du Centre National Hospitalier et Universitaire de Cotonou pour décrire le profil épidémiologique et clinique des mycoses superficielles. Elle a inclus sur 10 ans tous les patients chez qui un diagnostic clinique de mycose superficielle a été retenu. Résultats : La prévalence des mycoses superficielles était de 9,6% (1037/10787 patients). Les deux sexes étaient uniformément représentés et l'âge moyen était de 32,2 ans. Trois groupes cliniques de mycoses superficielles étaient retrouvés : dermatophytoses (44,7%), candidoses cutanéo-muqueuses (32,8%) et pityriasis versicolor (31,3%). Les épidermomycoses (93,4%) étaient réparties en dermatophytoses de la peau glabre et des plis (36,4%), pityriasis versicolor (31,3%) et candidoses des plis (25,7%). Les onychomycoses (9,7%) étaient soit de suspicion candidosique (6,4%) ou soit dermatophytique (3,3%). Les teignes représentaient 5% de l'ensemble des mycoses superficielles et la candidose muqueuse 0,7%. Les principaux facteurs favorisants identifiés étaient l'utilisation abusive des savons antiseptiques (20,4%) et l'usage à visée cosmétique de produits dépigmentants (12,7%). Conclusion : Les mycoses superficielles étaient fréquentes avec une prédominance des épidermomycoses dans le service de dermatologie de Cotonou. Les habitudes cosmétiques représentaient un important facteur favorisant de ces épidermomycoses

Aislamiento e identificación fenotípica y genotípica de cepas de Malassezia spp. en pacientes con pitiriasis versicolor / Isolation and identification phenotypic and genotypic strains of Malassezia spp. in patients with pytiriasis versicolor

Antecedentes: Pitiriasis versicolor (PV) es una infección micótica superficial crónica de la piel, debido a la colonización del estrato córneo por Malassezia sp. Tradicionalmente M. furfur era considerada el agente causal de PV, hoy en día se ha demostrado que las especies de Malassezia más comunes cultivadas a partir de de lesiones de PV son M. globosa y M. sympodialis. Objetivos: Evaluar la epidemiología de la dermatomicosis PV, en pacientes de la ciudad de Talca, Chile. Metodología: En este estudio, 19 pacientes diagnosticados con PV fueron evaluados. Se realizó identificación fenotípica e identificación molecular por técnica de PCR-RFLP. Para esto, se diseñaron partidores que amplificaron una zona del 26S ADNr presente en todas las especies de Malassezia. Resultados: De un total de 19 pacientes con PV, 7 correspondieron a sexo masculino (36,8 por ciento) y 12 a sexo femenino (63,2 por ciento). Se obtuvieron 18 cepas, a partir de las pruebas fenotípicas fue posible identificar presuntivamente 11 especies de M. globosa (61,1 por ciento) y 7 especies de M. sympodialis (38,9 por ciento). Con los resultados obtenidos en la PCR-RFLP fue posible identificar 11 especies de M. globosa (61,1 por ciento) y 7 especies (38,9 por ciento) de M. sympodialis. Conclusiones: La especie identificada fenotípicamente y molecularmente en mayor proporción fue Malassezia globosa seguida de Malassezia sympodialis. Por lo que hay concordancia entre ambas técnicas de identificación. Este es el primer trabajo de investigación realizado en Talca, Chile, que identificó las especies de Malassezia spp. involucradas en PV, siendo un aporte al estudio de este cuadro clínico.

Background: Pytiriasis versicolor (PV) is a fungal infection of the skin due to the stratum corneum colonization by Malassezia sp. M. furfur traditionally was considered the etiological agent of PV but today it has been shown that M. globosa and M. sympodialis are the most common Malassezia species cultivated from PV lesions. Objective: To evaluate the epidemiological features of PV in patient of the Talca city, Chile. Method: In this study, 19 patients with diagnosis of PV were evaluated. Phenotypic and molecular identified were performed using PCR-RFLP. To do this, primers to amplify 26S ADNr secuence were designed. Result: From a total of 19 patients who presented PV, 7 were male (36.8 percent) and 12 female patients (63.2 percent). Eighteen strains were obtained, from the phenotypic tests, it was possible to presumably identify 11 species of M. globosa (61.1 percent) and 7 species of M. sympodialis (38.9 percent). With PCRRFLP results it was possible to identify 11 species of M. globosa (61.1 percent) and 7 species (38.9 percent) of M. sympodialis. Conclusion: The most commonly isolated species were Malassezia globosa followed by Malassezia sympodialis. So, there is agreement between both techniques of identification. This is the first research work carried out in Talca, Chile, which identified the species of Malassezia spp. Involved in PV, being a contribution to the clinical diagnosis.

Tinea Versicolor Mimicking Pityriasis Rubra Pilaris caused by Malassezia globosa / 대한의진균학회지

Tinea versicolor (TV) is a common fungal skin disease caused by the Malassezia species. This disease usually presents as hypopigmented- or hyperpigmented coalescing scaly macules, papules, patches or plaques on the trunk and upper arms. Herein, we report a rare clinical manifestation of TV in a 29-year-old man presenting with marked follicular, erythematous, and hyperkeratotic papules on the trunk with erythematous scaly macules and patches on the upper extremities with intermittently spared skin. We initially suspected pityriasis rubra pilaris, however, skin biopsy results and mycological examination revealed TV. Polymerase chain reaction-based sequence analysis revealed Malassezia globosa. The patient was successfully treated with oral itraconazole and topical terbinafine.

In vitro Susceptibility of the Six Malassezia Species to Itraconazole, Fluconazole and Terbinafine / 대한의진균학회지

BACKGROUND: Malasseiza species are dimorphic and lipophilic fungi which are part of normal mycota of the human skin, and also associated with some skin diseases. In many skin diseases such as pityriasis versicolor, Malassezia folliculitis, seborrheic dermatitis, atopic dermatitis and psoriasis, Malassezia yeasts may have a key role. OBJECTIVE: To investigate susceptibility of antifungal agent including itraconazole, fluconazole and terbinafine, we conducted in vitro susceptibility test revealing minimum inhibitory concentration of drugs for each Malassezia strains. METHODS: Malassezia restricta CBS7877, M. globosa CBS 7966, M. slooffiae KCTC 27517, M. sympodialis CBS 7222, M. pachydermatis CBS 1879 and M. furfur CBS 1878 were used in this experiment. The strains were grown in Leeming and Notman medium. MIC was determined using the method suggested by Sugita, et al. with modification. Malassezia cells were grown in each well and incubated for 2 days at 34℃, and MIC was determined by agar dilution method. RESULTS: Most Malasseiza strains of all Malassezia species were most sensitive to itraconazole, with MICs ranging from 0.015 to 0.06 µg/mL. MIC values of fluconazole and terbinafine against Malassezia species were higher and wider range than MIC of itraconazole. CONCLUSION: Itracozanole would be the first choice drug for treatment of Malassezia associated skin diseases. Isolation of pathologic species of Malassezia from various skin diseases in Korea would be fundamental research for the target therapy, and drug susceptibility test would be helpful for proper treatment.

Dermatophytes and other associated fungi in patients attending to some hospitals in Egypt

Dermatophytes are keratinophilic fungi that infect keratinized tissues causing diseases known as dermatophytoses. Dermatophytes are classified in three genera, Epidermophyton, Microsporum, and Trichophyton. This investigation was performed to study the prevalence of dermatomycosis among 640 patients being evaluated at the dermatology clinics at Kasr elainy, El-Husein and Said Galal hospitals in Cairo and Giza between January 2005 and December 2006. The patients were checked for various diseases. Tinea capitis was the most common clinical disease followed by tinea pedis and tinea corporis. Tinea cruris and tinea unguium were the least in occurrence. Tinea versicolor also was detected. The most susceptible persons were children below 10 years followed by those aged 31–40 years. Unicellular yeast was the most common etiological agent and T. tonsuranswas the second most frequent causative agent followed by M. canis.

Sixteen years o Pityriasis Versicolor in metropolitan area of Porto Alegre, Southern Brazil / Dezesseis anos de Pitiríase Versicolor na Região Metropolitana de Porto Alegre, Sul do Brasil

SUMMARYPityriasis versicolor is the most common of the diseases caused by Malasseziayeasts. The aim of this study is to determine the prevalence of pityriasis versicolor and its etiological aspects in the metropolitan area of Porto Alegre, Brazil. A retrospective crosssectional study with data from patients of a reference hospital from 1996 to 2011 was performed. Collected data included: date, age, gender, ethnicity, anatomical region of lesion and the direct mycological examination results. Among the positive results in the direct mycological examination, 5.8% (2,239) were positive for pityriasis versicolor. The angular coefficient (B) was -0.3%/year, showing a decrease over the years. The disease was more prevalent in men (7.1% of men versus 5.1% of women that underwent the direct mycological examination); younger age (median 31 years old); "pardo" and black people (3.7% more than expected in the sample); trunk (73.44% of the affected anatomic sites). Lesions in rare sites (groin, genitals, legs, feet and hands) were also observed in this study. In conclusion, due to the decrease in the prevalence of pityriasis versicolor, long-term epidemiological studies in the metropolitan area of Porto Alegre, Brazil, are needed to continue the monitoring of this disease.

RESUMOPitiríase versicolor é a mais comum das doenças causadas pelas leveduras do gênero Malassezia. O objetivo do trabalho foi determinar a prevalência de pitiríase versicolor e seus aspectos etiológicos na região metropolitana de Porto Alegre, Brasil. Foi realizado um estudo retrospectivo transversal com dados de pacientes de hospital de referência entre 1996 a 2011. Os dados coletados foram: data, idade, gênero, etnia, local anatômico da lesão e resultados do exame micológico direto. Dentre os resultados positivos do exame micológico direto, 5,8% (2.239) foram positivos para pitiríase versicolor. O coeficiente angular (B) foi -0,3%/ ano, mostrando uma diminuição ao longo dos anos. A doença foi mais prevalente em homens (7,1% dos homens versus 5,1% das mulheres que se submeteram ao exame micológico direto); jovens (mediana de 31 anos); pardos e pretos (3,7% acima do esperado para a amostra); tronco (73,4% dos locais anatômicos afetados). Lesões em locais raros (virilha, genitálias, pernas, pés e mãos) também foram observadas no estudo. Em conclusão, devido à diminuição da prevalência de pitiríase versicolor, estudos epidemiológicos de longo prazo são necessários para continuar o monitoramento da doença na região metropolitana de Porto Alegre, Brasil.

Frequency of superficial fungal infections in renal transplant recipients

To determine the frequency of superficial fungal infections in renal transplant recipients. This cross-sectional study was conducted in the outpatient clinic, Department of Dermatology, Dow University of Health Sciences and Civil Hospital Karachi. Patients of 20-60 year of age undergone renal transplant 3 to 12 months back were enrolled while patients with diabetes were excluded from study. Patients were evaluated for the presence of superficial mycoses. Skin scrapings and nail clippings were collected mycologic evaluation. A total of 62 patients were enrolled. The mean age of enrolled patients was 39.9 +/- 10.3 years and 37 [59.7%] were male. The mean duration of transplant was 7.6 +/- 2.9 months. 23 [37.1%] were on steroids. Fungal infections were documented in 38 [61.3%] patients. Of 38 patients, 19 [50%] had candidiasis. Stratified analysis showed fungal infections to be similar in >/=40 or <40 years of age [63.6% v. 58.6%], female and male [64% vs. 59.5%]; duration of transplant <8 or >8 months [63.9% vs. 57.7%] and those who were on steroids [69.6%] or other drugs [62.5%]. It is concluded from this study that patient's undergone renal transplant has increased frequency of fungal infection

Progress in Malassezia Research in Korea

Yeasts of the genus Malassezia are part of the normal flora of human skin. However, they are also associated with various skin diseases. Since the introduction of Malassezia to the Korean Dermatologic Society two decades ago, remarkable progress has been made in our knowledge of this genus. In this paper, we review recent developments in Malassezia research, including taxonomy and methods for species identification, recent genome analyses, Malassezia species distribution in healthy conditions and in specific skin diseases, trials investigating the mechanisms underlying Malassezia-related diseases, as well as therapeutic options. This review will enhance our understanding of Malassezia yeasts and related skin diseases in Korea.

Ocorrência de micoses e pitiose em animais domésticos: 230 casos / Occurrence of mycoses and pythiosis in domestic animals: 230 cases

A retrospective study was performed to determine the main mycoses and oomycosis that affected domestic animals diagnosed in the Laboratório de Patologia Veterinária (LPV) of the Universidade Federal de Santa Maria (UFSM). A total of 29,686 exams (9,487 necropsy reports and 20,199 biopsy reports) performed between January 1990 and December 2012 were analyzed. Two hundred and thirty cases (78% of mycoses and 22% of pythiosis) were found. Data about epidemiology, clinical signs, gross and histologic lesions were obtained from the reports. In two cases the fungi observed were not identified. The main diseases observed, in descending order of prevalence, were: pythiosis, candidiasis, aspergillosis, zygomycosis, dermatophytosis, mallasseziosis, cryptococcosis, megabacteriosis, and sporothrichosis. Others diseases with only one cases each were histoplasmosis and pneumocystosis. Pythiosis affected mainly horses and the mycosis affected mainly companion animals (dogs and cats).

Para determinar as principais micoses e oomicoses que acometeram animais domésticos na área de abrangência do Laboratório de Patologia Veterinária (LPV) da Universidade Federal de Santa Maria (UFSM), foi realizado um estudo retrospectivo em 9.487 protocolos de necropsias e 20.199 exames histopatológicos (totalizando 29.686 casos), realizados no LPV-UFSM, entre janeiro de 1990 e dezembro de 2012. Do total de protocolos analisados, 230 apresentaram micoses ou pitiose (oomicose), sendo 179 casos (78%) de micoses e 51 casos (22%) de pitiose. Os protocolos foram revisados para determinar os principais achados referentes à epidemiologia, sinais clínicos e às alterações macroscópicas e microscópicas. Em dois casos (0,8%) não foi possível determinar o gênero ou o grupo do fungo observado. As principais doenças diagnosticadas, em ordem decrescente de prevalência, foram: pitiose, candidíase, aspergilose, zigomicose, dermatofitose, malasseziose, criptococose, megabacteriose e esporotricose. Outras doenças diagnosticadas numa única ocorrência cada foram histoplasmose e pneumocistose. Os equinos foram os mais acometidos pela pitiose e os animais de companhia (cães e gatos) foram os mais acometidos pelas micoses.