Imunoterapia de dessensibilização para Malassezia spp. - Relato de caso experimental / Desensitization immunotherapy for Malassezia spp: experimental case report

A pitiríase versicolor (PV) consiste em uma infecção fúngica ocasionada por leveduras de Malassezia spp., que apesar de manejo simples, é uma doença com elevadas chances de recidiva e cronificação, além da pouca variedade de terapias efetivas para tratar cepas resistentes. Existem relatos na literatura sobre utilização de dessensibilização para Malassezia spp., mas para o tratamento de dermatite atópica e não PV, conferindo caráter inovador ao relato em questão. O caso apresentado consiste em um paciente de 28 anos, do sexo masculino, com manifestações típicas de PV em região de face, cervical, dorsal e axilar, há 4 anos, com resistência aos esquemas terapêuticos tópicos e sistêmicos. Uma vez identificada a ineficácia das terapias tradicionais, foi iniciado o tratamento com dessensiblização para Malassezia spp., em aplicações semanais, com aumento progressivo da dosagem e posterior aumento no intervalo das aplicações. Após onze meses de realização do novo tratamento, o paciente evoluiu com melhora completa das lesões. Conclui-se que a utilização de técnicas imunoterápicas para o tratamento de PV foi considerado eficaz no caso relatado, apesar de ainda não haver evidências que amparem sua utilização em maior escala.

Pityriasis versicolor is a infection caused by Malassezia yeast species, which, despite simple management, involves a high risk of recurrence and chronicity, and there are few effective therapies for resistant strains. Desensitization for Malassezia spp. has been reported in the literature, but for atopic dermatitis, rather than pityriasis versicolor, making this an innovative report. The case presented herein is of a 28-year-old man who had typical manifestations of pityriasis versicolor in the face, cervical, dorsal, and axillary region for 4 years that were resistant to topical and systemic therapies. Once the ineffectiveness of traditional therapies had been determined, weekly Malassezia desensitization sessions were begun, progressively increasing first in dosage and then in frequency. After 11 months, the lesions had improved completely. In this case, immunotherapeutic techniques effectively treated pityriasis versicolor, although the evidence is as yet insufficient to support large-scale use.

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.

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>

Comparison of fluorescent staining versus KOH wet-mount microscopy for detection of superficial fungal infection / 中华皮肤科杂志

Objective To compare the diagnostic value of fluorescent staining versus KOH wet-mount microscopy in detecting superficial fungal infection.Methods Totally,600 specimens from cases of clinically diagnosed superficial fungal infections and 102 from cases of clinically diagnosed Malassezia infection (including 54 cases of pityriasis versicolor and 48 cases of Malassezia folliculitis) were collected from the dermatology clinic of Tenth People's Hospital of Tongji University between July 2017 and February 2018.These specimens were subjected to fluorescent staining and KOH wet mount separately followed by direct microscopy,and the positive rate and average time for slide reading were compared between the two methods.Culture served as the gold standard method,and the missed diagnosis rate was compared between the two methods.Statistical analysis was carried out using chi-square test or Fisher's exact test for comparing enumeration data,and paired t test for comparing emeasurement data.Results Of the 600 specimens from clinically diagnosed superficial fungal infection cases,fungi were detected in 546 (91.00％) and 489 (81.50％) by fluorescent staining and KOH wet-mount microscopy respectively (x2 =22.83,P ＜ 0.05).Fluorescent staining showed significantly shorter average reading time (73.67 ± 13.56 s)compared with KOH wet-mount microscopy (87.12 ± 15.83 s,t =14.60,P ＜ 0.05).Among the 54 specimens from pityriasis versicolor cases,fluorescent staining and KOH wet-mount microscopy positive results in 51 (94.44％) and 50 (92.59％) specimens respectively (adjusted x2 =0,P ＞ 0.05),with the average reading time being 38.36 ± 8.79 s and 41.25 ± 15.67 s respectively (t =1.14,P ＞ 0.05).Of the 48 specimens from Malassezia infection cases,43 (89.58％) and 11 (22.92％) specimens were detected to be positive for fungi by fluorescent staining and KOH wet-mount microscopy respectively (x2 =43.34,P ＜ 0.05),and fluorescent staining showed shorter average reading time (42.14 ± 12.61 s) compared with KOH wet-mount microscopy (103.56 ± 9.48 s,t =17.83,P ＜ 0.05).Among the 600 specimens from superficial fungal infection cases,culture yielded fungi in 479.Moreover,476 specimens were found positive by fluorescent staining,and 3 were found negative (0.63％),while KOH wet-mount microscopy showed 465 positive results and 14 negative results (2.92％).There was a significant difference in the missed diagnosis rate between the two methods (x2 =7.25,P ＜ 0.05).Conclusion Compared with KOH wet-mount microscopy,fluorescent staining can increase the detection rate,reduce missed diagnosis rate and shorten reading time.

White piedra, black piedra, tinea versicolor, and tinea nigra: contribution to the diagnosis of superficial mycosis

Abstract Superficial mycoses are fungal infections restricted to the stratum corneum and to the hair shafts, with no penetration in the epidermis; they are: white piedra, black piedra, tinea versicolor, and tinea nigra. This study presents images of mycological tests performed in the laboratory, as well as exams performed at the authors office, in order to improve the dermatologist's knowledge about the diagnosis of these dermatoses, which are common in many countries.

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.

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.

Treatment of pityriasis versicolor with topical application of essential oil of Cymbopogon citratus (DC) Stapf - therapeutic pilot study / Tratamento de pitiríase versicolor com aplicação tópica do óleo essencial de Cymbopogon citratus (DC) Stapf - estudo terapêutico piloto

BACKGROUND: Pityriasis versicolor is a fungal infection caused by Malassezia spp. that has frequent relapses. OBJECTIVES: The main objective of this research was to perform phase I and II clinical studies, using formulations containing essential oil of Cymbopogon citratus in patients with pityriasis versicolor. METHODS: Phase I study included twenty volunteers to ascertain the safety of the formulations. In phase II, 47 volunteers randomly received essential oil formulations at 1.25 μL/mL concentration, for forty days. The shampoo should be applied three times a week and the cream twice a day. A control group in phase II, consisting of 29 volunteers, received the same formulations but with 2% ketoconazole as the active ingredient. RESULTS: No significant adverse events were observed in volunteers during Phase I. In Phase II, 30 (63.83%) volunteers using essential oil and 18 (62.07%) using ketoconazole remained until the end of the study. We observed a predominance of lesions in disseminated form, with M. sympodialis detected as the predominant agent identified in cultures. After 40 days of treatment, the rate of mycological cure was 60% (p <0.05) for the group treated with essential oil of C. citratus and over 80% (p <0.05) for the group treated with ketoconazole formulations. CONCLUSIONS: Notwithstanding the safety and antifungal effects observed in this study after application of formulations containing the essential oil of C. citratus, further studies with larger populations should be performed to confirm the actual potential of these formulations in the treatment of patients with Pityriasis versicolor. .

FUNDAMENTOS: Pitiríase versicolor é uma micose causada pela Malassezia spp., e que apresenta frequentes recidivas. OBJETIVOS: Este trabalho objetivou realizar estudos clínicos de fase I e II, para essa patologia, com óleo essencial de Cymbopogon citratus. MÉTODOS: Na fase I, participaram vinte voluntários para averiguar a segurança das formulações. Na fase II, 47 voluntários receberam as formulações do óleo essencial a 1,25 μL/mL, as quais deveriam ser utilizadas por quarenta dias, sendo o xampu três vezes por semana e o creme duas vezes ao dia. Um grupo controle na fase II, constituído por 29 voluntários recebeu as mesmas formulações, com cetoconazol a 2%. RESULTADOS: Verificada a segurança das formulações com a finalização da fase I, onde nenhuma reação adversa significativa foi observada nos indivíduos sadios, conduziu-se a fase II. Nesta segunda fase, 30 (63,83%) voluntários utilizando óleo essencial e 18 (62,07%) cetoconazol permaneceram até o final do estudo. Observaram-se nos pacientes com pitiríase versicolor predomínio de lesões na forma disseminada e M. sympodialis foi o agente predominante identificado em cultura. Após 40 dias de tratamento, obteve-se um percentual de cura micológica de 60% (p < 0,05) para o grupo tratado com óleo essencial de C. citratus e superior a 80% (p < 0,05) para o grupo tratado com cetoconazol. CONCLUSÕES: Apesar da segurança e efeito antifúngico observados após aplicação das formulações contendo óleo essencial de C. citratus, outros estudos com maior número de portadores de pitiríase versicolor precisam ser realizados para confirmar o real potencial destas f...

Pityriasis versicolor: clinical-epidemiological characterization of patients in the urban area of Buerarema-BA , Brazil / Pitiríase versicolor: caracterização clínico-epidemiológica em pacientes da área urbana de Buerarema-BA, Brasil

BACKGROUND: Pityriasis versicolor (PV) is a cutaneous pigmentation disorder caused by a lipophilic yeast of the genus Malassezia sp. It is a superficial mycosis characterized by well-defined, slightly scaly skin lesions of variable color. In Brazil, the number of reported cases is small, and there are few epidemiological studies. OBJECTIVES: to assess incidence, characteristics of the lesions, effectiveness of the Zileri's Sign procedure, and the epidemiological profile of PV in the urban area of Buerarema - Bahia. METHODS: Biological samples were collected on pre-established days at Basic Health Care Units from July to September 2010. Sample collection was followed by laboratory diagnosis using Porto's Method. RESULTS: Of the 158 patients with suspected PV participating in the study, 105 (66.5%) were positive; 72 (68.6%) were female and 33 (31.4%) were male. Sex and location of lesions showed statistically significant differences (p<0.05). The region with the highest rate of cases of PV was found to be the center of the city, with 40.9% of diagnosed cases. The most affected age group was between 10 and 19 years. There was a significant association between the results produced through Zileri's Sign and Porto's Method in relation to positive and negative results (p<0.05). CONCLUSIONS: The results showed a higher prevalence of PV among individuals at puberty. The Zileri's Sign method proved to be counterproductive, because it showed low efficacy as a method for clinical diagnosis, yielding negative results for 36 (34.3%) patients who had been diagnosed with PV through laboratory examination. .

FUNDAMENTOS: A pitiríase versicolor é um distúrbio de pigmentação cutânea causada pela levedura lipofílica do gênero Malassezia sp. É uma micose superficial caracterizada por produzir lesões delimitadas, com descamação fina e de cor variável. No Brasil, o relato do número de casos e de estudos é restrito. OBJETIVOS: Analisar a incidência, as características das lesões, a eficácia do Sinal de Zileri e o perfil epidemiológico da pitiríase versicolor na área urbana do município de Buerarema-BA. MÉTODOS: Foram coletadas amostras biológicas no período de julho a setembro de 2010, em dias pré-establecidos, nas Unidades Básicas de Saúde. O Método de Porto foi utilizado como diagnóstico laboratorial. RESULTADOS: Dos 158 pacientes cadastrados com suspeita de pitiríase versicolor, 105 (66,5%) mostraram-se positivos, sendo 72 (68,6%) do sexo feminino e 33 (31,4%) do sexo oposto. Ocorreu diferença estatisticamente significante entre sexo e localização das lesões (p<0,05). A região com maior índice de pitiríase versicolor foi detectada no centro do município com 40,9% dos casos diagnosticados. A faixa etária mais acometida foi entre 10 e 19 anos. Houve associação significante entre o resultado do Sinal de Zileri e do Método de Porto em relação aos resultados positivos e negativos (p<0,05). CONCLUSÕES: Frente aos resultados, observou-se maior prevalência da pitiríase versicolor em jovens no período da puberdade. O Sinal de Zileri mostrou-se ...

Pityriasis Versicolor on Penile Shaft in a Renal Transplant Recipient

Pityriasis versicolor is a superficial infection of the stratum corneum, which is caused by the Malassezia species. Tge Malassezia species consist of 12 subspecies, including M. furfur, M. pachydermatis, M. symphodialis and M. globasa. The Malassezia species are classified as a normal flora, particularly in the sebum rich areas of the skin, and they convert from saprophytic yeast to parasitic mycelial morpholgic form to cause clinical disease. But majorities of their distributions are in the upper back, the neck, the thighs, and the forearm, and not in the penis. It is well known that the renal transplant patients, who take immunosuppressive agents, have impairment in the protective cell mediated immunity. Thus, they are more susceptible to infectious diseases, such as a fungal infection. Therefore, clinical manifestations show higher incidence of disease, but they mostly occur in an expected distribution. We here report a case of pityriasis versicolor in a renal transplant recipient on penile shaft, which is an unusual area.

Random amplified polymorphic DNA combined with microfluidic chips in the identification of Malassezia species / 中华皮肤科杂志

Objective To evaluate the performance of microfluidic chips in the identification and genotyping of Malassezia species.Methods This study included 6 reference Malassezia strains and clinical Malassezia isolates from the scrapings of patients with pityriasis versicolor and follicular contents of patients with Malassezia folliculitis.These isolates were identified by DNA sequencing,random amplified polymorphic DNA (RAPD)-PCR and microfluidic chips.Cluster analysis was carried out and tree diagrams were generated.Results A total of 83 Malassezia isolates were obtained from 72 patients with pityriasis versicolor and 11 patients with Malassezia folliculitis.Genomic DNA of most strains was successfully amplified by PCR with two primers S22 and S24,and PCR with S22 primer produced more stable and clear amplification bands than that with S24.Positive bands of different sizes were repetitively obtained by using microfluidic chips,with interspecies and intraspecies polymorphisms observed in all the strains.On the basis of DNA sequencing,microfluidic chips and RAPD-PCR could be used to successfully distinguish the following eight species,i.e.,M.furfur,M.sympodialis,M.globosa,M.pacbydermatis,M.slooffiae,M.Japonica,M.yamatoensis and M.dermatis.Conclusions As a rapid,high-throughput and high-sensitivity method,microfluidic chips combined with RAPD-PCR shows an advantage for analyzing interspecies genetic diversity,genetic relationship of Malassezia species,as well as for identifying new Malassezia species.

Novos aspectos na evolução clínica da pitiríase versicolor / New aspects in the clinical course of pityriasis versicolor

FUNDAMENTO: A pitiríase versicolor é uma doença infecciosa causada por várias espécies de Malassezia com uma tendência a se tornar recidivante ou crônica. OBJETIVOS: Este trabalho foi conduzido na tentativa de conhecer a evolução clínica da pitiríase versicolor em relação ao número de recidivas após um tratamento adequado no período de 12 meses e correlacionar o número de recidivas com as espécies de Malassezia isoladas. MATERIAL E MÉTODOS: Cento e dois pacientes com diagnóstico clínico e laboratorial de pitiríase versicolor foram acompanhados por um período de 12 meses para observarmos o número de recidivas da doença. RESULTADOS: A pitiríase versicolor, após um tratamento adequado, apresentou três tipos de evolução clínica num período de 12 meses: pitiríase versicolor sem nenhum episódio de recidiva (32,35 por cento); pitiríase versicolor recidivante, com um a quatro episódios de recidiva (52,94 por cento) devidos a fatores de predisposição relacionados; e pitiríase versicolor crônica, com mais de quatro episódios de recidiva (14,70 por cento) sem nenhuma relação com fatores de predisposição. CONCLUSÕES: A pitiríase versicolor apresentou uma evolução clínica de acordo com o número de episódios de recidiva da doença analisados durante um período de 12 meses que pode ser considerada da seguinte maneira: pitiríase versicolor com cura clínica e micológica, pitiríase versicolor recidivante e pitiríase versicolor crônica.

BACKGROUND: Pytiriasis versicolor is an infectious disease caused by several Malassezia species which has a tendency to become relapsing or chronic. OBJECTIVES: This study was conducted in an attempt to investigate the clinical course of pityriasis versicolor with regard to the number of relapses after a 12-month therapy and correlate this number with isolates of Malassezia species. MATERIAL AND METHODS: 102 patients with clinical and laboratory diagnosis of pityriasis versicolor were monitored for 12 months to investigate the number of relapsing episodes of the disease. RESULTS: After appropriate treatment, pityriasis versicolor presented three types of clinical course: pity - riasis versicolor without relapsing episodes (32.35 percent), relapsing pityriasis versicolor with one to four relapsing episodes (52.94 percent ) due to associated predisposing factors, and chronic pityriasis versicolor with more than four relapsig episodes (14.70 percent) with no relation to predisposing factors. CONCLUSIONS: The clinical course of pityriasis versicolor varied according to the number of relapsing episodes of the disease analyzed over a period of 12 months and can be classified as follows: pityriasis versiolor with clinical and mycological clearing, relapsing pityriasis versicolor and chronic pityriasis versicolor.

Ausencia de afectación axilar en dos casos de pitiriasis versicolor / Absolutely sparing axillae in two cases of versicolor pityriasis

La pitiriasis versicolor (PV) es una infección micótica superficial común de la piel producida por diferentes especies del género Malassezia. Las lesiones se localizan principalmente en la parte superior del tronco, pudiendo diseminarse a cuello y brazos. En los últimos años dos publicaciones han llamado la atención acerca de la ausencia de afectación axilar en la PV, lo que contrasta con la creencia de que la humedad y sudoración excesiva son factores que predisponen a su desarrollo. Se describen dos nuevos casos en varones jóvenes sanos, con lesiones extensas típicas de PV en el tronco, pero con absoluta ausencia de lesiones a nivel axilar. Los factores responsables de esta situación son desconocidos, aunque se ha sugerido que diferencias en el pH, temperatura y flora microbiana especial en las axilas podrían inhibir el crecimiento de la Malassezia en estas áreas. Otro hecho a considerar es la posible acción germicida o fungostática de diversos componentes presentes en desodorantes y antisudorales de uso común.

Pityriasis versicolor (PV) is a common superficial fungal infection of the skin caused by diverse species of the genus Malassezia. The lesions are mainly located on the upper trunk but they can spread to the neck and arms. On the last years, two reports have called attention about the sparing of axillary areas in PV, which contrasts with the view that humidity and excessive sweating are predisposing factors for its development. In this report, another two cases are described, being both young healthy males with extensive typical lesions of PV affecting the trunk, but absolutely sparing the axillae. The responsible factors involved in this situation are unknown, but it has been suggested that differences in pH, temperature and the special microbial flora of the axillae could inhibit the growth of Malassezia on these areas. Another fact to be considered is the possible germicide or fungistatic action of diverse components in deodorants or antiperspirants of common use.

Aspectos clínicos de pacientes com pitiríase versicolor atendidos em um centro de referência em dermatologia tropical na cidade de Manaus (AM), Brasil / Clinical aspects of patients with pityriasis versicolor seen at a referral center for tropical dermatology in Manaus, Amazonas, Brazil

FUNDAMENTOS: A pitiríase versicolor (tinha versicolor) é uma micose superficial crônica, causada por leveduras do gênero Malassezia spp. comensais das camadas queratinizadas da pele e que, sob determinadas condições ainda não esclarecidas, se torna patogênica, determinando as manifestações clínicas da doença. É uma dermatose recidivante e, mesmo após tratamento, pode deixar hipopigmentação persistente, causando problemas sociais aos indivíduos acometidos. OBJETIVO: Descrever as características clínicas e epidemiológicas de pacientes com diagnóstico de tinha versicolor atendidos em uma unidade de referência em Dermatologia (Fundação Alfredo da Matta). MÉTODOS: Estudo de série de casos em que foram detalhadas as manifestações cutâneas e as características epidemiológicas de pacientes atendidos na Fundação Alfredo da Matta com diagnóstico de tinha versicolor. RESULTADOS: Cento e dezesseis pacientes foram incluídos no estudo no período de janeiro a agosto de 2008. A maioria dos indivíduos é do sexo masculino, de cor parda, da faixa etária jovem e formada por estudantes, que apresentavam fatores predisponentes ao surgimento das manchas. Também a maioria apresentava lesões extensas e história passada da doença. CONCLUSÃO: O estudo mostrou alta proporção de indivíduos com quadros extensos e de longa duração da doença.

BACKGROUND: Pityriasis versicolor (tinea versicolor) is a chronic superficial mycosis caused by yeasts of the Malassezia spp. genus commensal of the keratinized layers of the skin. Under conditions not yet understood, it becomes pathogenic determining the clinical manifestations of the disease. It is a recurrent skin condition and persistent hypopigmentation may remain after treatment, causing social problems to those affected. OBJECTIVE: To describe the clinical and epidemiological features of patients diagnosed with tinea versicolor treated at a referral center for dermatology (Alfredo da Matta Foundation). METHODS: Case-studies in which cutaneous manifestations and epidemiological characteristics of patients diagnosed with tinea versicolor treated at Alfredo da Matta Foundation were detailed. RESULTS: One hundred and sixteen patients were included in the study from January to August 2008. Most subjects were male, of mixed ethnicity and young age. Most were students who were predisposed to the development of macules. The majority had extensive injuries and past history of the disease. CONCLUSION: The results revealed a high proportion of individuals with extensive clinical manifestations and duration of the disease.

Random amplified polymorphic DNA analysis of Malassezia isolates from cutaneous lesions of pityriasis versicolor / 中华皮肤科杂志

Objective To investigate intraspecific and interspecific variation within Malassezia iso-lates from patients with pityriasis versicolor by random amplified polymorphic DNA (RAPD) analysis, to learn the difference between RAPD analysis and physiological and biochemical methods in the typing of Malassezia species, and to explore the relationship between RAPD patterns and Malassezia species. Methods A total of 47 Malassezia isolates were obtained from 34 patients with pityriasis versicolor, and they were classified into 5 species by morphological, physiological and biochemical features, I.e., M. Fin'fur, M. Obtusa, M. Globosa, M. Restricta and M. Sympodialis. Genomic DNA was extracted from the 47 clinical isolates and 10 reference strains (including 7 species) of Malassezia. PCR was performed using 4 random primers including S22, S24, S25 and S33. RAPD patterns were analyzed by NTSYS software and dendrogram was autogenerated. Results Genomic DNA of most strains was successfully amplified with four primers, espe-cially with primers S22 and S24 that resulted in rather stable and clear DNA bands. A total of 82 fragments were amplified from all tested strains. These strains showed both interspecifie and intraspecific variation. Multiple swains were isolated from different body sites of 4 patients and identified into different species by biochemical and morphological typing; those swains from same hosts occupied contiguous positions in the dendrogram and exhibited a high genetic convergence. Conclusion The phenomenon that different strains from a co-host show a high genetic convergence indicates that species specificity and evolution of Malassezia are closely related to its hosts.

Resultados del rratamiento con yodo salicilico y ketoconazol en la pitiriasis versicolor / The results of the treatment of Tinea Versicolor utilisig salicylic iodine and Ketoconazol

El tratamiento de la Pitiriasis Versicólor depende de varios factores como la localización, el tamaño, el número de lesiones y la edad. La vía a utilizar puede ser sistémica o local;se prefiere esta última por tener menos efectos adversos (cremas de tolnaftato, ketoconazol, pinceladas de yodo salicílico, pinceladas de timol y otros). El universo de estudio estuvo integradopor 50 pacientes portadores de Pitiriasis Versicolor diagnosticados por la clínica y el exudado micológico, la mitad de los cuales usó pinceladas de yodo salicílico y la otra mitad crema de ketoconazol durante 3 semanas de forma tópica dos veces al día. El resultado fue similar, con una mayor eficacia de la pincelada de yodo salicílico (92%) sobre la crema de ketoconazol (88 %). El costo por tratamiento fue significativamente menor en los tratados con pinceladas de yodo salicílico ($0.50) que los tratados con crema de ketoconazol ($3.80). Se concluye que debe utilizarse de elección la pincelada de yodo salicílico por ser más barata y efectiva.

The treatment of Tinea Versicólor depend on various factors, such as location of the lesions, size, number and age. The way of the treatment use might be systemic or local, rather preferable is the last one, because of less adverse effects ( Tolnaftate cream, Ketoconazol, Salicylic Iodine brushes , Timol brushes and others) The total of patients was conformed by 50 patients clinically and mycological diagnosed of Tinea Versicólor, 25 of them utilised salicylic iodine brushes in the lesions and the rest, Ketoconazol for 3 weeks, Bid. The results was similar, with higher efficacy on the salicylic iodine brushes (92%) , compared with an 88% of Ketoconazol cream The treatment cost was significantly less in the brushes than with the cream. It is concluded that the choice must be made on the salicylic iodine brushes compared with the Ketoconazol cream.

Isolation and Identification of Malassezia Species from Lesional and Non-lesional Sites of Patients with Pityriasis Versicolor / 中华皮肤科杂志

Objective To investigate the distribution of Malassezia species in lesional and non-lesion-al sites of patients with pityriasis versicolor(PV),species-variation in different anatomic sites and in lesions with different pigmentation,and the relationship between various Malassezia species and severity and age of PV patients.Methods A total of629skin specimens taken by sterile adhesive tape from the lesions and non-lesional skin were inoculated on media containing rapeseed oil in113patients with PV.Isolated colonies were identified to species based on physiological and morphological characteristics.Results The isolation rates of Malassezia spp.were not significantly different from both lesions and corresponding non-lesional skin.Among non-lesional sites,the isolation rate was significantly higher in forehead and trunk than that in upper and lower extremities.Five species were identified out of565strains obtained from the patients,including M.sympodialis(44.78%),M.furfur(32.94%),M.globosa(11.68%),M.obtusa(5.84%)and M.restricta(4.76%).Two dif-ferent species were isolated simultaneously from27sites.There was no obvious difference in species distribu-tion patterns between lesions and non-lesional sites.M.restricta was isolated from forehead exclusively.Species-variation was closely linked to lesions with different pigmentation and the age of patients,not to the severity of disease.Conclusion There is neither statistical difference of Malassezia isolation rate and species distribution between lesions and non-lesional skin,nor correlation between disease severity and species-varia-tion.The anatomic sites,the diversity of pigmentation pattern and the age of patients seem to be associated with different Malassezia species.

Genotyping of Clinical Isolates of Malassezia from Patients with Tinea Versicolor by PCR-RFLP / 中华皮肤科杂志

Objectives To develop a rapid genotyping method of clinical isolates of Malassezia from patients with tinea versicolor by PCR-RFLP,and to evaluate reliability of the approach as compared with biochemical classification.Methods Tween assimilation test and catalase reaction were carried out to identify 74 isolates of Malassezia species from patients with tinea versicolor and 7 Malassezia reference strains.The sequence of 28S rDNA of Malassezia species was amplified by PCR,and then the product was analyzed by RFLP with Eco88I,Bsp143Ⅱ and BshNⅠ,respectively.Results M.restricta,M.obtusa and M.pachydermatis were successfully identified by three restriction endonucleases.M.restricta was found to be more diverse from the other 6 species in genetic homology.By comparison with PCR-RFLP technique,a possible mistake was discovered with biochemical method.Conclusion PCR-RFLP is a promising molecular biological technique,which could rapidly and correctly classify Malassezia species.

Tinea Versicolor; A Prospective Survey / 대한의진균학회지

BACKGROUND: Tinea versicolor is regarded as one of the most common dermatoses. It constitutes about 3% of dermatological patients. OBJECTIVE: The present study was undertaken to evaluate the frequency of tinea versicolor among patients with fungal skin infections. Special attention was paid to sex and age distribution, as well as to the associated cutaneous and systemic disorders. MATERIAL AND METHODS: The study was based on 2665 questionnaires. The clinical diagnosis of tinea versicolor was confirmed by positive direct mycological examination in 10~20% potassium hydroxide solution with addition of dimethyl sulfoxide and by yellow-orange Wood's lamp fluorescence of the lesions. RESULTS AND CONCLUSIONS: Tinea versicolor was diagnosed in 325 patients (12.2% of all patients with different fungal skin and nail infections). Female patients constituted 52.3% and males 47.7%. The majority of patients were from the big towns (81.2%), only 4% of patients lived in the rural areas. 45.3% of patients finished secondary school, 23.4% had higher education. The age of patients varied from 10 to 79 years, mean age 36.1 +/- 15.3 years. Tinea versicolor was diagnosed in 45.0% of patients between the age of 16 and 35 years and it was uncommon in children (5.2%). The duration of the disease was 1 week to 23 years, mean 2.5+/-3.5 years. 49.5% of patients were previously treated with different regimens, Other cutaneous abnormalities were found in 20.6% of patients with tinea versicolor. Among them acne (4.9%), seborrheic dermatitis (3,1%) and onychomycosis (3.1%) were the most common ones. 14.5% of tinea versicolor patients suffered from systemic diseases, such as arterial hypertension (4%), thyroid abnormalities (3.1%), coronary insufficiency (2.5%) and diabetes melllitus (1.5%).

A Case of Tinea Versicolor of the Scalp and Face in Infancy / 대한의진균학회지

Tinea versicolor is a superficial mycosis caused by Malassezia furfur. Tinea versicolor in infancy is rare and the distribution of the lesions differ from that of adult. The predilection sites for tinea versicolor are the chest and back in adults, whereas the face and scalp are commonly involved in childhood tinea versicolor. We report a case of tinea versicolor in a 5-month-old male infant. He had fine scaly whitish macules on the scalp, face and posterior neck. The lesions were successfully treated with topical ketoconazole for 3 weeks.