Changes in fungal ultrastructure after short-course ciclopiroxolamine therapy in pityriasis versicolor.

The clinical outcome and the effects on morphogenesis and cell ultrastructure induced by a 1% ciclopiroxolamine solution in six patients with proven pityriasis versicolor were studied. Treatment regimens consisting of a once-daily application for 1 day, 2 days (Days 1 and 4) or 3 days (Days 1, 4 and 8). Clinical evaluation, scanning (SEM) and transmission electron microscopy (TEM) were performed on skin scrapings before treatment, and at 3, 7, 15 and 21 days after the start of therapy. SEM techniques have shown severe changes in the surface ultrastructure of yeasts and hyphae of Pityrosporum spp. (Malassezia furfur) 15 days after the start of therapy. TEM techniques showed extensive internal disruption, mainly severe necrosis of the cytoplasm, 3 and 7 days after the start of treatment. However, KOH direct microscopy showed apparently normal morphology of Pityrosporum spp. (Malassezia furfur) at all assessment points. The final clinical cure in all the patients was achieved 21 days after the start of therapy.

A clinical double-blind trial comparing amorolfine cream 0.5% (RO-14-4767) with bifonazole cream 1% in the treatment of dermatomycoses.

In a double-blind parallel study, 40 patients with dermatomycoses (one cutaneous candidosis and 39 dermatophyte infections) were treated topically with amorolfine (RO-14-4767) cream (0.5%), a new antifungal compound, or with bifonazole cream (1%). The treatment was applied once daily and was continued until 1 week after resolution of the symptoms, the maximum duration of treatment was limited to 6 weeks. Assessment of results was based on both clinical and mycological parameters. The percentages of amorolfine- and bifonazole-treated patients who were clinically and mycologically cured were 83.33% and 78.95%, respectively. Two patients treated with amorolfine and one patient treated with bifonazole were withdrawn from the trial because of side-effects. There was no significant difference between the two creams in clinical and mycological cure rates and tolerance.

Infection of the central nervous system by Rhinocladiella atrovirens in a patient with acquired immunodeficiency syndrome.

A case of central nervous system invasion by Rhinocladiella atrovirens is described. The patient was an intravenous drug abuser suffering from acquired immunodeficiency syndrome.

Pityriasis versicolor and Pityrosporum ovale. Morphogenetic and ultrastructural considerations.

Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) have been performed on skin material of patients with pityriasis versicolor who were orally treated with itraconazole. Before as well as after therapy, variously sized spherical structures were observed on the surface of the keratinocytes with SEM. TEM examination revealed Pityrosporum ovale, predominantly in its mycelial phase, inside keratinocytes. The spherules as observed by SEM appeared to be amorphous, lipid-like droplets originating from the inside of the keratinocytes. The cytoplasm of the keratinocytes was at least partly occupied by the same amorphous material. It is therefore suggested that P. ovale penetrates the keratinocyte where degradation of the normal keratinous content to amorphous material takes place. This newly formed lipidic substrate may be an essential nutritive factor. The lipidified state of the stratum corneum persisted for at least 3 weeks after eradication of the fungus by itraconazole. It is speculated that the presence of large quantities of this lipid-like material might be the cause of hypopigmentation because it may constitute an ultraviolet light block.

Randomized comparative clinical trial of itraconazole and selenium sulfide shampoo for the treatment of pityriasis versicolor.

Forty patients with pityriasis versicolor, fluorescence of involved areas under Wood's light, and positive microscopic identification of Malassezia furfur were randomly assigned to treatment with either oral itraconazole (200 mg once daily for five consecutive days) or 2.5% selenium sulfide shampoo (once daily application for seven days). Each treatment group consisted of 20 patients. On assessment three weeks after the end of treatment, all patients given itraconazole showed a response: 17 were healed, and three had mild residual lesions. Likewise, all patients in the selenium sulfide group responded to therapy: 16 were healed, and four had mild residual lesions. Tolerability, acceptability, and compliance were excellent with itraconazole. All 20 patients given the drug stated a preference for oral treatment. In the selenium sulfide group, five patients (25%) had adverse reactions attributable to the medication; one of these patients experienced an irritation severe enough to warrant the discontinuation of treatment on the third day. Ten patients in this group stated a preference for oral treatment.

Randomized comparative trial of three regimens of itraconazole for treatment of vaginal mycoses.

A randomized comparative study of three treatment regimens with itraconazole was carried out in 60 nonpregnant women with acute vaginal candidosis. Vaginitis was demonstrated by both a positive culture and positive findings on microscopic examination of a vaginal smear as well as by the presence of clinical symptoms. Sixty patients seen over a three-month period were randomly allocated to receive one dose of 200 mg daily for two consecutive days (regimen A), 200 mg twice a day for one day (regimen B), or 200 mg once a day for three consecutive days (regimen C). Each group comprised 20 patients. In group A, 65% were clinically and microbiologically cured, 5% were clinically but not microbiologically cured, and 30% relapsed. In group B, 55% were clinically and microbiologically cured, 10% were clinically but not microbiologically cured, 15% did not respond to treatment, and 20% relapsed. In group C, 75% were clinically and microbiologically cured, 10% did not respond, and 15% relapsed.

A clinical and mycological assessment of tioconazole solution in the treatment of superficial dermatomycoses.

The efficacy, acceptability, and tolerability of tioconazole solution (1%) in a pump spray were evaluated in an open-label trial in 26 patients with dermatophytosis, superficial candidiasis, and tinea versicolor. Medication was applied twice daily for 30 consecutive days. Eighteen patients had dermatophyte lesions: four patients had tinea pedis interdigitalis (one of these also had tinea cruris), and 14 patients had tinea corporis. Of these, four patients did not respond to treatment and were considered therapeutic failures and ten were carriers and remained so one month after therapy. Five patients were clinically and mycologically cured at the end of therapy and did not relapse one month after therapy. All of the eight remaining patients were clinically and mycologically cured at the end of treatment and one month later: these included seven patients with tinea versicolor and one with anal candidiasis.

Itraconazole therapy in pityriasis versicolor.

The efficacy of itraconazole was assessed in an open trial in 30 patients with disseminated lesions of pityriasis versicolor confirmed by direct microscopy. The patients were allocated randomly to one of two treatment regimens, 200 mg once daily for 5 days or 100 mg once daily for 10 days. On assessment 3 weeks after the end of the treatment, 25 patients were healed, two patients had mild residual lesions, two had considerable residual lesions and one patient had relapsed. One patient reported dyspepsia and one patient reported stomach ache. One patient had asymptomatic elevation of serum transaminase (GOT and GPT) but this had returned to normal 3 weeks after the end of therapy.

Double-blind randomized comparative trial: ornidazole (Tiberal) versus tinidazole (Fasigin) for the treatment of non-specific vaginitis.

In a double-blind, randomized trial 60 patients with demonstrated bacteriological and clinical non-specific vaginitis were treated with tinidazole versus ornidazole. Thirty patients received tinidazole 2 g daily taken orally in two separate doses for two consecutive days. Twenty-three patients (76%) were cured, 3 patients (10%) relapsed and 4 patients were therapeutic failures. Thirty patients received ornidazole with the same regimen. Twenty-eight patients (93%) were cured, 1 patient (3.3%) relapsed and 1 patient had intolerance to the medication.

[Treatment of interdigital tinea pedis using a solution of 1:100 bifonazole (Bay h 4502)]. / Tratamiento de Tinea pedis interdigitalis con solución de bifonazol al 1 por 100 (Bay h 4502).

An open mycologically controlled trial was undertaken to evaluate the efficacy, acceptability and tolerance of bifonazole 1% solution for the treatment of patients with Tinea pedis interdigitalis. The solution of bifonazole was applied once daily for three consecutive weeks. Only patients with positive direct microscopy of scrapings and positive culture (dermatophytes) were included in the trial. Assessments were performed one week after start of therapy, and three days, two weeks and six weeks after therapy end. Twenty-three patients were evaluated (17 males and six females), the average age was 33.6 years (seventeen-sixty-five years) years. In 1 case T. rubrum var. granulare was the infecting organism, in 11 cases T. rubrum and finally 11 cases were due to T., mentagrophytes var interdigitale. Twenty patients were clinically and mycologically cured at the end of treatment and there were no relapses two weeks and six weeks later. One patient (T. rubrum) was cured clinically, but had positive direct microscopy and negative cultures after treatment. This finding persisted two and six weeks after therapy end, but there was no clinical relapse. Two patients (T. mentagrophytes var. interdigitale y T. rubrum var. granulare) did not respond to therapy. One patient had mild irritation (burning and reddening) but was able to finish treatment. All the patients found the medication acceptable and easy to apply.

Topical ketoconazole (2% dermatological cream) for the treatment of superficial dermatomycoses.

A total of 48 patients with superficial dermatomycoses took part in an open trial to study the efficacy, acceptability and tolerance of topical ketoconazole (2% dermatological cream) applied twice daily. Forty patients (23 women and 17 men) were available for review upon completion of therapy. After 30 days of therapy, 11 patients were cured clinically and mycologically and 5 patients were cured clinically but had positive mycological findings. One of the patients in this group relapsed one month later. After 60 days of treatment, 22 patients were clinically and mycologically cured. Two patients did not respond to treatment. Only 2 patients in this group relapsed one month later.

Double-blind investigation of R-42470 (terconazole cream 0.4%) and clotrimazole (cream 1%) for the topical treatment of mycotic vaginitis.

A total of 78 patients took part in a double-blind randomized comparison of the efficacy, acceptability and tolerance of a new antifungal terconazole (R-42470) (cream 0.4%) with the well established and clinically effective clotrimazole (cream 1%) for the topical treatment of mycotic vaginitis. Five grams of cream were applied to the vagina for 7 consecutive days. Twenty non-pregnant and 19 pregnant patients were included in each group. Clinical and mycological controls were carried out one week and one month after completion of therapy and 89.7% of the patients treated with terconazole responded to therapy and 82.1% patients treated with clotrimazole were cured. Statistical analysis showed no significant difference when the results of the terconazole treated patients and the clotrimazole group were compared.

Scytalidium hyalinum infection diagnosed in Spain.

Scytalidium hyalinum infection of the soles and toe webs was diagnosed in a 40-year-old male immigrant to Spain from Equatorial Guinea. Short courses of therapy with oral ketoconazole (Nizoral) 400 mg day-1 and topical clotrimazole (Canesten) failed to improve the condition.

Nosocomial infection by Rhizomucor pusillus in a clinical haematology unit.

Three patients suffering from acute leukaemia were treated with cytotoxic agents and broad-spectrum antibiotics and received blood transfusion and nasal packing for severe epistaxis. All developed necrosis of nasal and facial tissues, with facial swelling an oedema; two biopsies showed typical phycomycete mycelium, and Rhizomucor pusillus was grown from one biopsy. Air and surfaces in the unit and the air intake and ducting were all heavily colonized by Rh. pusillus and other phycomycetes. It is suggested that Rh. pusillus spores from the air invaded the tissues in the conditions promoted by the nasal packing in these patients with impaired defences.

Orbital phycomycosis.

3 cases with rhinoorbital phycomycosis and a 4th case, in which it was considered retrospectively, are presented in hematological patients. 2 of the 4 patients survived. In the first 3 cases, which appeared in a period of 2 months in the Hematology Unit, an epidemiological study was made, showing that the cause of the infections was contamination of the air-conditioning systems of this unit by numerous Phycomycetes and Mucor pusillus.