Expression Levels of Inflammatory and Oxidative Stress-Related Genes in Skin Biopsies and Their Association with Pityriasis Alba.

Background and objectives: Pytiriasis alba (PA) is a common skin disorder which affects 80% of children between six and 16 years. The etiology of PA is unclear, but hypo-pigmented patches in photo-exposed zones characterize the disease. Because the high ultraviolet exposition of the skin promotes an acute inflammatory response and an increase of oxidative stress (OS), this study aimed to evaluate the expression levels of inflammatory and OS-related genes in skin biopsies, and their association with PA. Materials and Methods: A cross-sectional study was carried out. Skin biopsies of the lesion sites and healthy skin (controls) from 16 children with PA were evaluated. The tissue expression of IL-4, IL-6, IL-17A, TNFα, INFγ, IL-1ß, SOD1, and HMOX1 was analyzed by qRT-PCR, using SYBR Green and glyceraldehyde-3-phosphate dehydrogenase gene as the endogenous control. Results: There were differences in the ΔCq values of HMOX1, SOD1, IL-6, and IFNγ between tissue with lesions and healthy skin (p < 0.05). Compared with healthy skin, IL-6, IFNγ, HMOX1, and SOD1 were predominantly under-expressed in the lesion sites. However, 25% of skin biopsies with lesions showed over-expression of these four genes. Positive correlations between the expression of IL-6 and HMOX1, SOD1, and IFNγ (p < 0.05) were also observed. Conclusions: Our results suggest the presence of molecular stages of PA, defined according to the over-expression (first stage) or under-expression (second stage) of the HMOX1, SOD1, IL-6, and IFNγ genes in abnormal skin tissue. These findings may have implications for the selection of treatment for PA-related lesions.

Pityriasis alba: Possible associations with intestinal helminths and pathogenic protozoa.

BACKGROUND: The aetiology of pityriasis alba (PA) remains uncertain, and children are at risk for PA and intestinal parasites. AIM: To determine the prevalence of intestinal parasites in PA patients and to evaluate their possible role in PA pathogenesis. METHODS: Overall, 180 PA patients and 100 healthy individuals were enrolled. Intestinal parasites were diagnosed by triple coproscopy, and the total serum Immunoglobulin E (IgE) levels were determined by ELISA. PA patients with intestinal parasites were treated with conventional antiparasitic drugs. Patient response to antiparasitic therapy was evaluated after 6 weeks. RESULTS: The prevalence of intestinal parasites in PA patients and controls was 60 ± 3.6% and 32 ± 4.6%, respectively (P < .0001). Regardless of the parasite species among the PA patients and control individuals, the total IgE levels were significantly higher in PA patients (P ≤ .05). The highest values of IgE were found in PA patients with Hymenolepis nana (641.7 ± 46.3 IU/mL). The total IgE level in PA patients with parasites decreased after antiparasitic therapy, but the reduction was only significant in patients with H. nana (P < .05). Complete disappearance of hypopigmented patches was observed after the elimination of H. nana, Giardia lamblia and Enterobius vermicularis in 65 ± 10.6%, 48.7 ± 8.0% and 33.3 ± 8.2% of cases, respectively. In total, a positive clinical response to antiparasitic therapy was achieved in 60 ± 4.7% of infected PA patients. CONCLUSION: A positive clinical response to antiparasitic therapy indicates the role of intestinal parasites in PA pathogenesis. Parasitological examination is justified by the recovery of 60 ± 4.7% of infected PA patients after the elimination of intestinal parasites.

Skin diseases associated with atopic dermatitis.

Atopic dermatitis is a common chronic pruritic inflammatory skin disorder, characterized by an abnormal skin barrier, immune dysfunction, and an altered skin microbiome. Atopic dermatitis may be seen in conjunction with a variety of other skin disorders due to the complex pathogenesis of atopic dermatitis, involving genetic and environmental factors that are associated with immune dysfunction, barrier defects, and altered skin microbiomes. Skin disorders associated with atopic dermatitis include diseases sharing similar genetic origins like ichthyosis vulgaris, infectious diseases such as impetigo, and eczema herpeticum, in addition to the cutaneous autoimmune diseases, alopecia areata, and vitiligo. Atopic dermatitis is also often linked to such benign conditions as pityriasis alba and keratosis pilaris. This review discusses the cutaneous comorbidities of atopic dermatitis and their relationship via their occurrence in conjunction with atopic dermatitis.

Pityriasis amiantacea: a study of seven cases.

Pityriasis amiantacea was first described in 1832. The disease may be secondary to any skin condition that primarily affects the scalp, including seborrheic dermatitis. Its pathogenesis remains uncertain. We aim to analyze the epidemiological and clinical profiles of patients with pityriasis amiantacea to better understand treatment responses. We identified seven cases of pityriasis amiantacea and a female predominance in a sample of 63 pediatric patients with seborrheic dermatitis followed for an average of 20.4 months. We reported a mean age of 5.9 years. Five patients were female, with a mean age of 9 years. All patients were successfully treated with topic ketoconazole.

[Etiology of acquired hypochromic patches in dermatological area in Mali]. / Etiologies Des Hypochromies Acquises En Milieu Dermatologique.

INTRODUCTION: In dark skin patients, hypopigmentation is the most disfiguring condition. Very few studies on hypochromic disorders have been conducted in specialized health centers. The present study is aimed to describe the etiologies of hypochromic patches in dermatological area, in Bamako. METHODS: We carried out a cross sectional study in the Dermatology Clinic of the "Centre National d'Appui à la lutte contre la Maladie (CNAM, Ex Institut Marchoux)". All acquired hypochromic patches (HP) were selected. HP was defined as a "skin patch lighter in pigmentation than normal surrounding skin with a diameter of at least 1 cm". The diagnosis was mainly based on clinical findings. RESULTS: The prevalence of HP was 3.42% and the main causes were seborrheic dermatitis (23.3%), pytiriasis alba (20.15%), vitiligo (18.9%), pityriasis versicolore (18.5%) and leprosy (12.6%). CONCLUSION: There are many causes of HP including leprosy, a disease though rare to date, but still prevalent in dermatological area.

Prevalence survey of dermatological conditions in mountainous north India.

BACKGROUND: Dermatological conditions account for a substantial proportion of the global burden of disease in low and middle income countries (Bickers D, Lim H, Margolis D, et al. The burden of skin diseases: 2004. A joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol 2006; 55: 490-500) and place major pressures on primary healthcare centers (Satimia F, McBride S, Leppard B. Prevalence of skin disease in rural Tanzania and factors influencing the choice of health care, modern or traditional. Arch Dermatol 1998; 134: 1363-1366). In mountainous North India, where limited resources are available for skin care, no dermatological data exists on prevalence, treatment patterns, or associations. The study aimed to measure prevalence and treatment of dermatological conditions and associated factors in Uttarakhand so to inform delivery of dermatological care and prevention programs in India. METHODS: Single stage cluster randomized sampling generated seven cluster units or villages. Household members (n = 1275) from each cluster were interviewed, and where possible, examined and offered treatment. RESULTS: Dermatological conditions were prevalent (45.3%), with 33% being of infectious etiology. Atopic dermatitis (9.2%), scabies (4.4%), tinea corporis (4.1%), and pityriasis alba (3.6%) were most prevalent. Multivariate analysis showed that cohabitation with animals (OR = 1.62, 95% CI-1.35, 1.95) was a predictor of any skin diseases. A health practitioner was not consulted in 64.7% of dermatological conditions, and where consulted, approximately 69% received inappropriate or ineffective treatments. Excessive spending on dermatological care was commonplace. Limitations associated with cross-sectional cluster methodology included the underrepresentation of seasonal conditions and conditions of short duration. Caste proved difficult to randomize across clusters given villages were often composed according to caste. CONCLUSION: These results demonstrate a high prevalence of dermatological conditions and a pattern of conditions somewhat distinctive to this mountainous area of North India. These findings will assist development of appropriate and cost-effective dermatological services in these mountainous regions.

Superficial fungal infections of the male genitalia: a review.

Fungal infections of the genitals are probably more common than realized; however, relatively few reports concerning fungal genital infections exist in the literature. In this review, the fungal microbiota of the penis are highlighted, and the epidemiological characteristics of Candida balanitis, penile pityriasis versicolor, and tinea genitalis are addressed. In addition, the benefits of circumcision on male genital infections are included. However, systemic mycoses affecting the penis and/or scrotum will not be addressed in this review. To obtain a reliable diagnosis of genital fungal infections, medical history, clinical examination, and mycological and histological investigations of the lesions are critical.

Características clínico-epidemiológicas de pitiriasis alba en población de 6 a16 años en colegios nacionales del distrito de Manuel A. Mesones Muro, Lambayeque, Perú / Clinico-epidemiological fetaures of pityriasis alba in six- to sixteen- year old children in public schools in Manuel A. Mesones-Muro district Lambayeque, Perú

Objetivo: Describir las características clínico-epidemiológicas de la pitiriasis alba en la población de 6 a 16 años en los colegios nacionales del distrito de Mesones Muro, durante el periodo MarzoûJunio 2010. Material y método: Estudio descriptivo, prospectivo y transversal. Se usó una ficha de recolección de datos clínicos- epidemiológicos y una ficha de patologías asociadas y antecedentes dirigida a padres o apoderados. Se utilizó el programa Epidat v.3,1, para hallar el índice kappa que indicó la fiabilidad de concordancia entre evaluadores. Se utilizó toda la población de 6 a 16 años de colegios nacionales que pertenecen a la jurisdicción educativa del distrito. Se usó estadística descriptiva y analítica, con nivel de significancia p<0,05. Para el análisis se empleó el programa SPSS v.17,0. Resultados: De 548 estudiantes, 390(71,2%) presentaron pitiriasis alba. La edad promedio fue de 10,16±2,99 años; sexo masculino 52,6%; etapa adolescente 55,1%; localización más frecuente cara con 93,6%; lesiones múltiples en 92,3%; fototipo de piel más afectado IV con 61,8%; tiempo de enfermedad fue 5,34 ±6,85 años. Hay asociación entre pitiriasis alba con: patologías asociadas de acné; antecedentes personales de pitiriasis alba y atopía; y antecedentes familiares de pitiriasis alba y rinitis alérgica, encontrada con prueba chi2 y test exacto de Fisher con p<0,05. Conclusiones: La pitiriasis alba en Mesones Muro es un problema común. Las características epidemiológicas difieren de las encontradas en otras poblaciones, las características clínicas son similares a otras poblaciones. Se encontró asociación entre pitiriasis alba con patología asociada de acné; antecedentes personales de pitiriasis alba y atopía; mas no se encontró asociación de pitiriasis alba con sexo y edad por etapas de vida.

Objective: To describe clinical and epidemiological features of pityriasis alba in a 6- to 16- year old population of students from public schools in Mesones-Muro district, from March to June 2010. Materials and methods: This is a descriptive, prospective and crosssectional study. We collected clinical and epidemiological data, including associated diseases and clinical history in a specially designed form, which was administered to parents and/or guardians. We used the Epidat v. 3.1 software, in order to find the kappa index which indicated the reliability of agreement between raters. We surveyed the whole 6- to16- year old schoolchildren population from public schools belonging to this district educational jurisdiction. We used descriptive and analytical statistics, and significance was fixed with using a p <0.05 value. SPSSv.17.0. software was used for data analysis. Results: Out of 548 students assessed, 390 (71.2%) had pityriasis alba.Their average age was 10.16 ± 2.99 years, 52.6% were male, and 55.1% were adolescents. Facial lesions were found in 93.6%, multiple lesions in 92.3%, the skin phototype IV was most frequently affected (61.8%), and the time with the condition was 5.34 ± 6.85 years. We found an association between pityriasis alba and the following conditions: acne, a history of atopy, and a family history of pityriasis alba and allergic rhinitis, according to chi2 testing and FisherÆs exact test all with p <0.05. Conclusions: Pityriasis alba is a common problem in Mesones-Muro district. Its epidemiological characteristics differ from those found in other populations, but its clinical features are similar to those reported in other populations. There was an association between pityriasis alba with associated conditions, such as acne and a history of atopy, but there was no association between pityriasis alba and sex and life development stages.

Pityriasis alba revisited: perspectives on an enigmatic disorder of childhood.

Pityriasis alba (PA) is a localized hypopigmented disorder of childhood with many existing clinical variants. It is more often detected in individuals with a darker complexion but may occur in individuals of all skin types. Atopy, xerosis, and mineral deficiencies are potential risk factors. Sun exposure exacerbates the contrast between normal and lesional skin, making lesions more visible and patients more likely to seek medical attention. Poor cutaneous hydration appears to be a common theme for most risk factors and may help elucidate the pathogenesis of this disorder. The end result of this mechanism is inappropriate melanosis manifesting as hypopigmentation. It must be differentiated from other disorders of hypopigmentation, such as pityriasis versicolor alba, vitiligo, nevus depigmentosus, and nevus anemicus. Alleviation of the various risk factors via patient education on proper skin care and hygiene, use of lubricants and emollients, topical corticosteroid therapy in the presence of inflammation, and the novel administration of topical anti-inflammatory drugs such as calcineurin inhibitors can play a crucial role in promoting remission or resolution.

Estudo epidemiológico da pitiríase versicolor na cidade de João Pessoa, PB, de 1999 a 2008 / Epidemiological studies of pityriasis versicolor in the city of João Pessoa,PB, from 1999 to 2008

A Pitiríase versicolor(PV) é uma micose superficial causada por leveduras do gênero Malassezia. Caracteriza­-se por manchas de tonalidades diversas, arredondadas, que podem formar placas, com descamação furfurácea. 0 diagnóstico de PV é clínico, associado ao exame micológico direto e cultura. Buscou-se avaliar a epidemiologia da PV na cidade de João Pessoa, PB, correlacionando sexo, faixa etária, raça, localizações das lesões e exame direto e cultura. 0 estudo exploratório e descritivo foi realizado no Laboratório de Micologia do Departamento de Ciências Farmacêuticas/CCS da Universidade Federal da Paraíba de 1999 a 2008. Em 196 pacientes com suspeita clínica de PV, houve predomínio no gênero feminino (62,24%). A faixa etária de 21 a 30 anos de idade foi a mais acometida. Houve registro de 53,57% pardos, 46,42% brancos, sem registro de negros. A região anatômica mais envolvida foi o trance (71,36%). 0 exame direto e cultura foram realizados para confirmar o diagnóstico. A PV ocorre em todas as idades, em especial adolescentes e adultos, sendo o gênero feminino e indivfduos da cor parda os rnais afetados.

Pityriasis versicolor (PV) is a superficial mycosis caused by yeasts of the genus Malassezia. It is characterized by round patches of various shades, which can form plaques with desquamation furfuracea. The diagnosis of PV is clinical and it is associated with the direct mycological examination and culture. The exploratory and descriptive study was conducted at the Laboratory of Mycology, Department of Pharmaceutical Sciences /CCS,Universidade Federal da Paraiba from 1999 to 2008. In 196 patients with clinical suspicion of PV, there was a predominance in females (62.24%). The age group 21 to 30 years of age was the most affected. There was record of 53.57% brown, 46.42% white, with no record of blacks. The most involved anatomical region was the trunk (71.36%). The direct examination and culture were performed to confirm the diagnosis. The PV occurs in all ages, especially adolescents and adults, being the females of brown color the most affected individuals.

Superficial fungal infections: clinical and epidemiological study in adolescents from marginal districts of Lima and Callao, Peru.

BACKGROUND: Since limited data on superficial fungal infections in teenagers exist in our setting, this study provides the first description of the clinical and epidemiological characteristics of these infections among teenagers in Lima and Callao, Peru. METHODOLOGY: The study involved 1,387 adolescents in five public schools from June to November 2006. Participants were examined for superficial fungal lesions. Samples of skin scrapings for microbiological investigations were obtained from suspicious lesions. RESULTS: A total of 257 subjects were identified with suspected superficial fungal infections. Microbiological assessment was positive for 166 of 257 (64.59%). The average prevalence was 12.61% with variation between different districts. Males were more affected (64%) than females (36%) (p = 0.001). Pet ownership, use of public baths, and wearing sneakers were identified as important risk factors. The majority (61.5%) of the subjects presented with itching although 38.5% were asymptomatic. Tinea pedis was observed in 62.6%, onychomycosis in 24% and pityriasis versicolor in 10.8%. Dermatophytes were isolated in 105 cases with T. rubrum being identified in 86 cases (59.7%), T. mentagrophytes in 14 (9.7%) and yeast in 39 (23.4%). Malassezia spp. was found by direct examination in 18 cases (12.5%), C. kruseii in 8 cases (5.6%), and C. albicans in 2 cases (1.4%). Mixed infections were found in 22 cases. CONCLUSIONS: Superficial fungal infection manifesting as tinea pedis, onychomycosysis and tinea versicolor is prevalent in our setting. As many infections remain asymptomatic, regular examination of this population is advocated. The associated risk factors for these infections also need to be addressed.

The frequency of common skin conditions in preschool-aged children in Australia: seborrheic dermatitis and pityriasis capitis (cradle cap).

OBJECTIVE: To determine the prevalence and severity of seborrheic dermatitis and pityriasis capitis in Australian preschool-aged children. DESIGN: A stratified cross-sectional skin survey using cluster sampling of centers throughout Victoria, Australia. SETTING: The study population included children attending child care centers, preschools, and Maternal and Child Health Centers, with the reference population being Australian children 5 years and younger. PARTICIPANTS: Of the 1,634 children in the original sample, 1.116 children aged 11 days to 5 years 11 months were included in the study. INTERVENTION: Parents completed a questionnaire recording demographic information and personal and family history of skin problems and related diseases. A dermatologist performed a total skin examination, including the diaper area for children younger than 12 months. MAIN OUTCOME MEASURE: The age- and sex-specific prevalence rates and site and severity of seborrheic dermatitis and pityriasis capitis were measured. RESULTS: The overall age- and sex-adjusted prevalence of seborrheic dermatitis was 10.0% (95% confidence interval [CI], 8.2%-11.7%): 10.4% (95% CI, 7.8%-12.9%) in boys and 9.5% (95% CI, 7.0%-12.0%) in girls. This was highest in the first 3 months of life, decreasing rapidly by the age of 1 year, after which it slowly decreased over the next 4 years. Most (71.9%) had disease classified as minimal to mild. Pityriasis capitis occurred in 41.7% (95% CI, 38.8%-44.6%) of the 1,116 children examined, with 85.8% categorized as minimal to mild only. CONCLUSIONS: Seborrheic dermatitis and pityriasis capitis are common in early childhood. Most children have minimal to mild disease that would require little if any treatment. Education programs directed at those caring for preschool-aged children are needed to provide information on simple preventative measures and treatment, if necessary, that could easily reduce the morbidity associated with these very common conditions.

Levantamento de casos de pitiríase versicolor em Goiânia-GO, Brasil / Research on pityriasis versicolor cases of Goiânia-GO, Brazil

A pitiríase versicolor é uma infecção fúngica superficial e cosmopolita, provocada por leveduras do gênero Malassezia. Indivíduos humanos, após a puberdade, são os mais suscetíveis à manifestação dessa micose, devido à característica lipofílica do fungo. Um estudo retrospectivo foi realizado no período de janeiro de 1998 a dezembro de 1999, sendo analisadas 1.805 fichas de pacientes atendidos no setor de micologia de um laboratório da rede privada de Goiânia-GO, Brasil. No grupo de indivíduos humanos acometidos de micoses superficiais, a prevalência de pitiríase versicolor foi de 17,0 por cento. No estudo realizado a maioria dos pacientes com essa micose era do sexo feminino, na faixa etária entre 31 e 40 anos, pele de cor morena e possuía lesões furfuráceas hipopigmentadas na região dorsal do corpo. Assim a pitiríase versicolor continua sendo uma das doenças fúngicas relevantes dentro das micoses que acometem a superfície da pele do homem.

Pityriasis alba: a study of pathogenic factors.

BACKGROUND: The aetiology of pityriasis alba (PA), a common dermatosis in childhood, is still controversial. The objective of this study was to assess the possible aetiopathogenic factors of this disease in infants. METHODS: Forty-four patients with PA and 31 healthy children were examined and compared. Personal hygiene habits, sun exposure, presence of Staphylococcus aureus in nasal fossae and presence of major or minor signs of atopy were assessed during anamnesis and physical examination. Susceptibility to ultraviolet (UV) B radiation was measured by the onset of a contact hypersensitivity reaction to diphenylcyclopropenone in individuals sensitized in previously irradiated areas. RESULTS: The prevalence of PA was higher in individuals with darker skin, in high phototype categories, as well as in males. The number of daily baths and sun exposure between 10.00 h and 15.00 h were significantly higher in the PA group when compared with controls (P = 0.03 and P = 0.0015, respectively). The presence of atopy signs was more common in pityriasis patients (P = 0.002). Susceptibility to UVB radiation was 29.6% in the PA group vs. 29.0% in the control group; nevertheless, important differences were found after stratification in order to control possible confounding factors. The presence of S. aureus in the nostrils was equal in both groups. CONCLUSIONS: Our results confirm that PA, in our population, is more prevalent in males and in individuals in higher phototype categories. In those with inadequate personal hygiene and sun exposure habits the disease is more accentuated, demonstrating that the xerosis presenting in individuals with atopic diathesis is an important element in the development of the disease. S. aureus is not an important aetiopathogenic factor in PA. Susceptibility to UVB becomes important when related to the patient's phototype.

Pityriasis rotunda in childhood.

Pityriasis rotunda is a rare disease characterized by round or oval patches, localized mainly on the trunk, arms, and legs. The patches are usually lighter than the surrounding skin, but sometimes may be darker, and are covered by fine, adherent scales. Two types of pityriasis rotunda have been described. Type I has been observed mainly in oriental and black patients older than 60 years of age, and is often associated with systemic disease or malignancy. Type II has been observed in white patients younger than 40 years of age, is often familial, and has never been observed in association with malignancy or internal disease. On Sardinia, a cluster of patients with type II pityriasis rotunda has been described. From 1981 until 1998, 51 cases of this disease have been observed in the Department of Dermatology, University of Sassari; 32 of them were children. The great prevalence of pityriasis rotunda on Sardinia, an island which until 40 years ago had limited contact with the Italian mainland, and the presence of a large number of familial cases suggest that type II pityriasis rotunda should be considered a genetically determined disease. The trend toward spontaneous resolution after the age of 20 years suggests that pityriasis rotunda should be considered a genodermatosis with a temporary phenotypic expression.

[Pityriasis rotunda: second Tunisian case]. / Pityriasis rotunda: 2ème cas Tunisien.

Pityriasis Rotunda is a dermatosis well known in Japan and Black Africa. Its unusual in Europe and North Africa. Several authors consider that Pityriasis Rotunda is an acquired ichtyose and that it represents a real paraneoplastic syndrome. We report the case of Tunisian men suffering from a Pityriasis Rotunda associated to a dilatation of branch.

The prevalence of skin conditions in Romanian school children.

Virtually nothing is known about the prevalence of skin conditions in children in the general population. Although we know something about the relative frequency of skin conditions seen by dermatologists, we do not know how such referrals are influenced by factors such as social class, accessibility to medical services or educational and cultural background. In order to estimate the burden and relative frequency of dermatological disease in children in the community, we measured the point prevalence of skin conditions in 1114 Romanian schoolchildren aged 6-12 years, using the British Association of Dermatologists diagnostic index. The overall point prevalence of children with one or more skin diseases was 22.8%, with no significant differences according to age group or sex, except for pityriasis alba which showed a male predominance (P = 0. 007). The most common diseases were infectious dermatoses such as viral warts and insect bites (6.3%), dermatitis/eczema (5.1%), pityriasis alba (5.1%), keratosis pilaris (4.0%) and urticaria (1. 9%). Together, these five groups accounted for more than 84% of the cases. Of the 1114 children, 213 (19.1%) had only one skin disease and 41 (3.7%) had two skin diseases. While acknowledging the limitations in defining which skin conditions can benefit from medical care, this study suggests that skin disorders are common in Romanian schoolchildren, affecting about one-quarter of 6-12 year olds. Such a point prevalence is likely to be conservative because of the tendency of prevalence estimates to exclude many other dermatoses of short duration. The finding that over 80% of the disorders can be grouped into fewer than six categories is important in informing training programmes and delivery of service for primary health care teams. This study provides a baseline for further studies into the morbidity and use of health care services by children with skin disease in the community.