308-nm excimer laser: a hopeful and optional therapy for pityriasis versicolor.

BACKGROUND: Pityriasis Versicolor (PV) is known as a superficial fungal infection. It is suggested that resistant strains to azoles may be developed and hence, the treatment would be difficult. This study aimed to evaluate the efficacy of excimer laser (308 nm) as an alternative therapy for PV. MATERIALS AND METHODS: This is a prospective intra-patient left-to-right, randomized, placebo-controlled study conducted on 26 patients with bilateral lesions which are not responding to the PV standard treatment. Patients were randomly assigned to right or left-side therapy for a duration of 8 weeks with either excimer laser (308 nm three times weekly) or topical placebo. Clinical assessment and mycological evaluation were performed before the initiation of treatment and at the fourth and eighth week of therapy. RESULTS: A decrease in the mean clinical score of cases was recorded from 7.1 at the baseline evaluation to 1.56 after 4 weeks and to 1.96 after 8 weeks of treatment. At week 4, there was a statistically significant reduction in the clinical scores compared with pretreatment scores and with the placebo group (p < .001). CONCLUSION: 308-nm excimer laser can be considered as a hopeful and optional therapy for PV.

Dermatological conditions encountered in The Independent State of Samoa and an exploration of possible strategies to manage dermatological health-care needs in this resource-poor setting.

This report adds to the limited existing literature concerning dermatoses in Samoa. Conditions encountered during a 4-day private clinic are reported. Amongst the 75 patients reviewed, eczema was the most frequent condition diagnosed. This was followed by infective dermatoses particularly pityriasis versicolor and tinea infections. Reassuringly, in 97% of cases, suitable medications were available locally.

Pigmentation Disorders: Diagnosis and Management.

Pigmentation disorders are commonly diagnosed, evaluated, and treated in primary care practices. Typical hyperpigmentation disorders include postinflammatory hyperpigmentation, melasma, solar lentigines, ephelides (freckles), and café au lait macules. These conditions are generally benign but can be distressing to patients. Appropriate dermatologic history, skin examination, and skin biopsy, when appropriate, can help exclude melanoma and its precursors. In addition to addressing the underlying condition, hyperpigmentation is treated with topical agents, chemical peels, cryotherapy, light or laser therapy, or a combination of these methods. Café au lait macules are treated with surgical excision or laser therapy if treatment is desired. Hypopigmentation disorders include vitiligo, pityriasis alba, tinea versicolor, and postinflammatory hypopigmentation. Treatment of vitiligo depends on the distribution and extent of skin involvement, and includes topical corticosteroids and calcineurin inhibitors, ultraviolet A therapy (with or without psoralens), narrowband ultraviolet B therapy, and cosmetic coverage. Patients with stable, self-limited vitiligo may be candidates for surgical grafting techniques, whereas those with extensive disease may be candidates for depigmentation therapy to make skin tone appear more even. Other hypopigmentation disorders may improve or resolve with treatment of the underlying condition.

Infective skin conditions in an adult sea-going population.

Infective skin conditions represent a significant element of the caseload for sea-going and shore-side clinicians. They are common within the wider military setting due to the frequent requirement to live in close proximity to others in conditions which favour the spread of skin and soft tissue infections (SSTI). Within the UK civilian population, 24% of individuals see their family doctor for skin conditions each year, accounting for 13 million primary care consultations annually. Of these, almost 900,000 were referred to dermatologists in England in 2009-2010 and resulted in 2.74 million secondary care consultations. Several recent articles have highlighted the problem of Panton-Valentine Leukocidin Staphylococcus aureus (PVL-SA) infection and carriage in sailors on submarines, and soldiers deployed to Afghanistan. However, the majority of published articles relate to land-based military personnel. This article aims to provide an overview of the most common infective skin conditions presenting among Naval personnel (based on the authors' experience), illustrated by several case studies, together with an approach to their diagnosis and management.

Identification of Malassezia species isolated from patients with extensive forms of pityriasis versicolor in Siena, Italy

Background. Pityriasis versicolor (PV) is an infection caused by various species of Malassezia yeast. There is no agreement in the literature concerning the species of Malassezia and the demographic, clinical, and mycological data. Aims. To prospectively identify Malassezia species isolated from lesions of patients with extensive, long standing and recurrent forms of PV and to estimate the relationship between Malassezia species and the demographic and clinical data of the patients. Methods. All patients with PV were enrolled over a four-year period. Malassezia species were isolated in cultures and identified by morphological features and physiological tests. In the last 2 years a PCR-based technique was used to confirm the species’ identification. Results. A total of 74 patients (43 males and 31 females, mean age 39.5 years) were enrolled. Only one species was isolated in 45 patients, and more than one species were identified in the remaining 28 patients (38%). M. globosa was the most frequently isolated (60.3%) species. There was a significant association between the isolation of 2 or more species and the presence of at least one predisposing factor. In the last 29 cases, which were subjected to PCR, there were no differences in the identification of isolated species as compared to traditional methods. Conclusions. The isolation of more than one species in a single lesion is not infrequent in PV and is related to the presence of one predisposing factor. The isolated species isolated were not influenced by demographic and clinical features. The traditional and more recent (PCR) procedures gave the same results in the isolated species (AU)

Micosis superficiales / Superficial mycoses

Las micosis superficiales constituyen una patología prevalente en Dermatología. Son producidas por dos grandes grupos de hongos: las levaduras y los dermatofitos (tiñas). Las primeras ocurren por una alteración de la microbiota que lleva a una proliferación del hongo y las segundas son infecciones exógenas en que el contagio está dado por transmisión de un animal u otra persona. A las tiñas se les denomina por el nombre del área anatómica afectada. En el presente artículo, se entregan las herramientas para el manejo de estas patologías por parte del médico no especialista, se señalanlos aspectos más relevantes de la clínica y los medicamentos usados en los diferentes tratamientos orales y tópicos. Se sugieren también los criterios de derivación al especialista.

Superficial mycoses are a prevalent dermatological pathology. These are produced by two major groups of fungi, yeasts and dermatophytes (tinea infections or ringworm). The former occur by an alteration of the microbiota that leads to a proliferation of yeasts and the latter are exogenous infections transmitted by an animal or another person. Tinea infections are called by the name of the affected anatomicalarea. This paper provides tools to non-specialist physicians to manage these conditions, identifying the most relevant clinical aspects and oral and topical treatment options. It alsosuggests criteria for referral to a specialist.

Cutaneous infestations and infections.

Cutaneous infections and infestations are common problems in childhood and adolescence. This article provides an update focusing on the diagnosis and management of several frequently encountered infections and infestations: scabies, bedbugs, head lice, tinea capitis, and tinea versicolor.

Management of common fungal infections in primary care.

Nurses are increasingly the first point of contact for patients in primary care settings such as general practice surgeries, community clinics and walk-in centres. Such roles are likely to continue to expand. This article discusses diagnosis and management options for the most common fungal infections and describes clinical situations that might require further investigation or referral. Accurate diagnosis is essential for successful therapy and, in all cases, can provide an opportunity for discussion, reassurance and advice.

Etiopatogenia y tratamiento de la pitiriasis versicolor / Etiology, pathogenesis and treatment of pityriasis versicolor

La pitiriasis versicolor es una infección fúngica superficial de la piel producida por hongos lipofílicos dimórficos pertenecientes al género Malassezia spp., que forman parte de la flora normal de la piel. De las especies descritas, las responsables más frecuentes de la clínica son M. globosa, M. sympodialis y M. furfur. En España, el agente patógeno más frecuente es M. globosa. Se presenta en forma de máculas redondas u ovales de pequeño a mediano tamaño y coloración, eritematosas, hiperpigmentadas o hipopigmentadas. Su superficie suele estar cubierta por una fina descamación. Son más frecuentes en las áreas de distribución de las glándulas sebáceas, sobre todo en el tercio superior del tronco, de forma especial en la espalda, la raíz de los miembros superiores, el cuello y con menor frecuencia en la cara. En su tratamiento se han utilizado diferentes agentes terapéuticos tópicos (ciclopiroxolamina, azoles, griseofulvina, terbinafina, succinato de litio) o sistémicos (ketoconazol, itraconazol, fluconazol) (AU)

Pityriasis versicolor is a superficial fungal infection of the skin produced by lipophilic dimorphic fungi belonging to the genus Malassezia spp, which form part of the normal skin flora. Of the species described, those most frequently producing symptoms are M. globosa, M. sympodialis and M. furfur. In Spain, the most frequent pathogenic agent is M. globosa. It most frequently presents as small or mediumsized circular or oval, erythematous, hyperpigmented or hypopigmented macules. The surface is usually covered by fine desquamation. The most frequently affected areas are those supplied by the sebaceous glands, mainly the upper third of the trunk, especially the shoulder, proximal upper extremities, the neck, and less frequently, the face. Various topical agents (ciclopirox olamine, azoles, griseofulvin, terbinafine, lithium succinate) and systemic agents (ketoconazole, itraconazole, fluconazole) have been used in the treatment of pityriasis versicolor (AU)

Pityriasis versicolor alba.

Pityriasis versicolor alba is a hypopigmented or depigmented variant of pityriasis versicolor characterized by maculous, partly pityriasiform, scaly depigmented lesions occurring particularly in seborrhoeic areas. Long-persisting hypopigmentation after healing of the pityriasis versicolor was first described by Gudden in 1853. Hypopigmentation and depigmentation were later differentiated as an independent variant of the disease. In 1848, Eichstedt recognized the pathogen-related character of pityriasis versicolor in its hyperpigmented form. Today it is generally accepted that the disease is caused by yeasts of the genus Malassezia, of which nine species are differentiated. It is controversial whether a single species is responsible for the disease. The pathogenesis of depigmentation has not been established. A screening effect by the scale layer as well as toxic effects on pigment synthesis by fungal metabolites have been discussed. With regard to the second mechanism, the newly discovered tryptophan-derived metabolites of M. furfur might be significant. Evidence-based data concerning the therapy of pityriasis versicolor alba do not exist. According to current recommendations, pityriasis versicolor should be rapidly treated with antimycotics, followed by ultraviolet therapy to induce maturation of existent melanosomes and accelerate repigmentation. However, depigmented lesions are difficult to improve by ultraviolet therapy.

An alternative treatment for pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei with topical application of honey, olive oil and beeswax mixture: an open pilot study.

OBJECTIVE: To evaluate the possible role of honey, olive oil and beeswax in the treatment of skin fungal infections. PATIENTS AND METHODS: Thirty-seven patients with pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei were studied. After clinical evaluation of redness, scaling, pruritus and burning/pain sensation and mycological assessment, honey mixture containing honey, olive oil and beeswax (1:1:1) was applied to the lesions three times daily for a maximum of 4 weeks. RESULTS: Clinical response was obtained in 86% of patients with pityriasis versicolor, 78% of patients with tinea cruris and in 75% of patients with tinea corporis. Mycological cure was obtained in 75, 71 and 62% of patients with PV, tinea cruris and tinea corporis, respectively. The patient with tinea faciei showed clinical and mycological cure 3 weeks after commencement of therapy. CONCLUSION: Honey mixture may have place in the management of these skin conditions and rigorous, controlled trials are justified.

Pityriasis versicolor: quality of studies.

OBJECTIVE: To evaluate the quality of the published literature on the treatment of pityriasis versicolor and to compare this evaluation with the number of times the work has been cited. METHODS: A search was performed using MEDLINE (1966-2002) to find publications evaluating the treatment of pityriasis versicolor. Two reviewers evaluated each clinical trial according to a list of pre-determined criteria including randomization and blinding, prior sample size calculation, treatment regimen clearly explained, and well-defined efficacy parameters. A maximum score of 20 could be attained by each publication. A citation count was performed using the ISI Web of Science Database (http://www.isinet.com/isi/products/citation/wos/). RESULTS: A total of 94 studies were included in this analysis of quality. Studies with a score of 8 or more were considered to be high quality, and 61 studies were rated as high-quality studies (65%). There was no significant correlation between paper quality and citation count. CONCLUSION: It is important for investigators and clinicians to be aware of the design of a high-quality protocol, since such high-quality studies are more likely to reflect accurate efficacy rates. Also, it is important for the information on the design and conduct of the trial to be conveyed to the reader so that a meaningful comparison between the studies can be made.

Common hyperpigmentation disorders in adults: Part II. Melanoma, seborrheic keratoses, acanthosis nigricans, melasma, diabetic dermopathy, tinea versicolor, and postinflammatory hyperpigmentation.

Nevi, or moles, are localized nevocytic tumors. The American Cancer Society's "ABCD" rules are useful for differentiating a benign nevus from malignant melanoma. While acanthosis nigricans may signal an underlying malignancy (e.g., gastrointestinal tumor), it more often is associated with insulin resistance (type 2 diabetes, polycystic ovary syndrome) or obesity. Melasma is a facial hyperpigmentation resulting from the stimulation of melanocytes by endogenous or exogenous estrogen. Treatments for melasma include bleaching agents, laser therapy, and a new medication that combines hydroquinone, tretinoin, and fluocinolone acetonide. Lesions that develop on the shins of patients with diabetic dermopathy often resolve spontaneously; no treatment is effective or recommended. Tinea versicolor responds to treatment with selenium sulfide shampoo and topical or oral antifungal agents. Postinflammatory hyperpigmentation or hypopigmentation can occur in persons of any age after trauma, skin irritation, or dermatoses.

Micosis superficiales: candidiasis y pitiriasis versicolor / Superficial mycosis: candidiasis and pityriasis versicolor

Se exponen las características clínicas de las lesiones cutáneas en las candidiasis y la pitiriasis versicolor. Se hace hincapié en las medidas de educación, prevención y control de estas afecciones a nivel primario de atención médica. Se exponen además las diferentes maniobras terapéuticas, tanto tópicas como sistémicas, con las que se cuenta para su tratamiento, y se hace referencia a las medidas terapéuticas alternativas que brinda la medicina natural y tradicional para estas afecciones(AU)

Micosis superficiales: candidiasis y pitiriasis versicolor / Superficial mycosis: candidiasis and pityriasis versicolor

Se exponen las características clínicas de las lesiones cutáneas en las candidiasis y la pitiriasis versicolor. Se hace hincapié en las medidas de educación, prevención y control de estas afecciones a nivel primario de atención médica. Se exponen además las diferentes maniobras terapéuticas, tanto tópicas como sistémicas, con las que se cuenta para su tratamiento, y se hace referencia a las medidas terapéuticas alternativas que brinda la medicina natural y tradicional para estas afecciones

Novedades 2000 en clínica dermatológica / New developments-2000 in dermatologic clinic

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