Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases.

Internationally approved guidelines for the diagnosis and management of Malassezia-related skin diseases are lacking. Therefore, a panel of experts consisting of dermatologists and a microbiologist under the auspices of the Danish Society of Dermatology undertook a data review and compiled guidelines for the diagnostic procedures and management of pityriasis versicolor, seborrhoeic dermatitis and Malassezia folliculitis. Main recommendations in most cases of pityriasis versicolor and seborrhoeic dermatitis include topical treatment which has been shown to be sufficient. As first choice, treatment should be based on topical antifungal medication. A short course of topical corticosteroid or topical calcineurin inhibitors has an anti-inflammatory effect in seborrhoeic dermatitis. Systemic antifungal therapy may be indicated for widespread lesions or lesions refractory to topical treatment. Maintenance therapy is often necessary to prevent relapses. In the treatment of Malassezia folliculitis systemic antifungal treatment is probably more effective than topical treatment but a combination may be favourable.

Prevalence of toe nail onychomycosis in diabetic patients.

Onychomycosis among diabetic patients has been reported in some studies to be of high prevalence. This study aimed to investigate the prevalence of onychomycosis among diabetic patients at a Danish University Hospital. Clinical and mycological examinations were performed on type 1 and 2 diabetic patients from in- and out-patient clinics. A total of 271 patients were enrolled, 72% males, mean age 61.3 years, 26% of the patients had diabetes type 1. The prevalence of toe nail onychomycosis (positive culture and/or microscopy) was 22% (n = 59) of which 55 cases were caused by dermatophytes (93%) and 4 cases by yeasts (7%). A correlation was found between onychomycosis and age (p =0.02) and severity of nail changes (p <0.001), respectively. However, no significant correlation was found to gender, type of diabetes, lower extremity arterial disease, neuropathy, toe amputation or oedema. Onychomycosis occurred with a high prevalence in diabetic patients, especially among older patients and those with severe nail changes.

The prevalence of onychomycosis in patients with psoriasis and other skin diseases.

Onychomycosis among psoriasis patients is reported with varying prevalence. This prospective, controlled study investigates the occurrence of onychomycosis among inpatients with psoriasis versus inpatients with other skin diseases. The inclusion period was 15 months. Scrapings from clinically abnormal nails (both fingernails and toenails) were examined using microscopy and culture. The prevalence of onychomycosis in patients with psoriasis was 17/79 = 21.5% compared to 18/142 = 12.7% for patients with other skin diseases (p = 0.13). In 17 mycologically positive psoriasis patients, dermatophytes, yeasts and moulds were isolated in 8, 10 and 4 cases, respectively, and in 18 mycologically positive patients with other skin diseases in 12, 7 and 5, respectively. Onychomycosis occurred more frequently in men than in women (psoriasis patients (p = 0.02), patients with other skin diseases (p = 0.03)). Psoriasis patients had a higher frequency of abnormal nails (82.3%) compared to patients with other skin diseases (37.3%) (p < 0.01) and more severe affection of their toenails than patients with other skin diseases (p < 0.01). It is concluded that the frequency of onychomycosis among inpatients with psoriasis compared to inpatients with other skin diseases is not significantly different.