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Dermatomycoses, fungal diseases that affect the superficial layers of skin, hair or nails, are a public health concern due to their high prevalence. In Brazil, dermatomycoses are not notifiable diseases, so only fragmented epidemiological studies have been reported in the national literature. To evaluate the epidemiological profile of dermatomycoses in preschoolers and school children in Sinop, Mato Grosso (MT), Brazil.Classic methods were used to perform 782 mycological examinations to identify dermatophytosis, cutaneous candidosis and pityriasis versicolor in preschoolers and school children aged between 6 months and 12 years in 11 educational institutions in Sinop, MT.Among the evaluated clinical specimens, 5.2% tested positive for dermatophytosis, with 58.45% of these cases corresponding to tinea capitis, followed by skin (tinea corporis and tinea pedis) and toenail (tinea unguium) lesions; zoophilic fungi predominated. Microsporum canis and Trichophyton mentagrophytes complex were isolated in 53.66% and 24.39% of the cases, respectively. Regarding cutaneous candidosis, 9.1% of the specimens tested positive for this disease, with 59.16% and 12.7% of the cases corresponding to toenails and interdigitoplantar lesions, respectively. Candida albicans caused 70.43% of the lesions. The remaining specimens (85.7%) tested positive for pityriasis versicolor; children aged between 6 and 12 were the most affected (71.79%).Our results agree with most epidemiological studies carried out in Brazil and demonstrate the high frequency of mycoses in preschoolers and school children, a result of poor personal hygiene and favourable weather conditions in Northern Mato Grosso, Brazil.

Dihydroxyacid dehydratase (DHAD) is a key enzyme in biosynthetic pathway of isoleucine and valine. This pathway is absent in human but exists in various organisms such as fungi. Using RNA-seq analysis in this study, we identified MGL_3741gene which encodes DHAD protein in Malassezia globosa (M. globosa). Furthermore, we found that mentioned gene is homologous to the Ustilago maydis, Saccharomyces cerevisiae, Aspergillus flavus, and Aspergillus fumigatus ILV3P. For understanding the probable role of this gene in pathogenicity of M. globosa, we applied Real-time PCR to investigate the differentially expressed of the MGL_3741 gene in healthy and pathogenic states. Our results indicate a significant difference between two mentioned stats. These results revealed that ILV3-like gene in M. globosa can be related to the pathogenicity of this yeast.

Summary Pityriasis versicolor is a frequent mycosis and the use of systemic corticotherapy is one of its predisposing factors. This is an observational, cross-sectional, analytical and comparative study, conducted from January 2012 to January 2013 in the following outpatient clinics: Dermatology Service, Cassiano Antonio Moraes Hospital (HUCAM), Vitoria, ES, Brazil; Nephrology Service, HUCAM; and Leprosy Department, Maruipe Health Unit, Vitoria, ES, Brazil. Patients, undergoing long-term systemic corticotherapy (or not), were assessed with respect to the presence of pityriasis versicolor. If there was mycosis, a direct mycological examination would be carried out. The spss 17.0 software was used for the statistical analysis. From the total of 100 patients, nine had pityriasis versicolor, being eight from the corticotherapy group and one from the group with no use of corticosteroids. Regarding the patients with mycosis, the prevalent age ranged from 20 to 39 years, with six patients; six were women; seven mixed race; eight were undergoing long-term systemic corticotherapy; seven were taking low-dose systemic corticosteroids; four had leucocytosis; five had normal total cholesterol and triglycerides; and four had normal glycaemia. There was increased frequency of pityriasis versicolor in the group undergoing systemic corticotherapy with statistical significance, corroborating the only study on the topic (1962).

Yeast of Malassezia, members of the microbiologic flora of the skin, cause pityriasis versicolor and have also been implicated in the pathogenesis of other superficial dermatoses. The mechanisms by which the yeast cause these dermatoses, however, are not yet clear, and there have been no studies on the interaction between fungi and keratinocytes, especially the effects of fungi on the production of reactive oxygen/nitrogen species by human keratinocytes. This is the first study we aimed to evaluate the role of oxidative/nitrosative stress in affected skin areas in patients with pityriasis versicolor. Sixty pityriasis versicolor patients and 60 healthy subjects as control group were enrolled. Scraping samples were obtained from the lesional skin areas in patients and from the normal skin areas in controls. The distribution of lesions of pityriasis versicolor was mild in all patients. We have isolated two Malassezia species: M. furfur being isolated in 75% of patients, followed by M. globosa (25%). The levels of oxidative/nitrosative stress biomarkers were significantly higher in patients than the controls (P

Pityriasis versicolor (PV) is a chronic superficial fungal disease caused by Malassezia spp. The incidence is as high as 30-40% in tropical climates. Previous studies indicate that the geographic factor has influence on the main species isolated from PV. Our aim was to identify Malassezia spp. from PV patients in Indonesia and their correlation to clinical characteristics. Isolates of Malassezia were collected from 98 PV patients (62 males and 36 females). Identification was based on morphological observation and biochemical evaluation. Leeming Notman agar was used as isolation culture medium. The biochemical evaluation consisted of specimen culture onto Sabouraud dextrose agar, Cremophor EL, Esculin, Dixon's agar at 37 degrees C and catalase reaction. The isolates found were Malasseziafurfur (42.9%), M. sympodialis (27.5%), M. globosa (13.3%), M. slooffiae (7.7%), M. obtusa (7.7%) and M. restricta (2.2%), and 7.14% specimens were unidentified. There was no statistically significant association between Malassezia spp. and demographic characteristics and clinical characteristics of the patients. Unlike reports from temperate climate countries, this study in Indonesia found M. furfur as the most frequently isolated Malassezia spp. in PV patients.

Zusammenfassung: An insgesamt 144 Patienten, die an Dermatomykosen bzw. Pityriasis versicolor litten, wurden Oxiconazol*-Creme bzw. -Losung bezuglich Wirksamkeit und Vertraglichkeit untersucht. Die Anwendung erfolgte bei 73 Patienten nur 1 x taglich, bei 71 Patienten 2 x taglich. Die Therapiedauer betrug in beiden Kollektiven im Durchschnitt 3 bis 4 Wochen. Weder hinsichtlich Wirksamkeit noch hinsichtlich Vertraglichkeit konnte ein Unterschied zwischen beiden Patientengruppen ermittelt werden. Somit wird mit der einmal taglichen Applikation von Oceral Roche der gleiche Therapieerfolg erzielt wie mit der zweimal taglichen Applikation. Summary: Oxiconazole cream or solution was tested for efficacy and tolerability in a total of 144 patients suffering from dermatomycosis or tinea versicolor. 73 patients received the treatment only once daily and 71 twice daily. In both groups the treatment lasted on an average 3–4 weeks. No difference was found between the two populations with respect to efficacy or tolerability. We may conclude that a single daily application of Oceral Roche provides the same therapeutic success as the twice daily application.

Summary Mycological and histopathological studies were done on 200 pityriasis versicolor patients chosen at random. Pityrosporum spores and hyphae have been demonstrated in all cases through direct microscopical examination as well as in histopathological sections. Culturing succeeded in 71.2% of the cases on mycological agar with olive oil pipetted over the surface of the medium. Negative results were obtained in anaerobic atmosphere and when mineral oil was used. Subculture of the organism was successful in a fluid medium containing Czapek-Dox, yeast extract and Tween-20. Zusammenfassung Mykologische und histopathologische Untersuchungen wurden bei 200 nicht ausgesuchten Patienten mit Pityriasis versicolor durchgefuhrt. Sporen und Hyphen von Pityrosporum wurden in allen Fallen sowohl direkt mikroskopisch als auch in histopathologischen Schnitten nachgewiesen. Die Kultur gelang in 71,2% der Falle auf mykologischem Agar, auf dessen Oberflache Olivenol pipettiert worden war. Negative Ergebnisse wurden erzielt, wenn Mineralo1 verwendet wurde und in anaerober Atmosphare. Subkulturen gelangen in flussigem Medium aus Czapek-Dox-Losung, Hefeextrakt und Tween 80. Die Tatsache, das die gezuchteten Organismen in Kultur nur selten Hyphen bilden, kann durch den diphasischen Charakter erklart werden, d. h. der Organismus hat 2 Phasen: eine Hefeform und eine Mycelform; in der pathogenen Form im Gewebe werden sowohl Mycelien als auch Blastosporen gebildet, in Kultur jedoch im allgemeinen nur Blastosporen und selten Hyphen. Experimentelle Infektionen bei 20 Personen mit Hautgeschabsel oder Kulturmaterial von Pityrosporum orbiculare hatten keinen Erfolg. Dies stimmt mit den Befunden von Gordon uberein. Die direkten mikroskopischen Befunde und die kulturellen Untersuchungen waren negativ.

Summary: A Pityrosporum infection in a 17-year-old male is reported. The clinical symptoms were erythematous macules with fine scales and appeared in both antecubital fossae. In a direct examination and in cultures of the scales, large numbers of Pityrosporum ovale and a few Pityrosporum orbiculare cells were seen. The histopathological findings, which resembled those of tinea versicolor, revealed clusters of Pityrosporum ovale around the orifices of the hair follicles. When the lesions were treated by topical application of 1% clotrimazole cream they disappeared, but left areas of pigmentation behind. Since the above findings corresponded with those of the clinical entity described by Soh, the name Malassezia intertrigo, which he proposed, is employed in this report. Zusammenfassung: Es wird uber eine Pityrosporum-Infektion bei einem 17jahrigen Mann berichtet. Die klinischen Symptome bestanden in erythematosen Macula mit feiner Schuppung und zeigten sich in beiden antecubitalen Fossae. Im Direktpraparat und in Kulturen der Schuppen fand sich massenhaft P. ovale und wenig P. orbiculare. Die histopathologischen Befunde ahnelten denjenigen bei Tinea versicolor und zeigten Anhaufungen von P. ovale um die Orifizien der Haarfollikel herum. Nach topischer Behandlung mit 1 %iger Clotrimazol-Creme verschwanden die Lasionen, hinterliesen jedoch pigmentierte Areale. Da diese Befunde mit den von Soh als klinische Entitat beschriebenen korrespondieren, verwenden auch wir den von ihm vorgeschlagenen Begriff Malassezia Intertrigo.

Summary: Tinea versicolor in Kuwait was found to be more predominant among males (60.9%) than females (39.1%). Patients of the age group 20–29 years had higher frequency of infection (48.2%). These patients had had the longest durations of infection and the most frequent rate of occurrence: Their infection tended to be chronic and recurrent. The most common sites of tinea versicolor infection were the chest and neck in both male and female patients. Anatomical distribution of infection was remarkably different in males than females. Although lesions of tinea versicolor were typically observed in locations such as the shoulders, arms and abdomen, eruptions in the interdigital spaces, axillae, face and groin were also seen. The observation of tinea versicolor lesions in the interdigital spaces adds another atypical site of infection with M. furfur. Hyperpigmented lesions were more predominantly observed than hypopigmented type of lesions. This predominance of hyperpigmentation might be due to the presence of M. furfur which was found in abundance in the hyperpigmented lesions. Genetic transfer of susceptibility to tinea versicolor infection was not substantiated in our investigation, although we found that 17.7% of our patients had positive family history. Occurrence of tinea versicolor was more common in the summer and spring months (89.7%) and gradually dissipated during the autumn and winter months. This predominance of tinea versicolor might be related to the hot climate in Kuwait during the months of April to September. Our findings suggest that sweating may have no role in determining the intensity of tinea versicolor infection or the extent of lesions, rather it seems likely that it could be an important factor in producing the unpleasent symptoms of tinea versicolor once infection has been established. Zusammenfassung: In Kuwait kommt die Pityriasis versicolor unter Mannern (60,9%) haufiger vor als bei Frauen (39,1%). Besonders betroffen war die Altersgruppe zwischen 20 und 29 Jahren mit einem Anteil von 48,2%. Diese Patienten hatten auch die langste Dauer der Infektion und zeigten die groste Ruckfallrate: Bei ihnen tendierte die Mykose zu besonders chronischem und haufig rezidivierendem Verlauf. Die Pityriasis versicolor war am haufigsten an der Brust und am Hals bei mannlichen und weiblichen Patienten lokalisiert. Bei Mannern wies im ubrigen die anatomische Verteilung der Erkrankung deutliche Unterschiede zu der Verteilung bei Frauen auf. Obwohl die Veranderungen der Pityriasis versicolor in typischer Lokalisation wie Schultern, Armen, Abdomen beobachtet wurden, fanden sich auch Herde in den Interdigitalraumen, in den Achselhohlen, im Gesicht und in den Leistenbeugen. Die Beobachtung von Pityriasis versicolor-Herden in den Fingerzwischenraumen stellt eine neue atypische Lokalisation dar. Hyperpigmentierte Herde wurden haufiger beobachtet als hypopigmentierte. Das Uberwiegen der Hyperpigmentierung ist moglicherweise auf die Gegenwart von Malassezia furfur zuruckzufuhren, da der Erreger in den hyperpigmentierten Herden besonders reichlich gefunden wurde. Die genetische Ubertragung einer Anfalligkeit fur Pityrasis versicolor wurde durch unsere Untersuchungen nicht gestutzt, obwohl wir feststellten, das 17,7% unserer Patienten eine positive Familienanamnese hatten. Das Auftreten der Pityriasis versicolor war in den Sommer- und Fruhlingsmonaten haufiger (89,7%) und nahm wahrend der Herbst- und Wintermonate langsam ab. Dieses gehaufte Auftreten der Pityriasis versicolor ist moglicherweise durch das heise Klima wahrend der Monate von April bis September in Kuwait bedingt. Unsere Untersuchungen deuten darauf hin, das das Schwitzen keine Rolle fur die Intensitat oder die Ausdehnung der Herde bei der Pityriasis versicolor spielt. Es scheint eher wahrscheinlich, das das Schwitzen ein wichtiger Faktor fur die Entstehung unangenehmer Symptome bei der Pityriasis versicolor ist, wenn diese Infektion bereits vorliegt.

Summary. A total of 4 294 clinically suspected cases of dermatomycoses belonging to 26 different nationalities were examined between April 1984 and April 1988. Fungi were demonstrated in routine potassium hydroxide/dimethyl sulfoxide mount in 3 814 cases (88.8%) and the etiology was determined by culture in 2 458 cases (57.2%). Tinea ver-sicolor was the predominant fungal infection (30.9% of all infections). Onychomycosis and pa-ronychia ranked second in prevalence (16.8%). Candidal onychomycosis was the most common type of infection. Scalp ringworm among children ranked third (15.3%), Microsporum canis was the main etiologic agent. Tinea pedis and tinea man-uum ranked fourth in prevalence (13.2%). Tinea corporis represented 10.7% of infections and M. canis was the main agent. Tinea cruris accounted for 8.7% of infections and Epidermophyton floc-cosum was the most common agent. Cutaneous can-didosis constituted 4.3% of infections. White piedra was seen in 6 cases (0.16%). Yeasts were proved not to be unimportant as a cause of disease of skin and nail in our study. Zusammenfassung. Zwischen April 1984 und April 1988 wurden im Dammam-Zentralhospital in der saudi-arabischen Ostprovinz insgesamt 4 294 Dermatomykose-Verdachtsfalle untersucht, die 26 unterschiedlichen Nationalitaten angehorten. In 3 814 Fallen (88,8%) wurden Pilze mikroskopisch in KOH-DMSO-Praparaten nachgewiesen und die Pilzatiologie kulturell in 2 458 Fallen (57,2%) be-legt. Tinea versicolor stellt die vorherrschende Pilz-infektion dar (30,9 % aller Infektionen). An zweiter Stelle standen Onychomykose und Paronychie (16,8%). Die Candida-bedingte Onychomykose war der haufigste Infektionstyp. An dritter Stelle lag Tinea capitis bei Kindern (15,3 %); hier war Microsporum canis der Haupterreger. Tinea pedis und Tinea manuum lagen an vierter Stelle (13,2 %). Bei Tinea corporis (10,7 %) war M. canis der Haupterreger. Tinea cruris (8,7 %) wurde uber-wiegend durch Epidermophyton floccosum verur-sacht. Die kutane Candidose machte 4,3 % der Infektionen aus. Weise Piedra wurde sechsmal (0,16%) gesehen. Ferner erwiesen sich in unserer Studie Hefen zu einem nicht unbedeutenden Anteil als Erreger von Haut- und Nagelkrankheiten.

WOS: 000230042300007 PubMed: 15982208 To assess the frequency of superficial mycoses in forestry workers and farmers in the rural region of Duzce, a total of 467 residents of the rural region were examined for dermatomycosis infection. Of these, 349 were forestry workers and 118 farmers. All specimens collected were analysed by direct microscopy and culture. Tinea pedis et manus was found in 23 (19.4%), and onycomycosis in 21 (17.7%) farmers. Tinea pedis et manus was found in 50 (14.3%), and onycomycosis in 28 (8%) forestry workers. One tinea corporis, two tinea inguinalis and two erosio interdigitalis cases were determined in the farmer group but no cases of tinea corporis, tinea inguinalis, or erosio interdigitalis were found in the forestry group. In total, five tinea versicolor cases were found in the two groups on clinical examination but no agent positivity was yielded in mycological cultures. The most frequently isolated agent in the two groups was Trichophyton rubrum. The frequencies of superficial mycosis and onychomycosis were found to be higher in the farmer group than in the forestry group, although similar aetiological agents were isolated in both groups. The farmers had greater rates of contact with pathogenic fungi present in soil as well as from infected farm animals than the foresters; furthermore, animal husbandry, and the wearing of rubber shoes and nylon socks were more frequent in the farmer group. These results suggest that habits such as the wearing of rubber shoes and nylon socks, and the practice of animal husbandry may be the most important factors in determining the frequency of superficial mycoses and aetiological agents in forestry workers and farmers. To our knowledge, there is no previous report about dermatophytoses in forestry workers.

Summary Background: The genus Malassezia (Pityrosporum), recognized as a member of microbiological flora of the skin in humans and warm-blooded animals, has been recently revised to include 10 Malassezia species. The aim of the study was the isolation, identification and analysis of Malassezia species distribution in skin of healthy volunteers and lesions of pityriasis versicolor (PV). Material and methods: Specimens were taken from 100 patients with PV and 30 healthy volunteers. Cultures were made in modified Dixon agar medium and the isolates were identified by morphological and physiological methods: macroscopy, microscopy, catalase, β-glucosidase and lipid assimilation tests. Results: Malassezia globosa was the predominant species in lesional skin of PV (65%). It was isolated alone in 47% of cases and associated in 18% with M. furfur (13%) or M. sympodialis (5%). In healthy skin M. globosa was found alone in 7.77% and associated in 15.54%, respectively, with M. furfur (4.44%), M. sympodialis (4.44%), M. restricta (3.33%) and M. slooffiae (1.11%). Conclusion: From these findings it was suggested that M. globosa presents the main species implicated in the pathogenicity of PV and M. furfur as the second agent of importance.

Anecdotal reports have shown that tumour necrosis factor (TNF)-α inhibition may cause unchecked superficial infection with the microorganisms responsible for pityriasis versicolor (PV). We observed several cases of PV, which is frequently resistant to topical therapies, in psoriatic patients undergoing anti-TNF-α monoclonal antibody therapy. To evaluate the incidence and the therapeutic management of PV in this group of individuals, between 1 January and 27 December 2010, we examined 153 psoriatic patients for the hypopigmented/hyperpigmented macular and scaling lesions associated with PV. All patients positive for PV were given topical therapy with miconazole nitrate cream twice daily for 28 days, after which they were re-evaluated. In patients non-responsive to topical therapy, we started systemic therapy with fluconazole, 300 mg week(-1) for 3 weeks. We diagnosed seven cases of PV. At the end of topical treatment, complete healing of lesions was observed in only one patient. In the other six patients, systemic treatment led to complete resolution of the infection. Although the onset of PV during anti-TNF-α therapy is seldom reported, it is not likely to be rare, but rather under-reported because of its limited pathological significance. In our opinion, the therapeutic management of this condition deserves greater consideration, as the use of topical treatments alone is largely ineffective compared with systemic treatment.

The clinical phenomena of pityriasis versicolor (PV), a common Malassezia-associated skin disease, such as hyperpigmentation, depigmentation and fluorescence of the lesions may at least partly be explained by the generation of Trp-derived indole pigments through the action of transaminase 1 (TAM 1). Cycloserine, a TAM inhibitor, was able to completely inhibit pigment production in M. furfur in vitro in a dose-dependent manner. Application of a 0.2-mol l(-1) aqueous cycloserine solution b.i.d. for 5 days in three patients with hyperpigmented PV resulted in complete healing within 3-5 days without side-effects. Topically applied TAM inhibitors may therefore represent a new therapeutic principle for prophylaxis and therapy of PV, thus underlining the importance of the TAM pathway for the pathogenesis of the disease.

Summary: The frequency of Pityrosporum orbiculare as a skin commensal in children is described. Sixty subjects including 26 girls and 34 boys aged 2 months to 14 years were examined. Negative results have been obtained without differences between the various age groups or the two sex groups studied. Zusammenfassung: Es wurde die Haufigkeit von Pityrosporum orbiculare als Hautkommensale an 60 Kindern (26 Madchen und 34 Jungen) im Alter von 2 Monaten bis 14 Jahren untersucht. Bei samtlichen Altersgruppen und bei beiden Geschlechtern waren die Resultate unterschiedslos negativ.

Summary: The frequency of Pityrosporum orbiculare as a skin commensal among israeli population was studied. Out of 74 subjects studied 51 (68.9%) gave positive results. However, the frequency of positive cases was not equally shared by the different age groups studied. It was positive in 77.1% of people between 15 and 45 years, while the positive results among younger and older subjects were 50% and 64.2% respectively. No difference in frequency was observed between the two sex groups. Zusammenfassung: Untersuchung uber die Haufigkeit von P. orbiculare als kommensaler Hautkeim in einer israelischen Bevolkerungsgruppe. Von 74 untersuchten Personen zeigten 51 (68, 9%) ein positives Resultat. Die Verteilung der positiven Nachweise war in verschiedenen Altersgruppen ungleich. Am hochsten lagen die Werte in der Gruppe mit einem Alter zwischen 15 und 45 Jahren: 77, 1%. Jungere bzw. altere Probanden waren mit 50% hzw. 64, 2% seltener befallen. Zwischen den Geschlechtern bestand kein Unterschied in der Haufigkeit des Befalls.

Summary: A case of confluent and reticulate papillomatosis (Carteaud and Gougerot) in a 25 year old man is reported in whom Malassezia furfur was found in the lesions. Tolnaftate was partially successful in treatment. Zusammenfassung: Ein Fall einer Papillomatosis confluens et reticulata von Carteaud und Gougerot wird berichtet. Bei einem 25jahrigen Mann konnte Malassezia furfur in den Herden nachgewiesen werden. Eine Behandlung mit Tolnaftat war teilweise erfolgreich.

Flutrimazole is an imidazole derivative that has been proven to be efficient in superficial skin fungal infections. The aim of this randomised double-blind study was to compare for the first time, the efficiency and safety of flutrimazole 1% shampoo versus ketoconazole 2% shampoo in the treatment of tinea versicolor. Study population consisted of 60 patients with pityriasis versicolor diagnosed clinically and through direct microscopy and culture. Patients were randomly assigned to two groups: one instructed to apply flutrimazole shampoo 1% and one instructed to apply ketoconazole shampoo 2% both on head and body for 14 days. Patients were re-evaluated 14 days after the end of treatment clinically and through direct microscopy and culture. Twenty-one of 26 patients (80.8%) in the ketoconazole and 22 of 29 patients (75.9%) in the flutrimazole group had both visual healing and negative mycological evaluation. Comparison of the response between the two groups with the Yates' corrected chi-square was found statistically not significant (chi(2) = 0.19, d.f. = 1, P = 0.91). None of the patients in the two groups reported any adverse effects. Fourteen (53%) patients in the ketoconazole group and 23 (79%) in the flutrimazole group assessed the shampoos as cosmetically acceptable regarding texture, smell and foam properties. Flutrimazole shampoo 1% appears to present efficacy comparable with ketoconazole 2% in the treatment of tinea versicolor.

The lipophilic yeast Pityrosporum ovale is a member of the normal human cutaneous flora in adults but also associated with several skin diseases. In pityriasis versicolor, under the influence of predisposing factors, P. ovale changes from the round blastospore form to the mycelial form. A great problem in pityriasis versicolor is the high rate of recurrence and to avoid this a prophylactic treatment is mandatory. Pityrosporum folliculitis is a chronic disease characterized by pruritic follicular papules and pustules located primarily on the upper trunk, neck and upper arms. In direct microscopy clusters of round budding yeast cells are found. The disease responds rapidly to antimycotic therapy. There are now many studies indicating that P. ovale plays an important role in seborrhoeic dermatitis. Many of these are treatment studies showing a good effect of antimycotics paralleled by a reduction in number of organisms. Severe seborrhoeic dermatitis often difficult to treat is associated with AIDS. In peripheral blood from a high number of patients with seborrhoeic dermatitis we found an increase in number of natural killer T-cells and decreased PHA and Con-A stimulation. Secondary we found low serum IgG antibody titres in patients compared to controls. Other studies have found a reduced lymphocyte stimulation reaction when lymphocytes from patients with seborrhoeic dermatitis were stimulated with a P. ovale extract. Additionally, IL-2 and IFN gamma production by lymphocytes from patients was markedly depressed and IL-10 synthesis were increased after stimulation with P. ovale extract. The majority of adult patients with atopic dermatitis localized to the head, neck and scalp are prick-test positive to a protein P. ovale extract. One study showed that p. ovale extracts increased IL-4, IL-10 and IgE synthesis in patients with atopic dermatitis. There are also treatment studies indicating that antifungal treatment may be beneficial in these patients.

In superficial tinea and pityriasis versicolor, the causative fungi are for the most part confined to the stratum corneum which is barely reached by leukocytes. Therefore, a role of non-cellular components in the epidermal antifungal defence was suggested. To investigate the presence of such factors in these infections, the expression of human beta defensins 2 and 3 (hBD-2, hBD-3), RNase 7, psoriasin, toll-like receptors 2, 4 and 9 (TLR2, TLR4 and TLR9) and dectin 2 was analysed by use of immunostainings in skin biopsies. We found that hBD2, hBD3, psoriasin, RNase7, TLR2 and TLR4 were significantly more often expressed in distinct layers of lesional epidermis as compared with uninfected epidermis. In both infections but not in normal skin, hBD2 and hBD3 were commonly expressed within the stratum corneum and in the stratum granulosum. Similarly, psoriasin was seen more often in the upper skin layers of both infections as compared with normal skin. No significant differences between normal and infected skin were found for the expression of TLR9 and dectin 2. Our findings clearly show the expression of specific antimicrobial proteins and defence-related ligands in superficial tinea as well as in pityriasis versicolor, suggesting that these factors contribute to fungal containment.

During a total population survey in 1988 and 1989 in Karonga district, northern Malawi, 4915/61735 (8.0%) people examined were found to have extensive pityriasis versicolor (PV). An additional 6085 people (9.9%) were diagnosed as having mild disease. The highest prevalence rates of extensive and mild PV were found among subjects aged 15-24 years. In this age group between 20% and 25% of people had extensive PV. Rates were generally higher among males than among females. PV was rarely found in prepubertal subjects.

We describe a 53-year-old woman with pityriasis versicolor together with erythrasma that was localized in the axillary and genitocrural region. The coexistence of these infections is rare and we propose the use of methylene blue stain for the diagnosis of both diseases.

Summary. In a double-blind, randomized study the efficacy and tolerance of flutrimazole 1% solution were compared with bifonazole 1% solution, applied once daily for 4 weeks, in 40 patients with culturally proven dermatophytosis or cutaneous candidosis. Forty patients with mycologically proven pityriasis versicolor were treated with once-daily application for 1 week. The four groups of patients and distribution of target lesions were similar, although in the flutrimazole group more patients had cutaneous candidosis (n= 8 versus n= 1). The distribution of the sum of clinical scores was also similar in both groups. At the end of therapy the proportion of patients with negative microscopy and culture was 85% in the flutrimazole group and 65% in the bifonazole group. There was a significant difference (P=0.022) in terms of efficacy, since 80% of patients in the flutrimazole group versus 40% in the bifonazole group were judged to have received effective treatment. At the assessment 6 weeks after the end of therapy the percentages of flutrimazole- and bifonazole-treated patients with negative mycology were 75% and 65% respectively. There were two relapses (one in each group), which represents a 5% rate. Fifteen flutrimazole-treated patients 75%) compared with 12-bifonazole-treated patients 60%) had overall effective therapy. Two patients treated with bifonazole (10%) and one treated with flutrimazole (5%) had a premature termination due to adverse events attributable to the medication. On assessment 3 weeks after the end of treatment, the patients with pityriasis versicolor were all clinically and mycologically healed with negative fluorescence, including the patients who withdrew from the full course of treatment (one in each group). Nine weeks after the end of therapy all the patients remained cured, with no relapses. The overall incidence of adverse events (mild local reactions such as irritation, burning and itching) was one and seven cases for bifonazole and flutrimazole respectively. One patient in each group had to abandon treatment owing to severe intolerance. Zusammenfassung. In einer randomisierten Doppelblindstudie wurden Wirksamkeit und Vertraglichkeit einer 1%igen Flutrimazol-Losung mit denjenigen einer 1%igen Bifonazol-Losung verglichen, wobei die Losungen 40 Patienten mit mikro-biologisch nachgewiesener Dermatophytose oder Candida-Infektion der Haut vier Wochen lang jeweils einmal taglich appliziert wurden. Ebenfalls 40 Patienten mit mykologisch nachgewiesener Pityriasis versicolor wurden einmal taglich eine Woche lang behandelt. Innerhalb der vier Patientenkollektive war die Verteilung der zu untersuchenden Verletzungen vergleichbar, wenn auch die Anzahl der Patienten mit Candidu-Infektion in der Flutrimazol-Gruppe groner war (n = 8 gegen n = 1). Die Summe der klinischen Bewertungszahlen war ebenfalls gleichmsig verteilt. Bei Therapieende waren 85% der Patienten aus der Flutrimazol-Gruppe sowie 65% aus der BifonazolGruppe mykologisch geheilt (Mikroskopie und Pilzkultur negativ). Ein signifikanter Unterschied (P= 0,022) war hinsichtlich der Wirksamkeit festzustellen, da 80% der Patienten der FlutrimazolGruppe gegenuber 40% der Bifonazol-Gruppe als wirksam behandelt beurteilt wurden. Bei der Auswertung sechs Wochen nach Therapieende betrugen die mykologischen Heilungsraten 75 (Flutrimazol) bzw. 65% (Bifonazol). In jeder Gruppe gab es einen Ruckfall (5%). Funfzehn Flutrimazot-Patienten (75%) verglichen mit zwolf Bifonazol-Patienten (60%) wiesen keinerlei klinische Symptome auf. Zwei mit Bifonazol behandelte Patienten (10%) und ein mit Flutrimazol behandelter (5%) brachen den Versuch wegen Medikations-bedingter Nebenwirkungen vorzeitig ab. Bei Auswertung drei Wochen nach Therapieende waren alle Patienten klinisch und mykologisch geheilt (keine Fluoreszenz), diejenigen eingeschlossen, die vorzeitig ausschieden (einer pro Gruppe). Neun Wochen nach Therapieende waren alle Patienten weiterhin geheilt, es gab keine Ruckfalle. An Nebenwirkungen traten insgesamt 1 (Bifonazol) bsw. 7 Falle (Flutrimazol) auf (milde lokale Reaktionen wie Hautreizung, Brennen oder Jucken). In beiden Gruppen brach ein Patient die Behandlung wegen starker Unvertraglichkeit ab.

Anecdotal reports have shown that tumour necrosis factor (TNF)-alpha inhibition may cause unchecked superficial infection with the microorganisms responsible for pityriasis versicolor (PV). We observed several cases of PV, which is frequently resistant to topical therapies, in psoriatic patients undergoing anti-TNF-α monoclonal antibody therapy. To evaluate the incidence and the therapeutic management of PV in this group of individuals, between 1 January and 27 December 2010, we examined 153 psoriatic patients for the hypopigmented/hyperpigmented macular and scaling lesions associated with PV. All patients positive for PV were given topical therapy with miconazole nitrate cream twice daily for 28 days, after which they were re-evaluated. In patients non-responsive to topical therapy, we started systemic therapy with fluconazole, 300 mg week for 3 weeks. We diagnosed seven cases of PV. At the end of topical treatment, complete healing of lesions was observed in only one patient. In the other six patients, systemic treatment led to complete resolution of the infection. Although the onset of PV during anti-TNF-alpha; therapy is seldom reported, it is not likely to be rare, but rather under-reported because of its limited pathological significance. In our opinion, the therapeutic management of this condition deserves greater consideration, as the use of topical treatments alone is largely ineffective compared with systemic treatment.

The goal of this study was to determine the prevalence of Malassezia species in pityriasis versicolor lesions and to examine if the range of species varies with patients characteristics such as: age, sex and family history and also clinical findings such as site and number of the lesions. In a prospective study from July 2006 to July 2007, the patients with a clinical diagnosis of pityriasis versicolor (n = 166) were asked to participate in the study. A total of 116 patients had positive culture for Malassezia species: M. globosa was found in 52 (31.3%) cases, M. furfur in 34 (20.5%) cases, M. pachydermatis in 12 (7.2%) cases, M. restricta in 12 (7.2%) cases, M. slooffiae in 6 (3.6%) cases. According to our data, M. globosa is the main species causing pityriasis versicolor, M. furfur was found to be the second-most frequent species. M. sympodialis and M. obtusa were not found in any case, and in 30.2% of patient's Malassezia culture was negative.

Mycoses are frequent affections in childhood. Fungal type varies according to the age and the affected organ. The aim of this study was to determine the aetiological agents of childhood dermatomycoses and to draw attention to the diversity of their clinical manifestations. Retrospective study dealing with children's cases with age

Ketomousse (K), a new thermophobic formulation (ketoconazole 1%), has proven its efficacy in the treatment of dandruff, caused by the same agent as pityriasis versicolor (PV). The objective of this study was to compare the efficacy and tolerability of K thermophobic foam vs. ketoconazole cream 2% (N) in the treatment of PV. Forty-six patients (22 in K and 24 in N group) with PV involving no more than 15% of the total trunk surface were randomly assigned for treatment either with K or N once daily for 14 days. Three weeks after the completion of treatment, improvement rate and side-effects were evaluated by clinical and mycological examination (Wood's light). Follow-up was available for 81% of subjects. Complete resolution was observed in five patients (29%) in K group and in nine (47%) in N group (P = 0.291). One patient in the N group reported urticaria while no adverse events were reported for K. Both products were cosmetically acceptable with respect to feasibility of application and formulation with a preference for K. Ketomousse (1% ketoconazole) provides an equal efficacy and tolerability compared to ketoconazole cream 2%. Therefore, Ketomousse could be considered an excellent therapeutic option in the treatment of PV.

We studied Malassezia furfur colonization of neonates in the neonatal intensive care unit (NICU) and found that the rate was astonishingly high as compared to the previous studies. In very low birth weight (less than 1,000 g) infants we recorded a colonization rate of 80%, and 4% infants with a birth weight greater than 2,000 g. Under 10 day's hospitalization the rate was 11%, and it was 70% after 20 days spent in the unit. Among the infants with the birth weight less than 1,700 g, antibiotic therapy was recorded as a significant risk factor for colonization. In the infants with a greater birth weight, the colonization rate was independent from the risk factors studied. M. furfur colonization could not be linked with occurrence of any symptoms of signs recorded and colonization by M. furfur was so common in NICU that the predictive value of surveillance cultures is poor.

Summary To study the clinical and epidemiological profile of Pityriasis versicolor (PV) and to determine the possible genetic model for PV in Chinese Han, we investigated 503 patients with PV who were recruited by a questionnaire method. Statistical analysis, heritability and complex segregation analysis were performed using EPI INFO 6.0, SPSS 10.0, the Falconer method and the SAGE-REGTL programs. In the total 503 PV patients, the mean age of onset was 22.85 ± 10.36 years. For male and female patients, the peak ages of initial onset were both 20‐29 years. A total of 106 (21.1%) patients were reported to have a positive family history of PV. The mean age of onset in males with positive family history was earlier than those with negative family history (t = 3.58, P < 0.01). Higher rate of recurrence and longer duration were seen in the patients with positive family history than those with negative family history. The heritability of PV in first-, second- and third-degree relatives was 48.13%, 40.11% and 27.20% respectively. Based on the REGTL results, the best model was a polygenic additive model for PV.

Topical drugs are often effective in limited lesions of pityriasis versicolor; but in extensive cases, systemic drugs are more suitable. Previous studies have shown that ketoconazole and fluconazole are effective in 42-97% and 74-100% of lesions respectively. Our purpose was to compare the effectiveness of a single dose of 400 mg ketoconazole with two doses of 300 mg of fluconazole with 2 weeks interval. Ninety patients with extensive pityriasis versicolor (body involved area > or =25%) were randomly assigned to treatment with either a single dose of 400 mg of ketoconazole or with two doses of 300 mg of fluconazole with 2 weeks interval. One month after the treatment, the improvement rate and side effects were evaluated by clinical examination and questionnaire. Sixty cases (66.7%) completed the study. They were 51 males and nine females, with a mean age of 30 years. At the follow-up visit (1 month after the end of treatment), the improvement rate for ketoconazole (87.9%) was not significantly different from fluconazole (81.5%), (Fisher test: P = 0.37). Due to the hepatotoxicity of ketoconazole, fluconazole appears to be more suitable in the treatment of extensive pityriasis versicolor.

This study concerns a culture research based on the data gathered from Korean subjects to examine distribution of Malassezia yeast. Malassezia yeast were cultivated out of samples from scalp, forehead, chest, arm and thigh. Malassezia restricta was recovered more frequently in the teens and young adults, while M. globosa was the predominant species in subjects older than 50 years of age. The population density of Malassezia yeast was significantly higher in the age group (AG) of 21-30 years compared with other AGs (P < 0.05). It was also significantly higher in the chest compared with the forehead, arm and thigh (P < 0.05). The key is to recognise the existence of a difference in the amount and type of Malassezia species in different AGs as well as body areas, which reflects differing skin lipid levels in various AGs and different body areas.

The yeast Malassezia furfur is a part of the resident flora of human skin. It causes various diseases such as pityriasis versicolor, which hardly shows signs of inflammation despite marked clinical symptoms (e.g. hypopigmentation). The pathophysiology related morphological picture might give a clue to this phenomenon. As a part of the literature data are controversial, the present study compared the inflammatory infiltrate of pityriasis versicolor with that of tinea corporis in 40 human skin preparations each from diagnostic specimens. All preparations were stained with HE and PAS. Neutrophilic granulocytes were counted in the HE stain, and hyphae and spores in the PAS stain. The number of counted cells was related to the size of the respective area and the values were compared between pityriasis and tinea corporis. Significantly, more neutrophilic granulocytes were found with tinea corporis (P0.01), while they were virtually not demonstrable with pityriasis versicolor. It is surprising that fungal load in the stratum corneum is significantly higher with pityriasis versicolor (P0.01). Obviously the immune response involving neutrophilic granulocytes does not occur despite high bacterial load. This might be explained by reduced immunogenicity because of high content of lipids in the cell membrane. Furthermore, pityriarubins that are produced during tryptophan metabolism might be involved, which, in a stimulus-dependent manner, can suppress the ROS production of neutrophilic granulocytes in vivo.

The lipophilic dimorphic yeast Malassezia furfur is a common skin commensal and the aetiological agent of pityriasis versicolor. A source of lipids is essential for its growth, and there are already demonstrations of in vitro lipase and lipoxygenase production. In eight wild strains, isolated from patients with pityriasis versicolor, we showed a phospholipase activity using a medium containing egg yolk emulsion as the only source of lipids; in this medium M. furfur grows and produces a phospholipase zone. Adding manganese sulphate, an unspecific inhibitor of phospholipase activity, M. furfur does not grow, because the lipophilic fungus cannot utilize the egg yolk as a source of fatty acids. Adding Tween 60 to the same medium, M. furfur also grows in presence of manganese sulphate.

PubMedID: 12950903 This study was carried out in a textile factory settled in the city center of Adana, Turkey. The workers were evaluated for the presence of superficial mycoses and the interaction of their working environment or working condition. A total of 431 textile workers were included in the study, with a male to female ratio of 378 (87.7%) to 53 (12.3%) and an age range of 19-52 (mean: 33.7 ± 6.8). Direct examination and/or culture revealed superficial mycoses in 73 (16.9%) workers, among them 56 (76.7%) were classified as dermatophytoses, 8 (11.0%) as Pityriasis versicolor while in nine (12.3%) of the cases, no causative agent could be determined. Trichophyton rubrum (57.1%) and T. mentagrophytes (42.9%) were the two species isolated on culture. This study emphasized that textile workers should be admitted as a risk group for superficial mycoses, especially tinea pedis.

Apart from pityriasis versicolor, Malassezia furfur is thought to play a significant role in the pathogenesis of seborrhoic eczema and Malassezia folliculitis. However, it has not been clarified whether in addition to host factors (e.g. immune status, greasy skin), yeast-dependent activities are responsible for manifestation of the disease. In this context interstrain variability of hydrolase activity of Malassezia isolates might be significant. For determination of hydrolase activity, washed yeast suspension was applied to selective agar for pathogenic fungi containing 8% (v/v) Tween 80 or Tween 60 and was incubated at 37 degrees C for 10 days. Growth was accompanied by formation of a dense white zone around the colony, in which free fatty acids corresponding to Tween 80 (C18:1) or Tween 60 (16:0, 18:0) were demonstrated by means of thin layer and gas chromatography. Thus, this phenomenon is a parameter for yeast-dependent hydrolysis of Tween 80 and Tween 60. Considering different growth behaviour, a "hydrolase zone' (H2) was determined using the quotient colony diameter/(ring+colony) diameter in each of the 150 strains tested. Although no significant H2 variations were observed in strains of different clinical origin, the present study revealed that in addition to a known enzyme, which is located within the cell wall and/or membrane systems, these Malassezia isolates produce a very active hydrolase diffusing into the medium.

Fine-structural investigations were done with surface material and slides of pityriasis versicolor, Malassezia-folliculitis and seborrheic eczema. Aspects of the microorganism Malassezia furfur, such as its presence, its distribution on the skin surface, and its shape, and changes in the host skin tissue, such as the structure of the horny layer and signs of an inflammation were registered. Two main types of Malassezia-associated dermatoses were defined. One type is characterized by a considerable number of microorganisms, adhering to regular cells of the horny layer (exemplified by pityriasis versicolor), the other type is characterized by signs of an inflammation and a very low number of visible fungal cells (exemplified by seborrheic eczema).