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Malassezia furfur is a lipophilic, yeast-like fungus that forms part of the normal human skin microflora and is associated with a wide range of infections, such as pityriasis versicolor, folliculitis, and systemic infections in immunocompromised patients. Although matrix-assisted laser desorption/ionization time-of-flight mass spectrometry has enabled rapid identification of Malassezia species, it is still a challenge to diagnose systemic infections because Malassezia fungemia can often be missed by automated blood culture systems. We report a case in which M. furfur in blood was detected by the presence of yeast-like fungi in blood smears. Yeast-like organisms were observed in the blood smears of a 3-year-old boy, taken over 2 weeks without any symptoms. He had undergone several courses of chemotherapy for neuroblastoma via an indwelling central venous catheter (CVC) that was placed in his right anterior chest for 11 months. Although the blood cultures obtained from an automated blood culture system were negative, M. furfur growth was detected in the subcultured blood taken from the CVC. The CVC was removed, and the scheduled chemotherapy was postponed. No systemic M. furfur bloodstream infection occurred; the infection resolved spontaneously without any specific treatment; only prophylactic fluconazole was administered. M. furfur fungemia may not be diagnosable by an automated blood culture system. Further, M. furfur may not cause infections in humans even when administered intravenously. This report may lead to the discovery of factors related to human infectivity of this disease in the future.

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.

Health is a blessing that is very important for humans, most of us, many of us don't really care about skin diseases caused by fungi such as tinea versicolor, water fleas, ringworm and scabies. In general, people are quite aware of how to deal with the symptoms of skin diseases suffered. But it would be better to include medical participation in detecting a disease symptom, because many disease symptoms are considered trivial by some people but can be fatal to human skin. So it is necessary to make an application based on medical knowledge to diagnose skin diseases in humans which is used as a tool in obtaining information about skin diseases in humans and provide recommendations as the first action that must be taken to repeat skin diseases in humans. The knowledge base is structured in such a way into a database with several tables. Drawing conclusions in this expert system using the forward chaining inference method. The expert system will provide questions to the user in the form of symptoms of several diseases and the user will answer these questions. Until the user will get a solution from the results of the question earlier.

Dermoscopy has traditionally been used for the diagnosis of neoplasms and more recently in the evaluation of inflammatory conditions. Recent observational studies have suggested a role for dermoscopy in identifying and differentiating acquired pigmentary disorders. This comprehensive review will summarize the growing literature on the use of dermoscopy for pigmentary disorders. A literature review was performed on PubMed dating from inception to October 2020. The following pigmentary disorders were included in this study: melasma, solar lentigines, poikiloderma of Civatte, exogenous ochronosis, lichen planus pigmentosus, erythromelanosis follicularis faciei et colli, pigmented contact dermatitis, Riehl's melanosis, postinflammatory hyperpigmentation, erythema dyschromicum perstans, ashy dermatosis, confluent and reticulated papillomatosis, acanthosis nigricans, pityriasis versicolor, tinea versicolor, idiopathic guttate hypomelanosis, and vitiligo. Search terms used included each pigmentary disorder along with the terms "dermoscopy" or "dermatoscopy." Relevant case reports and case series were included. Many pigmentary disorders have unique and distinguishable features on dermoscopy. Given that these disorders can be clinically challenging for clinicians and emotionally distressing for patients, dermoscopy provides an additional, useful tool in the evaluation and assessment process.

Herbal medicines are gaining more interest both in terms of medicinal and economic benefits and they are getting more patient compliance due to its fewer side effects as compared to allopathic medicines. The present research was aimed at phytochemical screening and antifungal evaluation of rhizomic extract of Zingiber wightianum Thwaites belonging to Zingiberaceae family. The rhizomes were subjected for Soxhlet extraction and the preliminary phytochemical screening of this extract proved the presence of alkaloids, carbohydrates, tannins, flavonoids, saponins, phenols. Subsequently, these extracts were evaluated for antifungal activity and minimum inhibitory concentration was determined. Hence revealed the potential to treat a fungal infection Tinea versicolor, caused by fungus Malassezia furfur. This investigation was also undertaken with a view to formulate and evaluate the herbal gel using Zingiber wightianum rhizomic extract. Thus, the overall studies concluded that the rhizomic extract of Zingiber wightianum Thwaites and its formulation would be a breakthrough in the field of modern antifungal drug.

Malassezia are lipophilic yeasts in the skin microbiome that abundantly colonize all parts of human skin except for the soles of the feet. Fungal microbiome analysis of keratotic plugs from the noses of 10 healthy individuals identified Malassezia restricta as the predominant species, followed by Malassezia globosa. Malassezia hyphae were observed in 5 of the 10 individuals. The hyphae were curved and thick-walled with spherical thick-walled and grouped blastoconidia, described as a "spaghetti-and-meatballs" configuration. In this study, we observed Malassezia hyphae in keratotic plugs of healthy subjects, although abundant Malassezia hyphae have previously only been observed in lesional sites of patients with pityriasis versicolor.

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Background: Both superficial tinea and pityriasis versicolor are very popular fungal skin infections that affect people all over the world. Recent research suggests that certain antimi-crobial peptides can also play a role in the body's natural defense against fungal infection. Aim of Study: The purpose of the current research would be to investigate the tissue expression of b2-defensin mRNA in lesions of tinea versicolor and lesions of tinea circinata and hence studying its role in fungal infection pathogenesis. Patients and Methods: Twenty patients with tinea versi-color, twenty with tinea circinata, and twenty controls were included in this case control study. For real-time PCR (RT-PCR) gene expression of b2-defensin mRNA, a punch skin biopsy was obtained from the patient's lesional and non-lesional skin, as well as normal skin from a control. Results: b2 defensin was upregulated in lesional areas of tinea versicolor and tinea circinata in comparison to non lesional areas of tinea versicolor, tinea circinata and control. These results reached a statistical significance for mRNA b2 defensin in tinea versicolor and tinea circinata (p-value

Background: Fungal skin infections such as superficial tinea and pityriasis versicolor are very common and affect people all over the world. Recent research suggests that certain antimicrobial peptides can also play a role in the body's natural defense against fungal infection. Aim of Study: The aim of this research is to look at the tissue expression of Cathelicidin mRNA in tinea versicolor and tinea circinata skin lesions to learn more about its function in fungal infection pathogenesis. Patients and Methods: Twenty patients with tinea versi-color, twenty with tinea circinata, and twenty controls partic-ipated in this case-control study. A punch skin biopsy was obtained from the patient's lesional and non-lesional skin, as well as the control's normal skin, for real time PCR (RT-PCR) gene expression of cathelicidin mRNA. Results: Cathelicidin was upregulated in lesional areas of tinea versicolor and tinea circinata in comparison to non lesional areas of tinea versicolor, tinea circinata and control. These results reached a statistical significance for mRNA cathelicidin in both diseases (p-value

Over the last decade, Malassezia species have emerged as increasingly important pathogens associated with a wide range of dermatological disorders and bloodstream infections. The pathogenesis of Malassezia yeasts is not completely clear, but it seems to be strictly related to Malassezia strains and hosts and needs to be better investigated. This study aimed to assess the enzymatic activities, biofilm formation and in vitro antifungal profiles of Malassezia spp. from pityriasis versicolor (PV) and healthy patients. The potential relationship between virulence attributes, the antifungal profiles and the origin of strains was also assessed. A total of 44 Malassezia strains isolated from patients with (n = 31) and without (n = 13) PV were employed to evaluate phospholipase (Pz), lipase (Lz), and hemolytic (Hz) activities and biofilm formation. In addition, in vitro antifungal susceptibility testing was conducted using the CLSI broth microdilution with some modifications. A high percentage of strains produced Pz, Lz, Hz and biofilm regardless of their clinical origin. The highest number of strains producing high enzymatic activities came from PV patients. A correlation between the intensity of hydrolytic activities (Lz and Pz activities) and the Hz activity was detected. Positive associations between Lz and the low fluconazole susceptibility and Hz and biofilm formation were observed. These results suggest that enzyme patterns and biofilm formation along with antifungal profiles inter-play a role in the pathogenicity of Malassezia spp. and might explain the implication of some Malassezia spp. in invasive fungal infections and in the development of inflammation. Lay Summary There is still little information on the virulence factors of Malassezia spp., despite their implication in severe diseases. Phospholipase, lipase, and hemolytic activities, biofilm formation and decreased antifungal susceptibility seem to contribute to their virulence in susceptible hosts.

We describe a case series of seven children presenting with pityriasis versicolor on the face, localized to the area of coverage by the mask. The increased use of face masks after the opening up of schools, combined with a humid environment and associated sweating might be responsible for an increased presentation of facial pityriasis versicolor in children in our community.

5 pags., 3 figs., Background: Although systemic therapies are recommended for severe or recalcitrant cases of pityriasis versicolor (PV), they are not free of important side effects and drug interactions. Photodynamic therapy (PDT) utilizes the action of singlet oxygen and free radicals produced by a light-activated photosensitizer to kill viruses, bacteria, or fungi. In this study, the effect of a PDT mediated by methylene blue (MB) in PV was evaluated. Methods: Five women with PV disseminated on the back and diagnosed by fresh microscopic analysis were treated with a solution of MB (2%) applied to the PV lesions for 3 minutes. Next, a red LED lamp (λ = 630±5 nm, 37 J/cm), placed 100 mm from the skin for 10 minutes, was applied on the dyed PV lesions. Six sessions of MB/PDT were implemented with a 2-week interval in between. Wood's lamp examination was used to monitor fungal infection at each time point. Results: Complete cure was observed in the five women at the 4 weeks post-treatment follow-up. Fluoresce images from PV lesions by Wood's lamp allowed to evaluate whether the lesions were healed or not at each time point. No patient showed relapse at the 6-month follow-up. The patients did not have any adverse effect, and good cosmetic outcome was observed. Conclusions: Six sessions of MB/PDT spaced at 14-day intervals are sufficient for the treatment for PV in healthy patients., Spanish Research Projects MINECO. Grant Number: MAT 2017‐83856‐C3 Fundación Eugenio Rodríguez Pascual

Allergists/immunologists see a variety of skin disorders, some of which have a known immunologic basis whereas others do not. We review the prevalence, etiology, clinical presentation, and effective and low-cost care of common dermatologic conditions seen in outpatient practices. Conditions discussed include pityriasis alba, seborrheic dermatitis, rosacea, acne, tinea infections, intertrigo, lichen planus, tinea versicolor, lichen simplex chronicus, scabies, pityriasis rosea, keratosis pilaris, and seborrheic keratosis. An understanding of frequently encountered cutaneous diseases and their therapies will help provide immediate access to treatment and improve the experience for both the affected patient and the clinician.

Pityriasis Versicolor (PV) is a commonly encountered infection of the skin caused by Malassezia species. Despite effective conventional antifungal drugs, the prevention and treatment of PV remain a challenge. The Unani pharmacopoeial preparations Itrifal Hakim Ali (IHA) and Habb-e-Kalaf (HK) have been used in the treatment of PV for a long time. The Unani practitioners recommend these formulations for the successful treatment of PV in clinical practice.This study aimed to evaluate the efficacy and safety of Unani formulations IHA (oral) and HK (topical) in the treatment of PV.A single centre, randomized, active-controlled, parallel-group and open-label clinical study was carried out in the outpatient departments of the National Research Institute of Unani Medicine for Skin Disorders, Hyderabad, India. The participants diagnosed with PV of any gender aged between 18 and 60 years were randomized into the test group (n = 37) to receive oral IHA (10g/day) and topical HK and the active control group (n = 35) to receive oral Itraconazole (100 mg/day) and local Terbinafine (1%) for the period of 6 weeks. Of them, 30 participants in each group completed the duration of the protocol therapy. The outcome of this study was based on a per-protocol analysis of the data. The efficacy of the interventions was measured by post-treatment change in subjective clinical symptoms/signs, mean TSSS, IGA score, direct microscopy of fungal elements and DLQI. The dermal safety was assessed by Berger/Bowman Scoring Scale and systemic safety was evaluated by Urinalysis, haematological and biochemical parameters.This study observed statistically and clinically significant post-treatment reduction in itching (test group vs. active control group; 73.4% vs. 89.1%), hypopigmentation (63.2% vs. 57.1%), hyperpigmentation (60% vs. 65.5%), and scaling (91.6% vs. 92.7%) (p 0.001). The differences in mean TSSS (5.4 ± 0.63 vs. 5.60 ± 0.32), IGA score (2.07 ± 0.15 vs. 1.74 ± 0.08) and DLQI (9.6 ± 2.06 vs. 9.04 ± 2.7) were also found clinically and statistically significant (p 0.001) in each group when compared baseline data to post-treatment. On inter-group comparison, the changes in mean TSSS and DLQI were not found statistically significant at p 0.05. But, the change in the mean IGA score was significant (p = 0.03). Further, the mycological cure was observed in 100% and 76.7% of participants in the test group and the control group respectively. On comparing inter-group the effects of the interventions on direct microscopy were found statistically significant (p = 0.034). In addition, no significant change in urinalysis, biochemical and haematological parameters from baseline to post-treatment in each group was observed.This study concluded that the test drugs (IHA and HK) were safe and effective in the treatment of PV. The oral (IHA) and local (HK) Unani formulations were tolerated well by all the participants The efficacy and safety of the IHA and HK were comparable to the standard drugs (Itraconazole and Terbinafine).

Background Pityriasis versicolor is a chronic superficial fungal infection seen worldwide, with high prevalence observed in hot and humid climates. Objectives The aim of this work was to isolate and identify Malassezia species from pityriasis versicolor using specific fast gtowth media; Chrom agar to obtain a better understanding of the role of each species in the etiology of disease. Patients and Methods This study was conducted on 70 patients with clinical diagnosis of pityriasis versicolor with positive KOH test. All of the participants were subjected to a well informed consents, full history taking including age, sex, site of the lesions and any previous treatment, full general and dermatological examination to determine site, color of the lesions and Wood's light examination. Results Our results reported 94.3% of studied patients yielded growth on culture while 5.7% did not show any growth. The predominant age group was ≥ 25 years old. Furthermore it was found that PV affected male subjects (62.90%) more than the females (37.1%). Conclusion Malassezia yeasts, although are considered a part of normal skin microbiome, is a known cause of pityriasis versicolor. PV was more common in males in the age group ≥ 25yrs. The most affected body site was the chest, the most common variant is hyperpigmented type, and the commonest isolate was M.furfur.

The genus Malassezia represents the dominant eukaryotic component of the skin microbial flora. There are complex interactions between this commensal and the skin, leading to various Malassezia-caused or Malassezia exacerbated skin conditions.To identify Malassezia species in lesions of patients with pityriasis versicolor (PV), atopic dermatitis (AD), and seborrheic dermatitis (SD), as well as corresponding sites in healthy subjects according to the culture methods used for Malassezia species isolation.Scrapings were collected from 80 patients (40 PV, 20 AD, and 20 SD) and 30 healthy subjects. For 10-14 days, specimens were cultured on Dixon's medium and Malt extract agar. Direct microscopic examination with Gram's stain, subculture on Hi chrome agar, Dixon's medium at various temperatures, Tweens assimilation, and hydrolysis of tryptophan were used for the identification of yeast isolates.The isolation frequency of Malassezia species in healthy subjects was 13.3% for M. furfur, 10.0% for M. globosa, and 3.3% for M.sympodialis. In patients with SD, M. furfur was isolated more frequently from scalp lesions (25.0%) and then M. sympodialis (15%) and M. globosa (10%). Malassezia sympodialis was the most prevalent isolated species in AD lesions (20%), followed by M. furfur (10%). Malassezia species isolation was found to be most prevalent in PV lesions, with M. furfur being the most prevalent identified species (52.5 %), followed by unidentified species (20%).Malassezia species composition was similar in PV, SD, and healthy subjects, with M. furfur being the commonest isolate, while Malassezia sympodialis was the prevalent species isolated in AD lesions. Chrome agar media can be promising for the identification of Malassezia species phenotypically. However, species differentiation has to be complemented by molecular methods.

Immunophenotyping of inflammatory dermal infiltrates in Malassezia folliculitis (MF) and pityriasis versicolor (PV) lesions is less reported. Immunohistochemistry was performed on 21 MF lesions, 10 PV lesions, and 10 control skin. CD3+, CD4+, CD8+, CD20+, CD68+, and CD117+ cells were increased in MF compared with PV and normal skin (P Lay Summary Malassezia folliculitis and pityriasis versicolor are common Malassezia-induced superficial mycoses. Their clinicopathological discrepancy may be due to the difference of cellular and humoral immune responses.

Glycosylphosphatidylinositols (GPI)-anchored proteins (GpiPs) are related to the cell wall biogenesis, adhesion, interactions, protease activity, mating, etc. These proteins have been identified in many organisms, including fungi such as Neurospora crassa, Candida albicans, Saccharomyces cerevisiae, and Fusarium graminearum. MGL-3153 gene of Malassezia globosa (M. globosa) encodes a protein which is homologous of the M. restricta, M. sympodialis, M. Pachydermatis, and U. maydis GpiPs. Real-time PCR assay showed that the expression of MGL_3153 gene was significantly up-regulated among M. globosa isolated from patients with pityriasis versicolor (PV) compared to a healthy individual, suggesting the contribution of this gene in the virulence of M. globosa. Accordingly, the sequence of this protein was analyzed by bioinformatics tools to evaluate the structure of that. The conservation analysis of MGL-3153 protein showed that the C-terminal region of this protein, which is responsible for GPI-anchor ligation, was highly conserved during evolution while the N-terminal region just conserved in Malassezia species. Moreover, the predicted tertiary structure of this protein by homology modeling showed that this protein almost has alpha helix structure and represented a stable structure during 150 ns of molecular dynamic simulation. Our results revealed that this protein potentially belongs to GPI-anchored proteins and may contribute to the virulence of M. globosa which warrants further investigations in this area.

Dermoscopic examination is a very effective and practical method that significantly reduces the need for invasive diagnostic procedures in many skin diseases. Dermoscopic features of many cutaneous conditions have been well described, however, only one single case report has defined dermoscopic features of notalgia paresthetica so far. The clinical presentation of this entity can mimic many dermatological conditions including lichen simplex chronicus, cutaneous amyloidosis, and tinea versicolor. We tried to identify dermoscopic findings of the notalgia paresthetica, aiming to facilitate the diagnosis.

Tinea versicolor is a common skin disorder seen in the daily dermatological practice. Tinea versicolor is an endogenous opportunistic infection caused by Malassezia yeasts which are part of the normal flora that normally live on the skin. Several systemic and topical treatments have been used in the treatment of tinea versicolor but their use has been limited by their side effects or variable therapeutic response. Therefore, there is ongoing search for safer and more effective drugs. In this study, it was aimed to evaluate the safety and the efficacy of topical clotrimazole in the treatment of tinea versicolor. The study included 20 patients of tinea versicolor (10 hypo- and 10 hyperpigmented TVC) who were treated with clotrimazole 0.1% cream. All patients were selected from the outpatient clinics of Dermatology and Andrology Department of Benha University Hospitals. From this study we can conclude that clotrimazole is equally effective in both forms of tinea versicolor.

Pityriasis versicolor (PV) is a superficial mycosis that it can occur at any age, even in newborns. In this review, we will describe epidemiological data, mycological characteristics of yeast, pathogenesis and clinical characteristics of the disease, different diagnostic resources, and the current recommendations for treatment. The typical morphology and topography of PV allow us to make a quick diagnosis, but atypical presentations have been described. Diagnostic tools, such as dermoscopy, can also reveal patterns that allow the evaluation of characteristics of scales and pigment in lesions. The discovery of new species and new mechanisms of interaction with the host has broadened the panorama of aetiological possibilities. Although PV is a common disorder, extensive research is necessary to better understand the pathophysiology of the disease, immunological characteristics of the pathogen-host relationship and resources needed to precisely diagnose the disease, treat the disease, and avoid its chronic and recurrent course.

The integration of botanicals in commercial cosmeceuticals, personal care products, and home remedies has fostered a need for a better understanding of the potential efficacies of these interventions. This review identified plants with antifungal activity against Malassezia, a commensal yeast implicated in inflammatory skin conditions. We sought to discover plants with potent activity comparable or superior to current antifungal agents. Malassezia plays a unique role in the pathology of skin disease, encoding for extracellular lipases that initiate an inflammatory response on the surface of the skin and prevent attack through the creation of biofilms. Antifungal resistance is on the rise, with current agents demonstrating increasing minimum inhibitory concentrations when tested in vitro. Several plant species exhibited anti-Malassezia activity, including Nyctanthes arbor-tristis, Allium sativum, and Hypericum perforatum, among others. We recommend further research aimed at identification of the plant secondary metabolites responsible for this activity.

Background and Objectives: There are several studies which gives the prevalence of dermatological lesions as well as prevalence of Diabetic Retinopathy (DR) in Diabetes Mellitus (DM) patients. A few studies have also looked upon the association between diabetic dermopathy, which is the commonest dermatological lesion in DM and retinopathy. However, there are no studies available in literature which gives the prevalence of Dermatological lesions in DR patients. This study is undertaken to find out the same. Materials and Methods: 170 DR patients between 40-70 years of age with history of DM of at least five years duration were included in the study. Skin and retina of these patients were examined. The study period was 12 months. Results: 170 DR patients included in the study were in the age group of 42 years to 70 years with a mean age of 59.15(SD 6.76) years. The duration of DM in the study group was 5 to 35 years with a mean duration of 13.43 years (SD 5.60). 147(86.47%) among 170 patients had various dermatological lesions. Most prevalent dermatological lesions noted among the patients were Diabetic dermopathy (shin spots), Xerosis, Idiopathic Guttate Hypomelanosis (IGH), Icthyosis, Intertrigo, Tinea Versicolor, Chronic Paronychia and Tinea Unguium. Conclusion: Prevalence of Dermatological lesions in Diabetic Retinopathy patients was 86.47%, the most common being Diabetic Dermopathy (shin spots) which was 42.94%. Keywords: Diabetes Mellitus (DM), Diabetic Retinopathy (DR), Dermatological lesions, Diabetic dermopathy, Xerosis.

Gradations in skin color are a consequence of differing amounts of melanin and their varying distribution. Although many darkly pigmented skin lesions are melanocytic and can be attributed to melanin content, the color of a black lesion can also be due to blood, necrotic tissue, or exogenous pigment. The source, pattern, and distribution of the color in black lesions usually offer important insight into its etiology. This contribution reviews conditions that can take on a black color, discussing the cause of the hue and any additional impact sun exposure may have.

Background: Pityriasis versicolor (PV) is essentially a clinical diagnosis characterized by hypopigmented or hyperpigmented patches on the skin. Dermoscopy is gaining popularity as a noninvasive procedure for the diagnosis of different pigmentary and inflammatory disorders. However, scarce evidence exists on the dermoscopic pattern of PV. Objective: To describe the dermoscopic features of hypopigmented and hyperpigmented lesions of PV. Methods: Dermoscopic images of PV lesions located on different body sites were retrospectively evaluated for the presence of predefined criteria. Results: A total of 178 lesions from 125 patients were included in the study among which 164 lesions were hypopigmented and 14 lesions were hyperpigmented. Nonuniform pigmentation was the most common dermoscopic feature seen in both hypopigmented lesions (n=152, 92.68%) and hyperpigmented lesions (n=14, 100%). Scales were seen in 142 hypopigmented lesions (86.56%) and 13 hyperpigmented lesions (92.86%). Patchy scaling was more common in hypopigmented lesions (n=95, 57.92%) while scaling in the furrows was more common in the dermoscopy of hyperpigmented lesions (n=5, 35.71%). Inconspicuous ridges and furrows and perilesional hyperpigmentation were other significant features seen in dermoscopy of the lesions. Conclusion: To our knowledge, this is the first study describing the dermoscopic features of PV in such a large number of patients. Description of these new features adds valuable information and may help to establish dermoscopy as an important auxiliary tool for the diagnosis of PV.

Labor and delivery, while perceived as gratifying and joyful, are nonetheless among the most painful events women can experience in life. Treating pain is nowadays one of the essential elements in assisting women during labor. Epidural analgesia is the best option to ensure the optimal control of pain for the mother without compromising the wellbeing of the fetus. The main contraindications to neuraxial analgesia techniques include patient refusal, known bleeding diathesis or abnormal coagulation tests, elevated intracranial pressure (particularly in the presence of an intracranial space occupying lesion), severe aortic or mitralic valve stenosis and infections at the puncture site [1]. There are many pathogens responsible for cutaneous infections at the dorsal-lumbar level, yeasts of the Malassetia genus being the most commonly implicated. Malassetia Globulosa is the predominant species in the Tinea Versicolor infection [2,3]. Also implicated are M. Sympodialis, M. Furfur and others as well [4]. These fungi are normal components of the cutaneous flora but the transformation from yeasts to micelia can lead to the pathology. The cause for this occurrence is still unknown, yet there are a few contributing factors leading to this infection that affects mostly adolescents and young adults; these are genetic predisposition [5], heat and humidity, immunosuppression, contraceptives, pregnancy and malnutrition. It manifests with characteristic hypo- or hyper-pigmented spots alongside the trunk, the neck, and the face. The majority of the times infection is entirely superficial but cases of meningitis and Central Nervous System (CNS) infections from hematogenous spread have been reported [6,7]. The literature supports with data that adequate antiseptic preparation of the skin effectively prevents meningitis occurrence after epidural puncture [8]; other cases are reported where a small incision of the skin allows for a safer passage of the needle directly in the subcutis without going thnrough the corneal layer.

In Rwanda, the roots of Pentas longiflora Oliv. (Rubiaceae) have been used for a long time to treat Pityriasis versicolor. However, many people reported the use of leaves instead of roots. This research was conducted to compare the phytochemical composition and establish chromatographic methods for the standardization of roots and leaves extracts of P. longiflora. During this process, three new pentalongin glycosides (pentalonginoside A, pentalonginoside B, and pentalonginoside C) and two known glycosides of the same type (harounoside and clarinoside), as well as rutin, luteolin-7-rutinoside were isolated from methanol extract of leaves. In addition, pentalongin and psychorubrin, previously isolated from ethylacetate roots extract, were also identified in Pentas longiflora ethylacetate leaves extract. The presence of the antifungal compound pentalongin in leaves may explain the traditional use of leaves in the treatment of Pytiriasis versicolor. Furthermore, harounoside, psychorubrin, and pentalongin were selected as markers for HPLC fingerprints of MeOH extract. The accuracy and risk profile demonstrated the reliability of the validated method. In general, considerable variations of concentration in plant metabolites, including pentalongin, were observed between samples from different sites. The content in pentalongin (expressed as juglone) in collected samples ranged between 1.7 and 70.0 mg/100 g. The highest concentration (70.0 ± 17 mg/100 g) was registered in the cultivated samples from Mukoni. This important variation of pentalongin concentrations according to sampling sites, shows that in order to guarantee equivalent efficacy, finished products with P. longiflora should be standardized based on their pentalongin content.

Disorders of pigmentation, both hyper- and hypopigmentation, are common entities encountered in dermatology. They can be caused by a variety of underlying systemic diseases and infections, as well as present as primary cutaneous disorders and secondary to injury or trauma. Contributing factors leading to both types of pigmentary alterations include both an effect on melanocytes and the activity and rate of melanin production. The most common disorders of hypopigmentation that will be discussed in this chapter include post-inflammatory hypopigmentation, hypopigmented mycosis fungoides, pityriasis alba, tinea versicolor, progressive macular hypomelanosis, idiopathic guttate hypomelanosis, and vitiligo. Hyperpigmentation disorders to be discussed include post-inflammatory hyperpigmentation, melasma, lichen planus pigmentosus, erythema dyschromicum perstans, and drug-induced and metabolic conditions causing hyperpigmentation.

Malassezia (M.) genus includes commensal yeasts of increasing medical importance, as they result in many diseases, ranging from pityriasis versicolor (PV) to systemic infections. Previous studies reported geographical variations in distribution of Malassezia species in PV lesions. The aims of the current study were to define the clinico-demographic features of PV in Tunisia, to characterize Malassezia isolates using phenotypic and molecular techniques and to find out any association between species and clinico-demographic parameters. In total, 120 PV patients were enrolled in this study. Skin scrapings were collected and inoculated on Sabouraud agar and modified Dixon medium. Malassezia species were identified using conventional phenotypic methods and 26 s rDNA PCR-RFLP. The highest prevalence of PV was observed among young adults' group. The most affected body areas were the back and neck. In overall, 50.8% and 35% of PV cases had pruritus and history of recurrence respectively. The overall concordance between phenotypic and molecular methods was high (80.95%). The discordant results are rather due to the presence of multiple species in a single culture than true misidentification. Using PCR-RFLP, M. furfur was the most isolated species (38.7%) followed by M. globosa (37.7%), M. restricta and M. sympodialis. No statistically significant association was noted between Malassezia spp. and clinico-demographic characteristics. Unlike many reports from temperate climate countries, M. furfur and M. globosa along together were the most frequently isolated species in Tunisian PV patients. Although phenotypic methods remain simple and cost-effective, molecular techniques are considered as fast and accurate methods for diagnosis purposes.

Background The pattern of dermatoses among underwater workers is undocumented and, hence, worth studying. The objective of the study was to document the pattern of dermatoses among underwater workers in a tropical seaside area. Methods A population-based cross-sectional study of 1 year from April 2015 among people regularly involved in underwater occupation, especially the collection of mollusks. Results Among 62 participants analyzed, the commonly noted dermatoses were scars of previous injuries, sea urchin prick reaction, onychomycosis, tinea versicolor, dermatophytosis, warts, and intertrigo. These workers stabilize their position under water by fixing elbows and knees to rocks, where they get accidentally pricked by sea urchins attached to the rocks. Hands also get pricked by sea urchins while trying to pluck mollusks from rocks, thus leading to the predominance of lesions in elbows, knees, and hands. Conclusion Documenting the pattern of dermatological diseases in any group of underwater workers has not been done previously. Along with doing that, the study also brought to light the existence of a rare disease, sea urchin prick reaction, in notable proportions among an underprivileged group. This study also detected a previously unrecorded clinical finding of a peculiar distribution pattern of lesions over the body in patients with sea urchin prick reaction. The evidence toward possible commensalism between the two species of organisms noted in this study extends its scope beyond the realms of dermatology and opens new areas for research in other branches of science also.

Fungal Infection is a hidden enemy for mammals because it is inhibiting commonly in nasal and oral mucosa, where it colonizes and starts unwanted growth and form infection. The differentiation between pathogenicity with colonization and regular colonization in upper respiratory system infection is difficult initially. Sometimes fungal infection rate becomes high due to the immune system weakening by the immunosuppressive drugs and old age because of a weak immune system unable to fight opportunistic fungi. The most common fungal infection is an endemic mycosis caused by dimorphic fungal species that are ubiquitously present in the soil and environment of particular geographic regions. Few most common fungal infections are listed Athlete’s foot is caused by a number of different fungi, including species of Trichophyton, Epidermophyton, and Microsporum, Tinea Versicolor, Onychomycosis, Tinea Capitis and Ringworm caused by Dermatophytes, Candidiasis by Candida sp.. In general, fungal skin infection is a more frequent and more recurrent pathogen that often goes hidden by the physician and persistent body. Fungal Infection becomes more serious when it occurred as a secondary infection after bacterial Infection. Frequently simple measures can prevent the hidden fungal Infection and therefore reduce the possibility of complications. This chapter presents information on mysterious diseases caused by different fungi besides some possible ways of protection and treatments.

The initial assessment of any skin disease is usually made by visual inspection of doctors and skin specialists. Further tests may be recommended such as biopsy and pathological examination for a more accurate diagnosis. With the use of skin disease identification system, the diagnosis of infected skin is readily attainable without undergoing biopsy and pathological examination. The infected skin disease image is identified using SIFT algorithms with local features and KNN classifier. The skin disease that will be identified are acne, psoriasis, eczema, rashes, hives, warts, tinea versicolor (an-an) and unknown skin disease. The system was confirmed to be efficient in identifying the aforementioned skin diseases. Identification of infected skin images is accomplished by K-Nearest Neighbors (K-NN) algorithm which shows an accuracy of 90% in functionality testing.

Pityriasis versicolor (PV) also known as tinea versicolor, which is chronic and superficial fungal skin disease caused by Malassezia yeasts. A permanent cure may difficult to achieve and this may explain the long-term nature of the disease. Consequently, a preventive treatment regimen may help to prevent the recurrence of pityriasis versicolor. Whether, the recurrence of tinea versicolor could be prevented by monthly itraconazole treatment regimen after a short course of itraconazole therapy. Open treatment followed by a randomized, single blind placebo control trial. Multi-center trial was characterized by an open, active treatment phase with itraconazole followed by a randomized placebo controlled treatment for prevention of recurrence. A total 200 patients (150 male and 50 female) were included in this study and was given 200mg itraconazole daily for 7 days (treatment phase). Patients in whom tinea versicolor was mycologically cured divided into Group A and Group B. Active open treatment was followed by preventive itraconazole treatment 200mg twice daily in Group A and placebo in Group B monthly for 6 consecutive months. The patients were diagnosed clinically and confirmed by Wood's lamp examination and KOH microscopy. Clinical improvement in 90%, negative Wood's lamp examination in 86.5% and Mycological cure in 85.5% were found at the end of open treatment. The mycological cure, 171 subjects were taken into this study for preventive treatment phase and divided into two groups- Group AGroup B. Preventive treatment was given in Group A and placebo in Group B. After the preventive treatment, the end point (After 6 months), clinical improvement, negative Wood's lamp examination and mycological cure were found in 81(90%), 76(84.4%) and 75(83.3%) in Group A and 44(55%), 41(51.3%) and 42(52.5%) in Group B respectively. In preventive treatment phase, 1 patient in Group A did not complete the study. No patient experienced any serious adverse effects. Prevention of recurrence of Pityriasis versicolor with itraconazole is as effective as treatment.

Pityriasis versicolor (PV) is a chronic superficial fungal infection. Management using azole drugs leads to drug resistance. The present study aimed to compare the clinical outcome of 0.1% adapalene gel vs 2% ketoconazole cream and their combination in PV. This randomized double-blinded study was conducted on 90 PV patients divided into three equal groups. GI was treated with topical ketoconazole 2% cream twice daily and placebo, GII was treated with topical 0.1% adapalene gel twice daily and placebo and GIII was treated with topical combination of 0.1% adapalene gel (at night) and ketoconazole 2% cream (in the morning). All patients received medications for 4 weeks. Evaluation was done at 2 and 4 weeks and included clinical assessment, laboratory assessment, and patient satisfaction. We found that after 4 weeks of treatment, all groups showed significant improvement. There was better response in GIII in terms of lower rate of positive potassium hydroxide staining, higher rate of significantly improved cases and higher rate of well-satisfied patients. However, the difference fell short of statistical significance. We concluded that a combination of adapalene gel and ketoconazole cream is very effective in treatment of PV with no or mild side effects.

Objective. The study aimed to assess the efficacy and safety of Senna alata (akapulko) plant extracts compared with topical antifungals in the treatment of superficial fungal skin infections. Methods. A systematic review and meta-analysis of randomized controlled trials that studied patients with diagnosed cutaneous tinea or dermatophytosis (excluding hair and nail), tinea versicolor, or cutaneous candidiasis, via microscopy or culture, and compared the efficacy and safety of S. alata (akapulko) extract versus topical antifungals. Two authors independently screened titles and abstracts of merged search results from electronic databases (The Cochrane Skin Group Specialized Register, CENTRAL, MEDLINE, EMBASE (January 1990 to December 2011), Health Research and Development Information Network (HERDIN), and reference lists of articles), assessed eligibility, assessed the risk of bias using the domains in the Cochrane Risk Bias tool and collected data using a pretested Data extraction form (DEF). Meta-analyses were performed when feasible. Results. We included seven RCTs in the review. There is low certainty of evidence that S. alata 50% lotion is as efficacious as sodium thiosulfate 25% lotion (RR 0.91, 95% CI, 0.79 to 1.04; 4 RCTs, n=216; p=0.15; I2=52%) and high quality evidence that S. alata cream is as efficacious as ketoconazole (RR 0.95, 95% CI, 0.82 to 1.09; 1 RCT, n=40; p=0.44) and terbinafine cream (RR 0.93, 95% CI, 0.86 to 1.01; 1 RCT, n=150; p=0.09) in mycologic cure. For adverse effects, there is very low certainty of evidence of increased harm with S. alata 50% lotion compared to sodium thiosulfate 25% lotion (RR 1.26, 95% CI, 0.46, 3.44; 2 RCTs, n=120; p=0.65; I2=19%). Adverse effects were few and mild. Conclusion. S. Alata 50% lotion may be as efficacious as sodium thiosulfate 25% lotion and is as efficacious as ketoconazole 2% and terbinafine 1% creams. There is insufficient evidence to compare the safety of S. alata 50% lotion with sodium thiosulfate 25% lotion

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.

Superficial fungal infections (SFIs) affect up to 25% of population all over the world. Although dermatophytosis is the main SFIs with worldwide distribution, tinea versicolor caused by Malassezia species and Candida-related infections are also common. SFIs have diverse etiologic agents, which differ in pathogenesis and geographic distribution with increasing rate of resistant species to current antifungal therapy. Nowadays, the conventional antifungal therapy of SFIs using current antifungals of azoles, allylamines, and griseofulvin have some drawbacks like liver toxicity, skin problem, severe headaches and sometimes recurrences and drug–drug interactions especially in patients who are under drug treatment for other diseases. The problem is more complicated in immunocompromised patients who undergone systemic immunosuppressive therapies. On the other hand, low penetration of antifungal drugs in hard tissues of nail in onychomycoses caused by the dermatophytes and Candida species in local therapies and drug resistance in emerging causative species are considered as other important limitations of current antifungal therapy against SFIs. Novel formulations of antifungals or new devices that increase the chance of the delivery of the drug into the site of the infection seem necessary in order to enhance the drug efficiency. Recently, nanotechnology has contributed into this area and proposes great opportunities for more effective treatments of SFIs. In this chapter, we highlight current status of antifungal nanotherapy using advanced nanoformulations to combat SFIs and discuss in details their application in future medicine.

Infectious processes in black skin are sometimes difficult to identify because of their varied presentations. This chapter highlights some common conditions and provides a plethora of clinical photographs to aid in identification.

A 58-year-old female with no significant past medical history presented with complain of skin pigment changes at various parts of the body for the past several months. She reported some associated itching at these sites.

Pityriasis versicolor (PV) is a superficial mycosis caused by yeast of the genus Malassezia. The most common isolated Malassezia species in PV lesions differ among M. furfur, M. globosa and M. sympodialis. We purpose to determine the distribution of Malassezia species in PV patients at the seafarers’ medical service in Dakar, Senegal and to examine whether any association between identified Malassezia species and patients’ profile. From May 2017 to August 2017, first a questionnaire was filled to get informative data before collection of skin scrapings taken from most scaly site using sterile scalpel blade and application of scotch® for direct examination (DE). At the laboratory, DE, culture and identification by MALDI-TOF MS were done. One hundred patients with PV – all men – were included with a mean age of 34 years. Among seafarers, 81% were sailors. Clinical prevalence of PV was highest in aged adults patients with ages of 31 to 60 years (56%). Seafarers with high level of education were less representative with only 2%. The mean duration of the PV was 26.83 months. 20% of subjects suffered lesions in more than one location. The chest was the most affected anatomical site. Furthermore, possible predisposing factors associated with PV were also detected. DE was positive in 95% but culture growth only in 46%. MALDI-TOF MS analysis of the positive cultures could be performed in 84.8% (39/46). Only M. furfur was identified in 100% (39/39). In definitive, M. furfur is the only causative agent of PV in Dakar.

To address the latest treatments used for pityriasis versicolor and identify those that have proven to be effective in recent publications. Even though Malassezia spp. have shown resistance to antifungals, classical treatments continue to be effective, and other novelty therapies including light therapies have shown promising results in the treatment of this condition. Pityriasis versicolor is a common superficial fungal infection of the skin. There are numerous and diverse topical and systemic therapeutic options that are successful for the treatment and prophylaxis of this mycosis. New substances that act against the fungus through other mechanisms of action different from those used until now are expected in the near future.

Background Malassezia furfur is lipodependent yeast like fungus that causes superficial mycoses such as pityriasis versicolor and dandruff. Nevertheless, there are no standard reference methods to perform susceptibility test of Malassezia species yet. Aims Therefore, in this study, we evaluated the optimized culture medium for growth of this lipophilic yeast using modified leeming-Notman agar and colorimetric resazurin microtiter assay to assess antimycotic activity of fluconazole against M. furfur. Results The result showed that these assays were more adjustable for M. furfur with reliable and reproducible MIC end-point, by confirming antimycotic activity of fluconazole with MIC of 2 μg/ml. Conclusion We conclude that this method is considered as the rapid and effective susceptibility testing of M. furfur with fluconazole antifungal activity.

Background Prevalence of skin diseases in Luanda (Angola) is unknown, and publications are barely found in the literature. We aim to describe, for the first time, the frequency of skin disease spectrum in phototype V-VI Angolan population in Luanda City. Methods We included Fitzpatrick phototype V-VI Angolan patients who consulted the Dermatology Unit in Luanda Medical Center during a 1-year period. Medical information was recovered from the electronic database, and diagnoses were based on ICD-10. Only the main complaint was registered, and the results were classified according to age and sex. Criteria exclusion consisted of incomplete clinical records, Fitzpatrick phototype I-IV Angolan, or foreign patients from the study. Results From a total of 3938 patients, 3554 met the inclusion criteria, of which 2742 were adults 13 years or older. In this group, acne (23.6%), dermatophytosis (11.0%), and pityriasis versicolor (8.6%) were the main complaints. On the other hand, in the pediatric population (n = 812), atopic dermatitis (29.4%), tinea capitis (13.7%), and molluscum contagiosum (12.5%) were the most frequent disorders. In adult females, acne (31.3%) was the main condition, while in adult males, dermatophytosis (13.5%). In children, the frequency of atopic dermatitis was comparable: 29.1% and 28.6% in girls and boys, respectively. Conclusions We published for the first time the frequency of the skin disease spectrum in Fitzpatrick phototype V-VI Angolan population in Luanda City, highlighting the prevalence of acne, dermatophytosis, and atopic dermatitis.

International audience; BACKGROUND: Malassezia species, usually part of normal human skin microbiota, may also cause cutaneous infections, mainly pityriasis versicolor (PV) which may rapidly spread in crowded communities, particularly in students' dormitories and sport leisure centers.OBJECTIVE: Few studies have been conducted on PV in students in the Middle East. The present study was designed to determine prevalence of Malassezia species and related diseases in students from city of Sabzevar, Northeast Iran.METHODS: Specimens were collected from 189students and analyzed by direct microscopy and cultures. Following PCR amplification of the large subunit of ribosomal DNA, species were identified by restriction fragment length polymorphism analysis (RFL-PCR).RESULTS: PV was suspected for 28students which was confirmed by direct examination and cultures. Cultures also revealed positive for 13students with healthy skin. Four Malassezia species were identified, with M.restricta as the most prevalent. A higher rate of PV was observed compared to other regions in Iran. However, despite the lipophilic feature of Malassezia species, no significant association was observed between PV or Malassezia species and fatty skin or gender.CONCLUSION: This study determined the frequencies of Malassezia species in part of Northeast Iran, but further studies are needed to identify risk factors for PV.

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.

A comparative evaluation of Terbinafine and Eberconazole in the management of Tinea versicolor

Background: Treatment of alopecia areata (AA) involves use of high potency topical corticosteroids under occlusion that, even very effective, can lead to several adverse effects. Objective: We report 10 cases of patients with AA that, after using high potency topical corticosteroids, have developed tinea versicolor of the neck area. Methods: Ten patients with AA, aged 18-38 years, were prescribed with clobetasone propionate 0.05% cream under occlusion every other day but, after 3-4 months of treatment, they returned to our facility complaining the appearance of multiple white or red-brown round or oval macules in the neck area. Results: Diagnosis of pityriasis versicolor was confirmed by direct microscopy examination of skin scrapings in 10% potassion hydroxide (KOH) solution. All patients received systemic antifungal therapy associated with the daily use of ketoconazole shampoo. Conclusion: Tinea versicolor of the neck should be included among a rare but possible side effect of prolonged application of high potency topical steroids on the scalp. These cases reinforce the importance of careful dermatologic examination and recommend preventive measures in patients with alopecia areata that are using these drugs.

The increasing incidence of fungal infections and antifungal resistance has prompted the search for novel antifungal drugs and alternative agents. We explored the antifungal activity of Myrtus communis essential oil (EO) against Malassezia sp. isolated from the skin of patients with pityriasis versicolor. These broad-spectrum antimicrobial activities of M. communis EO and its potent inhibiting activity on Malassezia growth deserve further research with aim to considerate this EO as candidate for topical use in treatment of skin diseases.