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The integrated approach is the new recommendation of the World Health Organization (WHO) for the control of neglected tropical diseases. The goal of this cross-sectional study was to implement this approach in 4 municipalities with a high prevalence of leprosy in Benin from September 2019 to August 2020. Mobile medical consultations were organized in these municipalities following the mobilization and sensitization of the populations. In the 4 municipalities, 6416 people were examined. The mean age was (27.3 ±19.8) years. Women represented 52.7% of people examined. Among the 6416 people examined, 1230 (19.2%) had skin conditions. The most common skin conditions were pityriasis versicolor (421 cases; 34.2%); eczema (203 cases; 16.5%); ringworm (159 cases; 12.9%); pruritus sine materia (81 cases; 6.6%); acne (62 cases; 5.0%); epidermophytia (37 cases; 3.0%); achromic nevus (35 cases; 2.8%); keloids (28 cases; 2.3%); chronic ulcers (27 cases; 2.2%) and depigmentation stigmata (24 cases; 2.0%). 8 new leprosy cases (0.7%) were detected. This study proves the efficiency of the integrated approach in the control of neglected tropical diseases (NTDs) with cutaneous manifestations in Benin. Key words: Neglected tropical disease, leprosy, skin disease, integration, disease control, Benin.

Primary cutaneous T-cell lymphomas NOS (CTCL not otherwise specified) involve a heterogeneous group of neoplasms that affect the skin, with no evidence of extracutaneous involvement at the time of diagnosis. The association with hemophagocytic lymphohistiocytosis (HLH) syndrome has been documented. They are rare in children, and usually are characterized by a dismal prognosis. We report an unusual case of a pediatric patient diagnosed as acute pityriasis lichenoide et varioliformis (PLEVA), with a torpid clinical course, association with HLH and a subsequent diagnosis of double negative (CD4/CD8) primary CTCL, with expression of cytotoxic molecules.

Background-Superficial Mycosis, which is the most common fungal infection affecting human beings, includes Dermatophytosis and Dermatomycoses, which are the infections of superficial keratinized layer of skin, nail & hair by Dermatophytes and non Dermatophytic moulds or yeasts respectively. This clinical entity is very common in hot, humid tropical climate of India with prevalence ranging from 30-60% but its precise case magnitude and epidemiology in North eastern India cannot be stated as there are only few studies conducted. So, this study is undertaken to 1) Find the prevalence of Superficial Mycosis in a tertiary health care centre of Southern Assam. 2) Study the clinical profile of the cases 3) Isolate and identify the causative agents of Superficial mycosis. Materials & Method- The study has been conducted on 250 samples from clinically suspected and untreated cases of superficial mycosis from Aug 2017 to Dec 2018. 2 separate sets of samples from edge of skin lesion/nail /hair were collected, of which 1 sample was subjected to direct microscopy with (10-40) % KOH and the other part was subjected to 2 sets of fungal culture in SDA tubes at 25°C and 37°C & followed for 3 weeks. In Culture positive cases, fungal identification was based on colony morphology, pigment production & LPCB mount. For confirmation of isolates, Slide Culture and biochemical tests were done. Result-Out of total 250 samples,115 samples (46%) showed presence of fungal elements in KOH examination, of which 73 were culture positive and of the KOH negative samples 10 samples were culture positive, thus making the prevalence 33.2% (83/250). Clinically, Tinea corporis was the most common form of both superficial mycosis & Dermatophytosis and Pityriasis Versicolor has been found the most common Dermatomycosis. Males(21-50yrs) were affected by superficial mycosis more than Females(16-30yr). Trichophyton mentagrophyte was the mostly isolated agent causing superficial mycosis. Keywords: Superficial mycoses, prevalence, Assam, Slide Culture, Urease.

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

Background Dermatologic toxicity is a very common immune-related adverse event (irAE) for patients with melanoma who are receiving immune checkpoint inhibitor therapy (ICI). Concurrent skin infection, such as in the case of pityriasis versicolor reported here, can mimic and/or exacerbate dermatologic toxicity from irAE. Case presentation A 58-year-old Caucasian man with a history of pityriasis versicolor infection and metastatic melanoma received ICI therapy. He developed progressively worsening pruritic maculopapular lesions 22 weeks into his treatment that ultimately covered 40% of his body. He was diagnosed with dermatologic toxicity due to ICI therapy with concurrent pityriasis versicolor. He was initially started on topical steroid and topical antifungal cream but achieved minimum improvement. His treatment was then escalated to oral prednisone, but it only achieved modest control of his dermatitis. All subsequent attempts to wean him from oral prednisone resulted in worsening of his dermatitis. Eventually he was started on oral fluconazole in combination with prednisone, which led to rapid resolution of his dermatitis. Conclusion We report a case of dermatological toxicity due to an irAE with concurrent pityriasis versicolor. The steroid treatment for irAE was likely exacerbating the underlying fungal infection, and the fungal infection was in term mimicking the symptoms of irAE. This patient’s severe dermatitis was only brought under control after receiving a more potent antifungal therapy in combination with a steroid. It is vital to look beyond the irAE when managing dermatitis in patients receiving ICI therapy.

Pityriasis lichenoides is a rare cutaneous disease that exists along a spectrum with acute and chronic features. The acute form, pityriasis lichenoides et varioliformis acuta (PLEVA), presents as a sudden onset scaly, erythematous, pruritic eruption while the chronic form, pityriasis lichenoides chronica, presents similarly but with a more indolent course. This inflammatory condition can have numerous triggers, including infections and medications. However, checkpoint inhibitors, despite being associated with a wide variety of cutaneous adverse events, have only rarely been associated with a pityriasis lichenoides-like eruption. We report a case of drug-induced pityriasis lichenoides-like eruption secondary to checkpoint inhibitor atezolizumab that was successfully treated with narrowband ultraviolet B (NBUVB) light. To our knowledge, this is the first case of an immune checkpoint inhibitor induced pityriasis lichenoides which responded well to NBUVB.

Objective: To compare the efficacy of oral fluconazole and oral itraconazole in the treatment of Pityriasisversicolor. Study Design: Comparative prospective study. Methodology: Total 72 patients of both genders with Pityriasis versicolor were included. Patients were randomly allocated into two treatment groups with 36 patients in each group: group A and group B by lottery method. Patients in group A received Cap Fluconazole 150 mg bi- weekly for two consecutive weeks while those in group B received two doses of 400 mg of itraconazole once weekly for two weeks. Patients were asked to follow-up after 4 weeks skin scrapings for microscopy using 10% KOH mount was done at follow-up. Efficacy was assessed in terms of negative fungal hyphae on microscopy. Results: In this study, age ranged from 18 to 40 years with mean age of 33.52 ± 4.12 years in group A, whereas35.055 ± 4.18 years in group B. Mean duration of disease was 4.66 ± 1.51 months in group A and 5.27 ± 1.70months in group B. Efficacy was seen in 77.8% of group A patients as compared to 50% in group B patients(p=0.014). Conclusion: Oral Fluconazole two doses of 150 mg/week (total 300mg/week) for two consecutive weeks wasfound more effective than oral itraconazole.

Pityriasis versicolor (PV) is an infection on epidermal layer of skin and the common caused by a type of yeast that live on the skin named Malassezia furfur. The increasing of fungal resistant against antifungal and high reccurence rate after cured in 2 years about 80%, requires alternative treatment that come from plants. Cengkodok leaves (Melastoma malabathricum) is used conventionally as an alternative medicine. Cengkodok leaf produces secondary metabolites which have antifungal activity . The aim of this study was to investigate the antifungal activity of ethanolic extract Melastoma malabathricum leaves (EEMML). Phytochemical screening of EEMML were performed using Thin Layer Chromatography (TLC). Melastoma malabathricum leaves were extracted with maceration method using 96% ethanol. The testing of antifungal activity was determined using disc-diffusion method with the concentration of 5; 20; 50; 100; 250; 500 ppm. Ketoconazole 10 ug/disc and Itraconazole 8ug/disc was used as positive control while negative control used 10% dimethyl sulfoxide (DMSO). EEMML didn’t showed zone of inhibition against Malassezia furfur although 100% concentration extract used. EEMML have no antifungal activity against Malassezia furfur

This study included isolation and identification of Malassezia spp. from patients of Pityriasis Versicolor (PV) diagnosis by the dermatological consultant at Al-Diwaniyah Teaching Hospital for the period from 1/10/2019 to 5/3/2020, and detection of the virulence enzymes of these species and their sensitivity to some antifungal agents. 87 specimens were collected (38 females 43.7%, and 49 males 56.3%). 73 specimens (84%) were positive while 14 specimens (16%) were negative to direct and indirect examination. The results of isolation and identification of Malassezia spp. based on direct examination of specimens with KOH10%, indirect methods of growing specimens on SDA medium, and biochemical tests showed that the most occurrence isolates is M. furfur with 30 isolates (34.4%) followed by M. globosa with 22 isolates (25.2%), then M. slooffiae with 16 isolates (18.3%), and M. pachydermatis with 5 isolates (5.7%), while 14 specimens (16.0%) that did not give positive growth. The results also showed the ability of some species to produce protease enzyme, the rates of transparent halo diameters around the colonies on the skimmed milk medium ranged from (9.66-11.66) mm, and M. pachydermatis showed the highest ability to produce lipase enzyme with a precipitation diameter (24 mm), followed by M. furfur (20.33 mm), M. globosa (15 mm), then M. slooffiae (13.3 mm), also M. pachydermatis showed the highest ability to produce hemolysin enzyme with a degradation zone diameter. (18.33 mm), followed by M. furfur (17.33 mm), M. slooffiae (13 mm), and M. globosa (11 mm). The antifungal sensitivity of Malassezia spp. was tested using eight tablet, the results showed that the Ketoconazole is the most effective in inhibiting the growth of the fungal species compared to other antifungals agents, as the average diameter of the inhibition zone was (46.66 mm) for M. globosa, which is the highest rate of inhibition compared with other species, followed by M. furfur (45.33 mm), M. slooffiae (43.66 mm), M. pachydermatis (38.66 mm), followed by the antifungal Fluconazole with an inhibition diameter (35.66 mm) for M. furfur, followed by M. slooffiae (33.33 mm), M. pachydermatis (33 mm) and M. globosa (20 mm), while Nystatin showed no effect on the growth of Malassezia spp.

Introduction: Indian continent has remarkable topographical variation between tropical and subtropical regions of the world. For this reasons, superficial mycoses is common in our country. There are other predisposing factors, like socioeconomic condition, overcrowded, poor hygiene, and contact with animal, and in the absence of proper medical care skin mycoses spread epidemically. In addition to its epidemic nature, the spectrum of dermatophytosis is also not static. Konaseema region is costal part of Andhra Pradesh, and no such study has been conducted in this region, so present study has been designed to study the clinical pattern of superficial mycoses among the patients who are attending outpatient department of Dermatology, venereology and leprosy and also to study the variations of species causing different morphological forms of superficial mycoses. Materials and Methods: Present study is a randomized cross sectional prospective study conducted in the dermatology, venereology and leprology department Konaseema institute of medical sciences Amalapuram from February 2016 to May 2018.The study population include 1200 patients diagnosed clinically having superficial mycoses randomly selected for this study based on exclusion and inclusion criteria. Result: Out of 1200 patients 786 (65.5%) were diagnosed as dermatophytosis 146 (12.1%) patients were diagnosed as pityriasis versicolor, 224 (18.666%) patients were diagnosed to be candidiasis and 44 (3.66%) patients were having tinea nigra. Out of 786 dermatophytes, 320 (49.10%) were clinically diagnosed as T. Cruris, 240 (30.53%) patients were clinically diagnosed as tinea. corporis, 104 patients (13.23%) were diagnosed as tinea Unguium, tinea mannum patients were 44 in number (5.59%), T capitis patients were 26, (3.3%). 20 patients that is 2.5% were diagnosed to be tinea. Barbae and 12 (1.5%) patients were diagnosed to be tinea. Faciei 2.5% patients were diagnosed to have tinea pedis. Discussion and Conclusion: We

Introduction: Malassezia are normal resident flora in humans and are opportunistic in nature. Superficial infections caused by Malassezia include pityriasis versicolor, pityriasis capitis (dandruff), seborrheic dermatitis and folliculitis. Though the manifestations due to Malassezia are trivial, chronicity and recurrence of lesions are associated with social embarrassment and decreased self-esteem. Aims and Objectives: The primary aim of the study was to detect the prevalence of Malassezia among superficial skin and scalp lesions. It also aims to compare Wood’s lamp examination, KOH mount examination and culture for the diagnosis of Malassezia and study the percentage of various species of Malassezia responsible for superficial infections of skin and scalp. Materials and Methods: One hundred samples collected from patients attending the Dermatology outpatient room with superficial infections of skin and scalp. Patients attending Dermatology outpatient room with complaints of hypopigmented / hyperpigmented / erythematous, scaly skin patches and patients attending Dermatology OP with complaints of itchy / non itchy scaly flakes of scalp (dandruff) were included in the study. Results: Among the 100 samples, 77% were Wood’s lamp positive, 64% were KOH positive and 59% yielded growth of Malassezia in culture. Overall prevalence of Malassezia in our study was 59%. In our study, M. globosa was the commonest species (57.62%) followed by M. furfur and M. sympodialis. Conclusion: Prevalence of Malassezia was 59% in our study. Wood’s lamp examination and KOH mount showed more positivity than culture. M. globosa was the most common species in the study. Wood’s lamp and KOH mount can be used for diagnosis of Malassezia in resource poor settings. But culture and speciation should be performed wherever possible to avoid treatment failure and recurrences. Keywords: Culture, Malassezia, Potassium hydroxide mount, Skin scrapings, Wood’s lamp.

Background The impact of Malassezia yeasts on skin mycobiome and health has received considerable attention recently. Pityriasis versicolor (PV), a common dermatosis caused by Malassezia genus worldwide, is a manifestation of dysbiosis. PV can be associated with hyper- and/or hypopigmented skin lesions. This disease entity is characterized by high percentage of relapses, which demands a proper antifungal therapy that is based on unambiguous species identification and drug susceptibility testing. Case presentation Comprehensive analysis of PV case in man presenting simultaneously hyper- and hypopigmented skin lesions was performed. Conventional and molecular diagnostic procedures revealed Malassezia furfur and Malassezia sympodialis, respectively as etiological agents of skin lesions observed. Susceptibility tests showed significantly lowered sensitivity of M. furfur cells to fluconazole. Based on susceptibility profiles local antifungal therapy with drugs characterized by entirely different mechanism of action was included. Conclusions Our study indicates that cases of PV represented by two types of skin lesions in one patient may be associated with distinct Malassezia species. Moreover, as observed in this case, each of the isolated etiological agents of PV may differ significantly in susceptibility to antifungals. This can significantly complicate the treatment of dermatosis, which by definition is associated with a significant percentage of relapses. In the presented case localized topical treatment was sufficient and successful while allowing maintaining the physiological mycobiome.

Background and Purpose: Malassezia yeasts are lipophilic normal flora of the skin in humans and other warm-blooded vertebrates. This genus includes 18 species and is responsible for dermatological disorders, such as pityriasis versicolor, atopic dermatitis, seborrheic dermatitis, folliculitis, and dandruff. The aim of the present study was to identify the etiologic agents of Malassezia infections among the patients referring to the Referral Dermatology Clinic of Al-Zahra Hospital, Isfahan, Iran, during 2018-2019. Materials and Methods: For the purpose of the study, clinical specimens, including skin scrapings and dandruff, were collected and subjected to direct microscopy, culture, and polymerase chain reaction (PCR) sequencing. Direct PCR was performed on the clinical samples to amplify the D1/D2 region of 26S rDNA, using specific primers; subsequently, the amplicons were sent for sequencing. Results: This study was conducted on 120 patients with suspected pityriasis versicolor and seborrheic dermatitis, who referred to the Referral Dermatology Clinic of Al-Zahra Hospital, Isfahan, Iran, during 2018-2019. Out of this population, 50 (41.7%), 26 (52%), and 24 (48%) cases had Malassezia infection, pityriasis versicolor, and seborrheic dermatitis, respectively. Malassezia globosa was found to be the most prevalent species (n=29, 58%), followed by M. restricta (n=20, 40%), and M. arunalokei (n=1, 2%). Conclusion: The epidemiologic study was indicative of the frequency of some Malassezia species, such as M. globosa and M. restricta, in Isfahan, Iran. It can be concluded that direct PCR on clinical samples could be used as a simple, precise, effective, fast, and affordable method for research and even routine medical mycology laboratory studies.

Tinea versicolor is a common superficial fungal infection of the skin, prevalent in the hot and humid environment of India. It is caused by the Malassezia species which is a dimorphic, lipophilic fungus most frequently affecting the seborrheic areas of the body like face, neck, upper back and chest. Normally 10- 15% of the general practitioner’s encounter skin disorders in their day to day practice with overall prevalence rate of 30% or more probably occurring in tropical zones. Kustha a type of skin disorder mentioned in Ayurveda is a Tridoshaja Vyadhi, where Twaka, Rakta, Mamsa and Ambu are the main Dushyas. According to Charaka, Sidhma is a Kapha Vata Pradhan Vyadhi and According to Sushruta, Sidhma is Kapha Pradhan vyadhi. Management of sidhma includes Shodhana, Shamana and Bahirparimarjana Chikitsa among them Shamana in the form of kwatha & Bahirparimarjana Chikitsa as Lepa has shown appreciable result in many previous researches. So, need of time is to go for cost effective, safe and efficient treatment of Sidhma. Although, there are many drugs available in modern medical science for the treatment of Pityriasis versicolor which is found to be effective but is unsatisfactory for long term prophylaxis, so there is need of the hour to look into the safe, efficient & satisfactory remedy which not only treat the above ailments, but also ensure reduction in the episodes of relapse of the disease. Keeping all the above points in mind Edagajadi yoga & Gandhapashanadi lepa has been selected to know its efficacy in treating Sidhma kushtha (Pityriasis versicolor). Edagajadi yoga & Gandhapashanadi lepa consists of 10 drugs with different properties which includes Edagaja, Vidanga, Haridra, Daruharidra, Amlatasa, Kushta, Pippali, Gandhak, yavkshar, sarshapa taila. Keywords: Sidhma, Pityriasis versicolor, Edagajadi yoga, Gandhapashanadi lepa

Background: Malassezia though known for its cutaneous infections can potentially cause invasion. The skin infections caused by Malassezia have poor patient compliance due to its chronicity and recurrent nature of the disease. There is also a lack of standardised antifungal susceptibility profile for Malassezia due to its complex growth requirement. Objective: This study was performed to understand the epidemiological pattern of disease and to study the antifungal susceptibility testing (AFST) profile so as to choose the appropriate drug/drugs to treat the infections caused by Malassezia. Materials and Methods: Samples were collected and processed, species were identified by conventional method and AFST was done by broth microdilution method. Results: The epidemiological pattern showed adolescent females commonly affected in torso. The most common lesion was pityriasis versicolor. The systemic antifungal of choice was itraconazole with the lowest minimum inhibitory concentration (MIC) of 0.125–1 μg/ml. The best topical drug with the lowest MIC value was clotrimazole 0.03–0.5 μg/ml. Conclusion: AFST is important as it will help the dermatologist to choose the appropriate antifungal agents for the patient and thereby reduce the chronicity of the disease with good patient compliance