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Hypopigmentation may be a clinical presentation of infectious and parasitic diseases, including pityriasis versicolor, leprosy, onchocerciasis, endemic treponematoses, and syphilis. A presentation of these diseases with an emphasis on skin manifestations is discussed.

Pityriasis versicolor (PV) is a chronic skin disease caused by virulence activities of Malassezia, a genus of skin-associated yeasts. Traditionally, Tioconazole is used as a topical antifungal for curing PV. Previous investigations cited that human amniotic membrane (HAM), a placental tissue, has antimicrobial and anti-inflammatory activities and is useful as a dressing for healing skin lesions. Moreover, tea tree oil (TTO) has a potent antifungal efficacy. This clinical trial aims to achieve an alternative therapeutic treatment able to kill Malassezia and heal PV lesions using TTO-saturated HAM (TOSHAM), with little application times. This study subjected 120 patients with hypopigmented or hyperpigmented PV lesions; half patients were treated weekly with TOSHAM compared with the others who applying 1% Tioconazole cream daily as a traditional treatment. Microbiological evaluation of in vitro fungicidal activity of TOSHAM versus Tioconazole was carried out against Malassezia furfur culture. The clinical outcomes of this study proved the superior activity of TOSHAM to heal PV lesions than Tioconazole; this was in harmony with microbiological findings. This study approached a novel therapeutic treatment of PV with great outcomes by using TOSHAM.

Objective: Identify perspiration, skin pH, and clinical features in patients with pityriasis versicolor in conditions of torrid climate. Methods: In the period of 2008-2011 years, there were 110 patients examined with the diagnoses of pityriasis versicolor (Pityrosporum) in the local clinical hospital No. 1, in Dushanbe.They were 63.6% men (70 persons), and 36.4% – of them women (40 persons), which part of them were rural residents 53.6%, and others were urban residents – 46.4%. The highest number of cases of diseases has mentioned with people in the age of 17 to 35 years (80.9%). Control group comprised to 30 healthy persons. The diagnosis of pityriasis versicolor was determined based on positive Besnier’s symptoms, Balzer tests, yellowish-brown fluorescence at Wood’s light, as well as revealing of a typical microscopic picture of “spaghetti and meatballs”. Colorimetric method was used to determine the skin pH. For quality assessment of perspiration intensity in patients with pityriasis versicolor was used perspiration indicator IIP-01. Results: Erythematic-squamosal form was the most frequent recorded forms (73.7%) among the 9 clinical types. The expanded version of the pityriasis versicolor with typical localization of the affected areas made 80.9%, hyperpigmental form prevailed over hypopigmental form. Rare atypical forms of the disease (white spot type, erythrasmoid, urticarioid, lichenoid, ring-shaped, obliterated) were recorded in 11.8% of cases. 20.9% of patients had atypical localization of the pathological disease process on the face skin, axillary cavities, inframammary crease, inguinal fold, clunis, genitals, poples, dorslims of hands. In comparison with healthy persons which indicates perspiration and pH indicators 51.8 mA±0,46 and 5,33±0,004, patients with pityriasis versicolor had higher perspiration and pH in all tested areas and made the average of 60.1 мА±0,2 and 6,23±0,003 accordingly. Conclusion: Pityriasis versicolor is clinically polymorphyc. Along with the frequent forms, there are atypical forms with unusual localization of the disease process that may lead to diagnostic errors. Increased perspiration in torrid seasons causes to shift the skin pH in terms of alkaline content, and creates favorable environment for dissemination of Malassezia furfur. Keywords: Pityriasis versicolor, perspiration, pH, clinical development, atypical form.

Background: Hypopigmentory and depigmented lesions are common among children and adolescent group. The parents are very much concerned about the condition and they seek dermatologist advice without fail. Aims and Objectives: To evaluate the Epidemiology and clinical characteristics of Hypopigmented and Depigmented Lesion in patients of Children and Adolescent age group in Hadoti region in Rajasthan. Materials and Methods: The study was conducted for the period one year from April 2015 to March 2016. This planned study is to be undertaken in children age 0-19 yr with hypopigmented and depigmented lesions irrespective of sex. Results: The most common disorder was Pityriasis alba, seen in 27.33%, followed by Pityriasis versicolor in 21%, Vitiligo 19.33%, Post inflammatory hypopigmentation in 14%, Primary disorders of hypopigmentation in 13%, Hansen's disease in 1.33%, and miscellaneous conditions in 4% of the cases. Conclusion: The most common hypopigmentary disorders are seen in our study is Pityriasis alba and other causes of hypopigmentary and depigmentory disorders are in decreasing order are Pityriasis versicolor, Vitiligo, Postinflammatory hypopigmentation, Primary causes of hypopigmentation and less common are Leprosy.

1 Assistant Professor, Dept. of Microbiology, D Y Patil University School of Medicine, Nerul 2 Professor & H.O.D., Dept. of Microbiology, D Y Patil University School of Medicine, Nerul 3 Assistant Professor, Dept. of Microbiology, D Y Patil University School of Medicine, Nerul 4 Senior resident, Dept. of Microbiology, D Y Patil University School of Medicine, Nerul Corresponding Author Dr N. Kamath 601, Aston Tower, Plot No.9B, Sector 20.Kharghar, Navi Mumbai, 410210 Email: nktallur@gmail.com Abstract Pityriasis versicolor is a common skin infection all over the world caused by Malassezia furfur. 10% KOH mount is done for all clinically suspected Tinea versicolor by taking skin scrapings. 10% KOH has shown 66.66 % positives in this study. When we add 1% Chicago Blue 6B stain it enhances the results to 93.33 % which is as good as the Gold standard that is culture on SDA with a overlay of sterile Olive Oil. Culture has shown 96.66% positivity as Malassezia furfur grows well when there is oil overlay. So 1% Chicago Blue 6B stain can be routinely incorporated in Mycology laboratories and also in Skin clinics as the procedure is simple, rapid, reliable and can be identified with a good contrast and specificity/sesitivity is as good as culture. 1% Chicago Blue 6B is more efficacious than usual 10% KOH mount in diagnosing superficial fungal infections caused by Malassezia furfur.

Pityriasis versicolor (PV) is caused by the fungus Malassezia, especially by Malassezia globosa. The predisposing factors for PV are heat, humidity, hyperhidrosis, oral contraceptives, stress, application of oily preparations, and treatment with corticosteroids. PV is found mainly on the seborrheic areas of the trunk, shoulders, upper aspects of the arms, and neck, but it may spread to the face, scalp, submammary areas, axillae, groin, skin folds, and buttocks. It is characterized by hyperpigmented, hypopigmented, or erythematous (versicolor), round-to-oval, finely scaling, thin plaques. Other less frequent clinical variants are papular, atrophic, imbricata, and pityriasis rubra pilaris-like presentations. The diagnosis of PV is usually made clinically with the aid of Wood’s light or dermoscopy. Direct microscopic examination, culture, biopsy, and molecular studies are among the laboratory diagnostic methods. Topical therapy is the treatment of choice for most patients. Systemic imidazole therapy is usually reserved for widespread or resistant cases.

BACKGROUND Pityriasis Versicolor is a superficial infection of the stratum corneum which is caused by a group of yeasts called Malassezia. OBJECTIVES To isolate and identify the causative fungi from clinically suspected cases of Pityriasis Versicolor by 10% KOH and to compare the results of 10% KOH with culture. METHODS 100 clinically diagnosed cases of Pityriasis Versicolor of all age groups and both sexes, attending the Outpatient Department of Dermatology at Bapuji Hospital and Chitageri Hospital were included in this study. Skin scrapings from lesions of all cases were subjected to 10% KOH examination and culture. A control group of 50 healthy individuals was studied to know the normal fungal flora of the skin. Differentiation of all Malassezia species performed using morphological features and physiological tests including catalase reaction, Tween assimilation test and splitting of esculin. RESULTS Out of 100 clinically diagnosed Pityriasis Versicolor cases, 97(97%) cases showed characteristic arrangement of fungal elements in 10% KOH preparation and culture was positive in 68 cases. The most frequently isolated species was M. globosa (54.41%), followed by M. furfur (25%), M. sympodialis (11.76%) and M. obtusa (8.82%). In control group, M. globosa was the common isolate. CONCLUSION In comparison with culture results, the sensitivity and specificity of 10% KOH is 100% and 9.37% respectively. It does not require highly skilled personnel to perform or interpret results. The only disadvantage of KOH examination is that the Malassezia species cannot be differentiated. Culture is the gold standard, but it is time consuming and requires considerable expertise. Therefore, 10% KOH examination is a rapid, simple, sensitive and effective diagnostic test for Pityriasis Versicolor. M. globosa was the most common isolated species followed by M. furfur, M. sympodialis and M. obtusa

Context: Diagnosis of superficial mycoses in clinically doubtful cases relies on demonstration of fungal elements on a 10% potassium hydroxide (KOH) slide mount which takes 30 min to 2 h. Rapid results will lead to reduced time to diagnosis. Aims: A comparative study of conventional 10% KOH wet mount against the cellophane strip method without a mounting medium under bright-field and phase-contrast microscopy was aimed to determine the comparative efficacy of these methods in demonstrating fungal elements of superficial mycoses. Settings and Design: The study was conducted at a skin center of a tertiary care hospital between November 2019 and January 2020. Material and Methods: One hundred and fifty consecutive clinically suspect cases of superficial cutaneous mycoses were examined. Skin scrapings for 10% KOH were collected with a blunt scalpel on one slide and examined half hour later. A cellophane strip collection of squames stuck onto another slide and examined directly by bright-field and phase-contrast microscopy. Statistical Analysis Used: Descriptive and inferential statistical analysis was carried out in the present study using SPSS 22.0, and R environment version 3.2.2 was used for the analysis of the data. Chi-square/Fisher’s exact test was used to find the significance of study parameters on categorical scale between two or more groups, nonparametric setting for qualitative data analysis. Fisher’s exact test was used when samples were very small. Results: The mean percentage positivity for fungal hyphae as seen on KOH mount was 76%, for cellophane tape 97.33%, and under phase-contrast microscopy 97.33%. Pityriasis versicolor was detected by all three methods (100%). Tinea corporis had the least positive result on KOH mount. Conclusion: Cellophane strip method without a mounting medium adequately demonstrates fungal elements on light microscopy.

Background: Papulosquamous skin disorder is a group of heterogenous dermatoses with a distinct histomorphological feature. The characteristic primary lesion is a papule, usually erythematous, that has a variable amount of scaling on the surface. The most common papulosquamous dermatoses are psoriasis, lichen planus, and pityriasis rosea. Because all papulosquamous disorders are characterized by scaling papules, clinical confusion may result during their diagnosis. Our study is to evaluate histomorphological findings in various papulosquamous skin disorders encountered at RIMS, Imphal. Materials and Methods: Skin biopsies of clinically diagnosed papulosquamous skin disorders along with their relevant clinical data received during a period of 2 years from September 2017 to August 2019 were included in the study. The diagnosis was confirmed by histopathological examination using hematoxylin and eosin stain. Results: A total of 115 papulosquamous skin disorders were studied with 75 cases of psoriasis (11–80 years), 36 cases of lichen planus (2–70 years), and 4 cases of pityriasis rosea. Age ranges from 2 to 80 years. Maximum cases were seen in the age group of 31–50 (70.6%) with a mean age of 39.18 years. Both genders were almost equally affected with a male: female ratio of 1.13:1. An analysis of the clinical with histopathological diagnosis of these papulosquamous skin lesions revealed a positive correlation in 76 (66.08%) cases and a negative correlation in 39 (2.9%) cases. Conclusion: Because of the varied clinical presentation and histopathological patterns of papulosquamous skin disorder, it is important to characterize the types of papulosquamous lesions as far as possible for definitive treatment.

Pityriasis rosea is a common, self-limited and inflammatory skin disease. The etiology is not clearly known. Viral agents, autoimmunity, psychogenic factors and drugs have all been suggested as risk factors. Isotretinoin is usually used in the treatment of resistant, nodulocytic acne. We present a case of pityriasis rosea-like eruption induced by isotretinoin. To our knowledge, this is the second clinical case of pityriasis rosea-like eruption induced by isotretinoin.

Pityriasis versicolor is a superficial mycosis affecting the skin. It is caused by malassezia species of fungi. Common sites of involvement are chest, neck and shoulders. We report a rare case of pityriasis versicolor affecting both arms and dorsum of both hands but sparing the commonly involved sites and masquerading vitiligo.

Cutaneous manifestations observed in COVID-19 include maculopapular rash, urticaria, pseudo chilblain, vesicles, livedo reticularis, petechiae, erythema multiforme-like, symmetric drug related intertriginous and flexural exanthem (SDRIFE)-like and pityriasis rosea-like lesions. Maculopapular rash involving the trunk and sparing palms and soles is the most common cutaneous manifestation reported in COVID-19 patients. We report cutaneous manifestations in six COVID-19 patients from the corona isolation ward and intensive care unit of a tertiary care center for COVID-19 management in Kerala, South India. The skin lesions observed were urticaria (two patients), atypical maculopapular rash with urticarial and erythema multiforme-like lesions, eruptive pseudoangiomatosis, exaggerated insect bite reaction and acute localized exanthematous pustulosis (ALEP)-like lesions. To the best of our knowledge atypical maculopapular rash with urticarial and erythema multiforme-like lesions, eruptive pseudoangiomatosis and acute localized exanthematous pustulosis-like lesions are not reported in COVID-19.

Background and objectives: Pytiriasis alba (PA) is a common skin disorder which affects 80% of children between six and 16 years. The etiology of PA is unclear, but hypo-pigmented patches in photo-exposed zones characterize the disease. Because the high ultraviolet exposition of the skin promotes an acute inflammatory response and an increase of oxidative stress (OS), this study aimed to evaluate the expression levels of inflammatory and OS-related genes in skin biopsies, and their association with PA. Materials and Methods: A cross-sectional study was carried out. Skin biopsies of the lesion sites and healthy skin (controls) from 16 children with PA were evaluated. The tissue expression of IL-4, IL-6, IL-17A, TNF&alpha, INF&gamma, IL-1&beta, SOD1, and HMOX1 was analyzed by qRT-PCR, using SYBR Green and glyceraldehyde-3-phosphate dehydrogenase gene as the endogenous control. Results: There were differences in the &Delta, Cq values of HMOX1, SOD1, IL-6, and IFN&gamma, between tissue with lesions and healthy skin (p &lt, 0.05). Compared with healthy skin, IL-6, IFN&gamma, HMOX1, and SOD1 were predominantly under-expressed in the lesion sites. However, 25% of skin biopsies with lesions showed over-expression of these four genes. Positive correlations between the expression of IL-6 and HMOX1, SOD1, and IFN&gamma, (p &lt, 0.05) were also observed. Conclusions: Our results suggest the presence of molecular stages of PA, defined according to the over-expression (first stage) or under-expression (second stage) of the HMOX1, SOD1, IL-6, and IFN&gamma, genes in abnormal skin tissue. These findings may have implications for the selection of treatment for PA-related lesions.

The human pathogenic yeast genus Malassezia may be an etiological agent of skin disorders and has received considerable attention from dermatologists in recent years. To investigate the different susceptibilities of Malassezia species to four antifungal drugs, we isolated a total of 244 Malassezia strains and identified six species of Malassezia from patients with clinical skin diseases. The minimum inhibitory concentration (MIC) of the four antifungal drugs was obtained by comparing the susceptibility of the isolated Malassezia strains to four antifungal drugs (ketoconazole (KTZ), itraconazole (ITZ), fluconazole (FLC) and amphotericin B (Am B)). We demonstrated that M. furfur, M. sympodialis, M. pachydermatis and M. globosa are the most common Malassezia species in the three skin diseases. The MICs of KTZ, ITZ, FLC and Am B against M. furfur, M. sympodialis, M. pachydermatis and M. globosa ranged from 0.03 - 16 mg/L, 0.03 - 2.0 mg/L, 0.03 - 8 mg/L, and 13 - 64 mg/L, respectively. The sensitivities of Malassezia to the four antifungal drugs from high to low were ITZ ≥ KTZ > Am B > FLC. The susceptibilities of the various Malassezia species to the four antifungal drugs were different, and the susceptibility of M. furfur to KTZ was significantly different from those of the three skin diseases (pityriasis versicolor, Malassezia folliculitis and seborrheic dermatitis). Our results suggested that the MIC analysis of the four antifungal drugs would be helpful in preventing drug resistance in the clinical screening of Malassezia and choosing better antifungal drugs to treat Malassezia-associated skin diseases.

Background. Oral azole drugs are a second-line option for the treatment of pityriasis versicolor but evidence on their efficacy and safety is unclear. Objectives. To determine the efficacy and safety of oral azoles in the treatment of patients with pityriasis versicolor. Methods: We searched MEDLINE, CENTRAL, EMBASE, LILACS, and HERDIN, from inception to the period between January to February 2014. We did not restrict the search by language or publication status.We included randomized controlled trials (RCTs) that compared the efficacy of oral azoles with placebo or no treatment, with topical agents, other oral azoles or dosing regimens in the treatment of pityriasis versicolor, and that measured any of the pre-specified outcomes (mycologic cure, clinical cure, recurrence, duration to cure, timeto-cure, and quality of life). For adverse effects, we also included non-randomized studies (NRS). We used Cochrane methods to select studies, extract data, assess risk of bias, pool studies, and calculate for treatment effects. Results. We included 38 RCTs (n=2894) and 56 NRS (n=3452). Overall, there were few pooled studies and evidence was low to moderate quality. Oral azoles were more effective than placebo (mycologic cure, RR 11.34, 95% CI 4.90, 26.28; 3 RCTs, n=131; I2=0%; low quality of evidence) and as effective as topical agents (mycologic cure, RR 1.02, 95% CI 0.86, 1.21; 4 RCTs, n=232; I2=60%; moderate quality of evidence).There were few adverse effects and were mostly minor and transient. Conclusions. Oral azoles may be more effective than placebo, and are probably as effective as topical agents in the treatment of PV. Triazoles are probably as effective as ketoconazole. Adverse effects were few, mostly minor, and transient.

AIM: The main objective is isolation and molecular characterisation of Malassezia spp. from pityriasis versicolor (PV) patients with special emphasis to risk factors in Diyala province, Iraq. METHODS: Fifty patients (32 males and 18 females) presented with PV, the age ranged (15-45) years were included. Direct wet mount using KOH 10%, culture of skin scraping and PCR were used for confirmatory diagnosis. RESULTS: Malassezia spp. was isolated from (54%) of skin scraping; M. furfur (32%); M. pachydermatis (8%) and M. globosa (14%). The age group (15-22) years were frequently exposed to Malassezia infection. A significant inverse correlation was reported between age and exposure to Malassezia spp. Infection. Males were frequently exposed to Malassezia infection, (40%). A significant correlation was reported between gender and exposure to Malassezia spp. Infection. Females were at risk of getting Malassezia infection (2.619) time than males. Patient resident in the urban area frequently exposed to Malassezia infection, (34%). Patients resident in the rural area appears to be at risk of getting Malassezia infection (1.093) time than those in an urban area. Patient with good economic status was frequently exposed to Malassezia infection, (36%). Patients with middle economic status appear to be at risk of getting Malassezia infection (0.42) time than those with good economic status. Patients with primary education were frequently exposed to Malassezia infection, (22%). A significant correlation was reported between education level and exposure to Malassezia spp. Infection. No significant correlation was reported between economic status; type of job; source of water; contact with dogs and birds and Malassezia spp. Infection. CONCLUSION: M. furfur, M. pachydermatis and M. globosa represent the most common Malassezia spp. causing PV. Using of PCR is very critical to confirm the diagnosis of Malassezia spp. Malassezia infection inversely correlated with age and positively correlated with females gender and education. The residency in a rural area and middle economic status increase the possibility of infection. Infection was not affected by the source of water; job and contact with dogs and birds.

Pityriasis amiantacea (PA) is a hair disorder characterized by matting of multiple hair shafts, typically occurring as an idiopathic condition. A 67-year-old woman with multiple myeloma who developed PA following a bone marrow transplant with melphalan conditioning is described.She noted initial changes in scalp hair regrowth 4 weeks posttransplant. During the next 4 months she developed multiple lesions of PA that rapidly responded to management, including mineral oil under occlusion in the evening followed by daily shampooing with alternating coal tar, salicylic acid, and ketoconazole shampoos. We review medications that have been associated with PA and conditions related to PA, including atopic dermatitis, bacterial infection, fungal infection, psoriasis, and seborrheic dermatitis. Our patient developed PA that was associated with either melphalan conditioning, bone marrow transplant, or both.

Background Pityriasis Alba (PA) is a common skin disorder affecting the children and it has multiple risk factors. Objectives To assess the serum levels of trace elements (copper, zinc, and magnesium) and hemoglobin (Hb) level in patients with PA. Method This is a case control study; 110 participants (55 cases and 55 controls) were recruited from pediatric dermatology and family medicine clinics, Cairo university hospitals. Patients were allocated into two groups, PA group (randomly selected male and female children age group (6–16) with PA lesions) and a matched control group. Full history was taken including sociodemographic data, present history of the lesions. Full general and dermatological examination was done. Blood samples were taken to asses iron and trace elements levels. The gained measures were analyzed by (SPSS) program version 22. Results This study showed that Hb levels, serum ferritin, copper, zinc and magnesium were significantly lower in PA group. There was statistically significant difference between both cases and controls regarding trace elements (copper, zinc, and magnesium) with (p value was 0.000, 0.000 and 0.003) respectively. Zinc deficiency increased the risk by more than 15 folds. Also, there was statistically significant difference between both groups regarding Hb levels and serum ferritin (p value was 0.000). The reduced Hb level increases the risk of PA by more than nine folds (OR 9.6) Conclusion PA is associated with reduced levels of Hb, serum zinc, ferritin, copper and magnesium; sun exposure, skin phototype were found to be important risk factors for PA.

BACKGROUND: The detection of pathogenic fungus is an important step and key to assessing the sensitivity of the antifungal drugs, and therefore choosing an effective treatment method. AIM: To identify Malassezia species from scales of a patient with pityriasis versicolor. METHODS: Three hundred patients with pityriasis versicolor who were positive with direct examination, were isolated by culture. RESULTS: Identification of Malassezia species by culture: the growth rate was 90.3%; the detection rate was 97.0%, including 11 species: M. globosa (42.4%), M. dermatitis (17.3%), M. furfur (14.4%). M. globosa was the most prevalent species in the 20-29 group 36.5%, in hyphae and yeast cells (42.2%). CONCLUSION: M. globosa is the main cause of pityriasis versicolor in Vietnam.

Amaç: Bu çalışmada papüloskuamöz hastalıklar grubunda bulunan, psoriasis pitriyazis rozea (PR), liken planus (LP), pitriyazis likenoides kronika (PLK) ve pitriyazis likenoides et varilioformis akuta (PLEVA) hastalıklarının çocuklardaki epidemiyolojik ve klinik özelliklerinin ortaya konulması, belirli laboratuvar parametrelerinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Çalışmaya 41'i psoriasis, 54'ü PR, 1'i LP, 3'ü PLK ve 1'i PLEVA olmak üzere toplamda 100 hasta dahil edildi. Hastalar; yaş, cinsiyet, hastalık başlangıç yaşı, hastalık süresi, rekürrens, hastalık başlangıç lokalizasyonu, bireysel ve ailesel atopi öyküsü, son bir ay içerisinde enfeksiyon öyküsü ve enfeksiyonun türü, son 2 ay içerisinde ilaç kullanımı, aşı öyküsü, aile hikayesi, bilinen sistemik hastalık, kaşıntı, ateş, atralji, fotosensitivite, tedavi öyküsü ve önceki tedavilere yanıt açısından değerlendirildi. Çalışmaya dahil edilen hastaların laboratuvar değerlendirmesinde tam kan sayımı, eritrosit sedimantasyon hızı, c-reaktif protein, total IgE, serum biyokimyasal testler, viral hepatit belirteçleri ve tam idrar tetkiki yapıldı.Bulgular: Psoriasis hastalarında ortalama yaş ve ortalama hastalık başlangıç yaşı her iki cinsiyette benzerdi. Hastaların %29,2'sinde tekrarlayıcı seyir öyküsü, %31,7'sinde aile hikayesi, %51,2'sinde son bir ay içerisinde geçirilen enfeksiyon öyküsü, %78'inde kaşıntı, %14,6'sında sistemik hastalık öyküsü mevcuttu. Ailede psoriasis hikayesi varlığı erkek hastalarda kızlara göre anlamlı olarak daha yüksekti (p=0,02). En sık hastalık başlangıç lokalizasyonu %32,3'lük oranla saçlı deri idi. Olguların %24,3'ünde guttat, %75,6'sında plak tip psoriasis saptandı. Hastaların (n=36) ortalama Psoriasis Alan Şiddet İndeksi (PAŞİ) değeri 6,35 ± 4,79 idi. 30 (%83,3) hastanın PAŞİ değeri 10'dan küçük, 6 (%16,7) hastanın PAŞİ değeri ise 10'dan büyüktü. PR hastalarında ortalama yaş ve ortalama hastalık süresi her iki cinsiyette benzerdi. Hastalık en sık kış (%46,3) mevsiminde gözlendi. Olguların %48,1'inde üst solunum yolu enfeksiyonu öyküsü vardı. Madalyon plak görülme sıklığı %50 olarak saptandı. En sık tutulum bölgesi %92,6'lık oranla gövde idi. Atipik PR olgusuna rastlanılmadı. Ülkemizde yapılan benzer çalışmalardan farklı olarak lezyonlar çoğunlukla diffüz dağılım göstermekteydi. Sonuç: Bu çalışmada çocukluk çağının en sık saptanan papüloskuamöz hastalığı PR olup hastaların %95'ini psoriasis ve PR'li hastalar oluşturuyordu. Ailede psoriasis hikayesi varlığı erkek hastalarda kızlara göre anlamlı olarak yüksek saptandı. Psoriasis hastalarında en sık izlenen hastalık başlangıç lokalizasyonu saçlı deri idi. Yüz ve saçlı deri tutulumu olan psoriasis hastalarında PAŞİ değerinin anlamlı olarak daha yüksek saptanması bu bölge etkileniminin çocuklarda şiddetli hastalık göstergesi olabileceğini düşündürdü. Olguların çoğunluğunun PAŞİ değeri %10'dan küçük olup çocukluk çağında psoriasisin sıklıkla iyi seyirli olduğu, başlangıçta topikal tedavinin yeterli olduğu görüldü. PR'li hastalarda erkek/kız oranı 1,4/1 idi. Hastalık olguların yarısından fazlasında kış ve sonbahar aylarında izlendi ve olguların %55,6'sında son bir ay içerisinde geçirilen enfeksiyon öyküsü vardı. Hastaların yarısında öncü lezyon madalyon olup lezyonlar sıklıkla diffüz dağılmaktaydı. Bu çalışmada elde edilen verilerin ülkemizin epidemiyolojik verilerine katkıda bulunacağını düşünmekteyiz.Anahtar kelimeler: Çocukluk çağı, papüloskuamöz hastalıklar, psoriasis, pitriyazis rosea Aim: The goal of this study was to determine the epidemiological and clinical characteristics of papulosquamous diseases consisting of psoriasis, pityriasis rosea (PR), lichen planus (LP), pityriasis lichenoides chronica (PLC) and pityriasis lichenoides et varioliformis acuta (PLEVA) diseases in the pediatric age group and to evaluate specific laboratory parameters. Materials and methods: 100 patients were included in the study that 41 patients with psoriasis, 54 patients with PR, 1 with LP, 3 with PLC and 1 with PLEVA. Patients were evaluated in terms of age, gender, onset age of disease, duration of the disease, recurrence, onset localization of disease, history of individual and familial atopy, infection history in the last month, drug use in the last 2 months, vaccination history, family history, known systemic disease, itching, fever, atralgia, photosensitivity, treatment history and response to previous treatments. Laboratory tests included a complete blood count, antistreptolizin, erythrocyte sedimentation rate, c-reaktif protein, serum biochemical tests, viral hepatitis and urine routine examination test.Results: The mean age and mean age of onset of disease in patients with psoriasis were similar in both genders. 29.2% of the patients had a history of recurrent episodes, 31.7% had a family history, 51.2% had a history of infection in the last month, 78% had itching, and 14.6% had a history of systemic disease. The most common initial localisation of the disease was scalp with a rate of 32.3%. Guttat type psoriasis was detected in 24.3% of the cases and plaque type was found in 75.6% of the patients. The mean Psoriasis Area and Severity Index (PASI) score of the patients (n = 36) was 6.35 ± 4.79. 30 (83.3%) patients had a PASI value of less than 10 and 6 patients (16.7%) had a PASI value of more than 10. Mean age and mean disease duration were similar in both sexes in patients with PR. The disease was most common in winter (46.3%). 48.1% of the patients had a history of upper respiratory tract infection. The incidence of herald patch was 50%. The most common site of involvement was trunk with a rate of 92.6%. No atypical PR was detected. Unlike similar studies in our country, the lesions were mostly diffuse.Conclusion: In this study, the most common papulosquamous disease was PR and the diagnosis of psoriasis and PR constituted 95% of all cases participating in the study. The family history of psoriasis was significantly higher in male patients than in female patients with psoriasis. The most common initial localization of psoriasis was detected as scalp. Significantly higher PASI value in patients with psoriasis with facial and scalp involvement suggested that this clinical presentation may be a sign of severe disease in children. The majority of the patients had PASI value less than 10% and psoriasis in childhood was seen to have good prognosis and topical treatment was sufficient. The ratio of male to female patients with PR was 1.4 / 1. PR was observed in more than half of the cases in winter and autumn seasons and 55.6% of the cases had a history of infection in the last month. In half of the patients, the leading lesion was a medallion and the lesion distribution were often diffuse. We believe that the data obtained in this study will contribute to the epidemiological data of our country.Key words: Childhood, papulosquamous diseases, psoriasis, pityriasis rosea 70

Pityriasis versicolor is a common infection of the epidermis in adults, but only a few cases of this infection (especially the hypopigmented type) have been reported in infants aged under one year. Herein, we document a report of these cases and a review of the literature. Two patients with infantile pityriasis versicolor, who presented with hypopigmented macules on the neck, upper back, and chest are reported. A KOH examination was suggestive of pityriasis versicolor and our patients responded well to 1% clotrimazole lotion (twice a day) for four weeks. Pityriasis versicolor should be considered in the differential diagnosis of hypopigmented macules and patches in infants.

Dermoskopi temel olarak melanositik ve melanositik olmayan pigmente lezyonların değerlendirilmesi ve melanomun erken tanısında kullanılmaktadır. Hızlı, ucuz ve invaziv olmayan bir yöntem olması nedeniyle klinik kullanımı oldukça yaygınlaşmıştır. Son yıllarda pigmente olmayan lezyonlarda ve çeşitli inflamatuar dermatozlarda dermoskopi kullanımı giderek artmıştır. Dermoskopik inceleme, klinik olarak net ayrımı yapılamayan dermatozlarda histopatolojik tanı öncesinde ayırıcı tanı açısından klinisyenlerin ellerini güçlendirmektedir. Bizim çalışmamızda gövde lezyonları olan plak psoriyazis (PP), liken planus (LP), mikozis fungoides (MF), pitriyazis rozae (PR) ve nummuler dermatit (ND) gibi klinik pratikte sık karşılaştığımız dermatolojik hastalıkların ayırıcı tanısında dermoskopik özelliklerin tanımlanması ve önemi vurgulandı. Çalışmaya 50 PP, 30 LP, 20 MF, 30 PR ve 20 ND'li hasta alındı. Lezyonlar X10'luk büyütmeye sahip polarize bir dermoskopla incelendi ve entegre edildiği fotoğraf makinesiyle görüntüler alınıp kaydedildi.Hastaların dermoskopik bulguları her bir lezyon için zemin rengi, damar tipi ve damar dağılımı, skuam rengi ve skuam dağılımı ve diğer ek bulgular açısından değerlendirildi. Dermoskopik bulgulardan zemin rengi açısından hasta grupları incelendiğinde PP, LP, MF ve ND'de açık ve koyu kırmızı renk, PR'de ise sarı ve sarı-turuncu renk daha ön plandaydı. PP ile MF, LP ve ND arasında zemin rengi açısından anlamlı farklılık görülmezken PR ile PP ve ND arasındaki farklılık istatistiksel olarak da anlamlıydı (p

One of the most frequent complaints in dermatology clinics is the eruption of hypopigmented patchy skin lesions. The aim of the study was to investigate the utility of dermoscopy in common hypopigmented macular diseases. Patients with the followings diseases were examined by dermoscopy: vitiligo, pityriasis alba, nevus depigmentosus, achromic pityriasis versicolor, idiopathic guttate hypomelanosis, and extragenital guttate lichen sclerosus. This study showed that these hypopigmented macular diseases might display specific dermoscopic features. In vitiligo, the mean dermoscopic features were the presence of a diffuse white glow with perifollicular pigment, perilesional hyperpigmentation, leukotrichia and the pigmentary network. In idiopathic guttate hypomelanosis, the characteristic features were the presence of multiple, shiny, scaly macules with welland ill-defined edges borders that coalesced into polycyclic macules. For nevus depigmentosus, the mean features were hypopigmented patches with irregular border with a faint reticular network. For pityriasis alba, the fairly ill-demarcated hypopigmented macules with fine scales were the mean feature. In lichen sclerosus, there were white structureless areas, perilesional erythematous halo, follicular plugging and white chrysalis like structures. Dermoscopy of achromic pityriasis versicolor showed a fairly demarcated white area with fine scales localized in the skin creases.

Atopic dermatitis is a common chronic pruritic inflammatory skin disorder, characterized by an abnormal skin barrier, immune dysfunction, and an altered skin microbiome. Atopic dermatitis may be seen in conjunction with a variety of other skin disorders due to the complex pathogenesis of atopic dermatitis, involving genetic and environmental factors that are associated with immune dysfunction, barrier defects, and altered skin microbiomes. Skin disorders associated with atopic dermatitis include diseases sharing similar genetic origins like ichthyosis vulgaris, infectious diseases such as impetigo, and eczema herpeticum, in addition to the cutaneous autoimmune diseases, alopecia areata, and vitiligo. Atopic dermatitis is also often linked to such benign conditions as pityriasis alba and keratosis pilaris. This review discusses the cutaneous comorbidities of atopic dermatitis and their relationship via their occurrence in conjunction with atopic dermatitis.

Epidermodysplasia verruciformis (EV) is an autosomal recessive skin disorder with a phenotype conditional on human beta-papillomavirus (beta-HPV) infection. Such infections are common and asymptomatic in the general population, but in individuals with EV, they lead to the development of plane wart-like and red or brownish papules or pityriasis versicolor-like skin lesions, from childhood onwards. Most patients develop non-melanoma skin cancer (NMSC), mostly on areas of UV-exposed skin, from the twenties or thirties onwards. At least half of the cases of typical EV are caused by biallelic loss-of-function mutations of TMC6/EVER1 or TMC8/EVER2. The cellular and molecular basis of disease in TMC/EVER-deficient patients is unknown, but a defect of keratinocyte-intrinsic immunity to beta-HPV is suspected. Indeed, these patients are not susceptible to other infectious diseases and have apparently normal leukocyte development. In contrast, patients with an atypical form of EV due to inborn errors of T-cell immunity invariably develop clinical symptoms of EV in the context of other infectious diseases. The features of the typical and atypical forms of EV thus suggest that the control of beta-HPV infections requires both EVER1/EVER2-dependent keratinocyte-intrinsic immunity and T cell-dependent adaptive immunity.

L'épidermodysplasie verruciforme, également appeléesyndrome de Lutz-Lewandowskyou la maladie de l'homme-arbre est une affection cutanée rare d'origine génétique. Elle se caractérise par une sensibilité anormale du revêtement cutané aux papillomavirus. L'affection commence habituellement entre 4 et 8 ans, le plus souvent avant l'âge de 20 ans mais peut exceptionnellement apparaitre plus tardivement. Elle se traduit par l'apparition de macules squameuses et de papules d'évolution parfois exubérante, pseudo-tumorale, essentiellement au niveau des mains et des pieds. Dans ces lésions, on retrouve des papillomavirus de type 5 et 8, virus que l'on retrouve chez 80% des sujets d'une population normale asymptomatique. D'autres types de papillomavirus peuvent être parfois identifiés. Felix Lewandowsky et Wilhelm Lutz ont fait la première description clinique de cette affection. La lésion cutanée la plus fréquemment observée est une éruption maculaire proche de celle connue dans le pityriasis versicolor; s'y associent des papules d'allure verruqueuses squameuses. Le risque de transformation particulièrement en carcinome épidermoïde est important. Plusieurs traitements ont été essayés (rétinoïdes, interféron, cimétidine) avec des succès peu ou pas reproductibles. Le plus important est la protection solaire, la surveillance clinique assidue et l'excision rapide de toute lésion en voie de dégénérescence carcinomateuse. Nous rapportons l'observation d'un homme de 30 ans qui consulte pour des lésions verruqueuses multiples des membres et tronc remontant à l'âge de 4 ans associés à des lésions pityriasis versicolor like. L'examen ne trouvait pas de lésions suspectes et un traitement à base de rétinoïdes a été démarré.

Although Pityriasis versicolor PV well responds to medical therapy recurrence is a common problem and management of recurrent and chronic PV is a challange sotretinoin cis retinoic acid is a vitamin A derivative decreases sebaceous gland size and sebum production up to Although the efficiency of isotretinoin is well known in acne and acne related disorders literature regarding its use in PV is scarce We present here a year old man succesfully treated and achieved long term remission with oral isotretinoin therapy who was suffering from diffuse recurrent PV for nearly years We believe that low dose and short term isotretinoin may be a good therapeutic option for recurrent and chronic PV

A 30-year-old pregnant female presented with a 2-week history of pityriasis rosea-like eruption. The rash started 2 days after the patient had started taking ondansetron 8 mg for alleviation of moderate-to-severe nausea and vomiting of pregnancy. Physical examination revealed erythematous papulosquamous lesions characterized by annular scaly margins and a dusky centre over the arms, chest, abdomen, lower back and legs. The rash did not involve the palms, sole or mucous membranes, and no lesions were observed on the lymph nodes. Ondansetron was discontinued. The rash ceased to spread and started to disappear within 2 weeks with full resolution noted after 1 month. Analysis of the case using the Naranjo adverse drug reaction probability scale indicated that ondansetron was the probable cause of the pityriasis rosea-like eruption. This is the first case report of pityriasis rosea related to ondansetron therapy.

Since the manifestations of skin disease are usually openly visible, patients may feel embarrassed. Nowadays, alternative medicine is promoted; therefore, efforts are being made to discover new herbal formulas for healing skin diseases. This study aimed to (1) investigate the diversity and source of medicinal materials for treating skin diseases, and (2) document the folk knowledge of using herbal medicines from the three southern border provinces of Thailand; Pattani, Yala and Narathiwat. Semi-structured interviews with ten healers were conducted to collect information including the formula name, herbal ingredients, material parts used, preparation, properties and treatment methods. The data were then further analysed. The results showed that 42 multi-species formulas and 30 single species were used to treat 22 skin diseases. The formulas were comprised of 54 plants and eight chemical elements or compounds. Most formulas were used for treating shingles, scabies, urticaria and itching of unknown cause. The most popular materials for various diseases were: Senna alata for ringworm and pityriasis versicolor, Areca catechu for shingles, Knema globularia for scabies and Tamarindus indica for itching of unknown cause. A review of the literature revealed that 36 plant species had already been tested for their pharmacological activities. The remaining species should be investigated for biological activity to confirm the folk utilization of the medicinal materials.

The objective of this research was to evaluate the efficacy of a new antifungal imidazole, dapaconazole tosylate, in the treatment of Pityriasis versicolor (PV).Sixty patients with clinical and mycological diagnosis of PV were randomly assigned to receive either 1 g dapaconazole tosylate 2% cream or 1 g ketoconazole 2% cream. Treatments were applied once a day for 28 days. A dermatologist evaluated efficacy and safety daily, and weekly laboratorial tests were performed. The primary end point was a clinical and mycological cure of lesions after 28 days of treatment. The secondary end point was the time to clinical healing assessed by Kaplan-Meier analysis and Log-rank testing.Fifty-three patients adhered to protocol rules. Clinical and mycological cure was achieved in 84.6% (22/26) and 92.6% (25/27) of patients treated with ketoconazole and dapaconazole, respectively (difference [effect size] = 8.0%, Standard error of difference: 8.69%, 95% CI: -6.3 to 22.3%). Median time to healing was 23.5 and 21 days for ketoconazole and dapaconazole, respectively (p = 0.126). Adverse events occurred only in ketoconazole-treated patients (13%; 4/30).Dapaconazole tosylate is non-inferior to ketoconazole when used at a dose of 20 mg/day for 28 consecutive days for the treatment of PV. Dapaconazole also demonstrated a good safety profile.

Background : Dermatomycosis often occurs in tropical countries. Many studies from tropical countries have reported high prevalence of dermatomycosis among elementary school children. Despite being a tropical country, prevalence of dermatomycosis among elementary school children in Indonesia is still unknown. The objective of this study was to determine the prevalence and characteristics of dermatomycosis among elementary school children in Jatinangor, Sumedang, West Java in September–November 2012. Methods : This study used a cross-sectional descriptive survey method. The 328 children from five elementary schools in Jatinangor were included in the study using multistage sampling technique. Medical history and physical examination was performed to all subjects. Subjects who had skin lesion suspected for dermatomycosis were examined with direct microscopic examination using 10% solutions of potassium hydroxide (KOH). Data were presented as frequent analysis distribution using Statistical Package for Social Sciences (SPSS) version 17.0. Results : Of 328 children (174 males, 154 females; aged 5–14 years), 35 (10.6%) had lesions suggestive of dermatomycosis but only 5 children (1.5%) were positive for dermatomycosis. Males are more prevalent females, patients were in ≥10 years age group. Four cases were Pityriasis versicolor, while one was diagnosed with tinea facialis. Conclusions : Dermatomycosis among elementary school children in Jatinangor had a low prevalence, with only 4 cases of Pityriasis versicolor and one tinea facialis case. [AMJ.2015;2(1):268–75]

Background: Pityriasis versicolor (PV), also known as tinea versicolor, is caused by Malassezia species. This condition is one of the most common superficial fungal infections worldwide, particularly in tropical climates. PV is difficult to cure and the chances for relapse or recurrent infections are high due to the presence of Malassezia in the normal skin flora. This review focuses on the clinical evidence supporting the efficacy of antifungal treatment for PV. Method: A systematic review of literature from the PubMed database was conducted up to 30 September 2014. The search criteria were “(pityriasis versicolor OR tinea versicolor) AND treatment”, with full text available and English language required. Conclusions: Topical antifungal medications are the first-line treatment for PV, including zinc pyrithione, ketoconazole, and terbinafine. In cases of severe or recalcitrant PV, the oral antifungal medications itraconazole and fluconazole may be more appropriate, with pramiconazole a possible future option. Oral terbinafine is not effective in treating PV and oral ketoconazole should no longer be prescribed. Maintenance, or prophylactic, therapy may be useful in preventing recurrent infection; however, at this time, there is limited research evaluating the efficacy of prophylactic antifungal treatment.

Pityriasis versicolor is a chronic, superficial fungal infection affecting the superficial layer of a stratum corneum. Malassezia furfur is the major species involved in pityriasis versicolor. Currently many researchers reported increase in the incidence of other species as a causative agent of pityriasis versicolor. Isolation and identification of Malassezia species from suspected Pityriasis versicolor patients was conducted in the Department of Microbiology and immunology Bangabandhu Sheikh Mujib Medical University (BSMMU) from September 2013 to August 2014. Ninety two clinically diagnosed patients of Pityriasis versicolor were studied and samples from skin lesion were processed for direct microscopy and culture. Species of Malassezia were identified by cultural characteristics in Dixon's agar media by macro and microscopic observation of the colonies and by catalase test, urease test, esculin test and tween assimilation test. A totalof 92 cases 70(70.08%) were positive by direct microscopy and 50(54.34%) were positive by culture. Malassezia globosa was found in 38(76%) cases as the commonest etiological agent and Malassezia furfur was found in 10(20%) cases and Malassezia obtusa in 2 (4%) cases respectively.Bangladesh J Med Microbiol 2015; 9 (2): 17-19

Pityriasis versicolor (PV) is a superficial fungal infection of skin caused by yeast Malassezia. Typical lesions are multiple small, round macules that coalesce to form confluent lesions. Eruption varies in color from patient to patient, but each person’s lesions are usually of a single hue. Here we present a combination of both hypo and hyperpigmentated lesions of PV in a single patient. On treating the patient for 4 weeks with antifungals, complete clearance of hyperpigmented lesions were seen whereas hypopigmented ones became more accentuated.

Pityriasis rosea (PR) is an acute, self-limited skin disease thought to be a viral exanthem caused by reactivation of HHV-7 and HHV-6 viruses; although, numerous studies have explored various pathogens. Several reports associate PR with drugs and vaccines. We report a typical case of PR in a 26-year-old male following intradermal anti-rabies vaccine (ARV). There are reports of vaccine-induced pityriasis like eruptions due to various vaccine. However, PR-like eruptions due to ARV is rarely reported. This case represents a new side effect of an already existing vaccine and throws light on varied etiologies of vaccine-induced PR.

The immune system depending on the degree of intestinal microbiocenosis disorders in patients with pityriasis versicolor was investigated. Patients with pityriasis versicolor have an immune system disorder, which is expressed by a decrease in the activity of cellular immune system and enhancement of humoral one. In addition, in most cases of the pityriasis versicolor there are disbiotic changes, that contribute to the long-term course of the disease and are difficult to treat. The different changes in the immune system depending on the severity of intestinal disbiotic changes in patients with pityriasis versicolor were shown. It was revealed that in patients with pityriasis versicolor changes in the immune system are in direct proportion to the severity of disbiosis. It is appropriate to take into account these changes in the selection of treatment strategy ofpatients with pityriasis versicolor.