Efficacy of Azoles Antifungals in Treatment of Pityriasis Versicolor

Introduction: Pityriasis versicolor is superficial fungal infection. Topical drugs are often effective in treatment of limited disease while systemic drugs are more suitable in extensive cases. The systemic triazole drugs, itraconazole and fluconazole have shown promising results at different doses. Aims: To assess the efficacy and safety of oral fluconazole combined with ketoconazole shampoo and oral itraconazole in the treatment of Pityriasis versicolor. Methods: The study was conducted at department of Dermatology at Nepalgunj Medical College from March 2019 to February 2020. Total 100 patients of both genders with Pityriasis versicolor were randomly allocated into two groups with 50 patients in each group. Patients in Group I received oral fluconazole 300mg a week for two consecutive weeks along with ketoconazole 2% shampoo twice weekly for two weeks while those in Group II received itraconazole 200mg daily for one week. Efficacy was assessed in terms of negative fungal hyphae. The drug is considered safe if no patients were withdrawn for clinical adverse effects or laboratory abnormalities. Results: In this study age ranged from 18 to 50 years with mean age of 31.1 years in Group I and 31.92 years in Group II. Efficacy was seen in 78% of Group I patients as compared to 54% in Group II patients at two weeks and 94% in Group I and 90% in Group II at four weeks. No significant adverse effects were reported in any of the group. Conclusion: Fluconazole along with ketoconazole shampoo is more effective than itraconazole in treatment of pityriasis versicolor with minimal side effects, at lesser cost.

Sinonasal mycosis following transfrontal craniotomy in three dogs

CASE DESCRIPTION Three dogs were presented for investigation of chronic nasal discharge and epistaxis 141, 250, and 357 days after undergoing transfrontal craniotomy to treat an intracranial meningioma (2 dogs) or a meningoencephalocele (1 dog). CLINICAL FINDINGS CT findings were consistent with destructive rhinitis and frontal sinusitis in all 3 dogs, with results of histologic examination and fungal culture of samples obtained during frontal sinusotomy confirming mycotic infection. Frontal sinusotomy revealed fungal plaques covering a combination of bone and residual surgical tissue adhesive at the site of the previous craniotomy in all 3 dogs. Aspergillus spp were identified in all 3 dogs, and Chrysosporium sp was also identified in 1 dog. TREATMENT AND OUTCOME Surgical curettage was followed by antifungal treatment (topical clotrimazole in 2 dogs and oral itraconazole for 3 months in 1 dog). Nasal discharge improved in the short-term but recurred in all dogs 99, 118, and 110 days after frontal sinusotomy. One dog received no further treatment, 1 dog received an additional 8.5 months of oral itraconazole treatment, and 1 dog underwent 2 additional surgical debridement procedures. At last follow-up, 2 dogs were alive 311 and 481 days after frontal sinusotomy; the third dog was euthanized because of status epilepticus 223 days after frontal sinusotomy. CLINICAL RELEVANCE Sinonasal mycosis should be considered as a potential complication in dogs developing persistent mucopurulent nasal discharge, intermittent epistaxis, and intermittent sneezing following transfrontal craniotomy. The pathophysiology may be multifactorial, and potential risk factors, including use of surgical tissue adhesive in the frontal sinus, require further investigation.

Expert opinion on current and emerging treatments in dermatophytosis

<p class="abstract">Dermatophytosis continues to be a worldwide public health problem, predominantly in developing countries like India. Early diagnosis and appropriate management are imperative to enhance patient outcomes and improve quality of life of individuals with dermatophytosis. Multiple focused group discussions involving 76 dermatologists across 36 cities in India were conducted to provide a consensus clinical viewpoint of expert dermatologists to gain insights toward effective diagnosis and management of Indian subjects with dermatophytosis. These discussions mainly aimed at reviewing current literature on prevalence, etiology, diagnosis and management of dermatophytosis and highlighting variations in diagnostic and treatment approaches in routine clinical practice. The current article summarizes the experts’ clinical viewpoint on overall management of dermatophytosis. Diagnosis of dermatophytosis involves clinical observation, microscopic examination and dermoscopy. Molecular techniques have certain advantages over conventional microscopy and culture methods but are associated with issues of cost and technique complexity. Oral itraconazole 200 mg–400 mg daily and terbinafine 500 mg/day could be considered for recalcitrant tinea infections. Topical azoles like luliconazole, sertaconazole, and terbinafine could be beneficial. A combination of oral and topical antifungal drugs is effective in patients with steroid-modified and difficult-to-treat tinea infections. Also, patient counselling and use of adjunctive therapies like antihistamines, retinoids, and moisturizers are essential for managing tinea infections. </p><p class="abstract"> </p>

Pulmonary fungal ball due to Trichophyton successfully managed with oral itraconazole: a case report

Pulmonary fungal balls are caused by long-term fungal infection of the lung. They are sometimes a complication of previous cavitary pulmonary tuberculosis. Pulmonary fungal balls caused by Trichophyton are extremely rare. A 65-year-old man who worked in a leather recycling factory was admitted because of a productive cough and shortness of breath. He had a history of tuberculosis with lung destruction. A chest radiograph showed an opacity surrounding an air lucency over the left lung field, and chest computed tomography showed a mass within a cavity, producing a ball-in-hole appearance, over the left upper lung lobe. Bronchoalveolar lavage was performed, and fungal culture of the lavage fluid yielded Trichophyton. After 6 months of treatment with oral itraconazole, the patient’s general condition improved. This case emphasizes the importance of awareness of fungal infection within cavitary lesions of the lung and shows that Trichophyton may be the etiologic organism in such cases. Itraconazole is a recommended treatment of pulmonary fungal balls.

Efficacy of Itraconazole vs Itraconazole Plus Isotretinoin in Treatment of Chronic Tinea

Background: About 20 to 25% of the global population is affected by the fungal skin infections. Different antifungal drugs used in traditional doses have developed widespread resistance, necessitating the development of an efficient antifungal treatment. Objective: To assess efficacy of itraconazole vs itraconazole plus isotretinoin in treatment of chronic tinea. Methodology: This was comparative study conducted at the Department of Dermatology Qazi Hussain Ahmad Complex Nowshera and alshifa clinic and skin aesthetic, Nowshera for duration of one year from November 2020 to November 2021. In both group A and B, 40 individuals were taken randomly. Treatment of group A patients was done with oral itraconazole and isotretinoin while patients of group B treatment was done with oral itraconazole alone. All patients were monitored for four weeks to assess their responsiveness to therapy and side effects. Results: Complete cure response was recorded in all the patients of group A, while in group B, complete cure response was recorded in 20 (50%) patients. A statistically significant treatment response was observed between both the groups (p<0.05). There were 22 (55%) individuals in group A and 7 (17.5%) patients in group B who had cheilitis and dryness of the lips as major adverse effects. Conclusion: Our study concludes that combination therapy with oral itraconazole and isotretinoin is efficient and safe for the treatment of chronic tinea. Our study recommends conducting study based on large sample size for better results.

Combination Treatment for Extensive Chromoblastomycosis: A Case Report

Chromoblastomycosis is a chronic and progressive recalcitrant fungal infection of the cutaneous and subcutaneous tissue caused by traumatic inoculation of a specific group of dematiacious fungi through skin. There are different treatment modalities for chromoblastomycosis (medical/surgical) having various efficacy. However, there is no treatment of choice for this disease. Though several therapeutic regimen has been proposed for almost 100 years, the disease may be recalcitrant and almost difficult to eradicate if diagnosed in later stage. Relapses are frequently reported. A combination of various treatment modalities is needed to achieve the best result. We report here a case of chromoblastomycosis in a 62-year-male who presented with verrucous nodules and plaques on right lower limb. The patient was unresponsive to oral itraconazole 400mg daily for 2 months but was subsequently treated with multiple serial sittings of surgical excision and carbon dioxide laser in combination with oral itraconazole over 6 months. This case report focuses on proper management and specifically on differential diagnoses and treatment modalities for chromoblastomycosis. Keywords: carbon dioxide laser; chromoblastomycosis; combination treatment.

A Study on Efficacy of Oral Itraconazole in the Treatment of Seborrheic Dermatitis

Seborrheic dermatitis is a common chronic disease. Malassezia yeasts have been implicated in the pathogenesis of this disease. Antifungal agents are known to be effective in the treatment of Malassezia yeast infections. This study was done to evaluate the efficacy of itraconazole in the treatment of seborrheic dermatitis. Sixty patients with Seborrheic dermatitis were evaluated in an open non-comparative study. Patients were treated with itraconazole capsule 100 mg twice a day for a week; then after a 3-week interval 100 mg capsule was given twice a day for 2 days of following months for two consecutive months. Four clinical parameters (Itching, burning erythema, scaling, and seborrhea) were assessed using a 0 to 3-point (0= absent, 1 = mild, 2 = moderate, 3 = severe) score. Mycological evaluation determined the presence of Malassezia spores in the scales using a direct smear. At the end of the initial treatment significant improvement was reported in four clinical parameters: Itching, burning erythema, scaling, and seborrhea. Maintenance therapy led to further improvement slightly. Burning sensation mildly improved during the treatment. The quantity of Malassezia spores present in the direct smear decreased throughout the treatment period. Blood test abnormalities were not found during the treatment. So initial treatment with itraconazole is beneficial in patients with seborrheic dermatitis. Faridpur Med. Coll. J. 2021;16(1):21-24

A Comparative Study of Safety and Efficacy of Oral Terbinafine and Itraconazole in Patients of Tinea Corporis/ Tinea Cruris Infection, A Randomized Open Label Parallel Group Study

Introduction: Superficial dermatophytosis is a common public health problem in India, due to its tropical climate with heat and humidity. Today, the triazoles, mainly Itraconazole and the allylamines, chiefly Terbinafine, are the main ammunitions against dermatophytes. This study is undertaken to compare the safety and efficacy of both the drugs. Materials and Methods: This study was conducted to find the efficacy of Oral Terbinafine and Oral Itraconazole in Tinea Corporis/Tinea Cruris infection. The primary efficacy parameter was change in composite score (pruritus, erythema, pigmentations) from baseline to end of the treatment period. And to compare the safety of Oral Terbinafine and Oral Itraconazole by comparing the following parameters, Liver enzymes - SGOT/SGPT before and after treatment with the study drugs. Drug Dosage: Group 1: Drug –Tab. Terbinafine: Dose 500 mg per day once daily at bedtime for 2 weeks. Group 2: Drug –Tab. Itraconazole: Dose 200 mg per day, once daily at bedtime for 2 weeks. Results: The study participants show significant reduction in itching at the second follow up (after 2 weeks of drug completion) in both groups. Pruritis was reduced in 92% subjects in group 1 and 97.5% subjects in group 2. There was 87% reduction in erythema in group 1 and 93% reduction in group 2. Pigmentations were seen in 2% subjects in both groups indicating relapse of infection. Conclusion: The significant outcome of the study was that oral Itraconazole 200mg/day for 14 days(2 weeks) can be the better antifungal.

Diagnosis and therapeutic management of malasseziosis in dogs

Malassezia spp. are commensals of the normal cutaneous microbiota of humans and animals. These yeasts may become opportunistic pathogens under certain conditions and cause dermatitis and otitis externa in dogs. Malassezia pachydermatis is the most common cause of malasseziosis in dogs. In this study skin and ear swabs from suspected cases were cultured on Modified Dixon’s Agar (MDA). The isolates obtained were initially characterized on the basis of colony characteristics, result of Gram staining and microscopic morphology. Total DNA was extracted from the pure cultures of the isolates and subjected to confirmation by polymerase chain reaction (PCR) targeting large subunit ribosomal RNA gene. Positive cases were treated with oral itraconazole at 5 mg/kg bodyweight, orally once daily for 28 days.

A Case of Cutaneous Purpureocillium lilacinum Infection Looking like Psoriasis

Purpureocillium lilacinum is a saprophytic fungus with a ubiquitous environmental distribution, and it can be detected in soil samples and decaying materials worldwide. It has been reported as an emerging pathogen in both immunocompromised and immunocompetent patients, showing various cutaneous presentations. Herein, we report a case of a patient with a localized cutaneous P. lilacinum infection, which resembles the skin lesions of psoriasis. A 72-year-old female was presented with a peripherally spreading, well-demarcated, asymptomatic, scaly, erythematous patch on her forehead for several months. Histopathological examination showed pinkish septated fungal elements and mixed inflammatory and granulomatous infiltrates in the dermis. Furthermore, a fungal culture on potato dextrose agar showed gray, velvety colonies with light yellow background after being subcultured. Phialides with chains of oval conidia were observed on lactophenol cotton blue staining. The ITS region of rRNA gene sequence obtained from the colony was identical to that of Purpureocillium lilacinum. The lesion was resolved with oral itraconazole (200 mg/day) after four months of treatment.