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 The drug is considered safe if no patients were withdrawn for clinical adverse effects or laboratory abnormalities.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.

The challenge of Diagnosing Common Dermatomycosis by Reflectance Confocal Microscopy

Background: Traditional detection of fungal infections of the skin relies on microscopy techniques or fungal culture. Currently, reflectance confocal microscopy (RCM) has been widely applied to assist the diagnosis of commondermatomycosis with advantages of non-invasiveness, celerity, real time, and repeatability. Materials and Methods: A total of 478 clinically suspected dermatomycosis patients were enrolled in this study including 148 cases of tinea manus and pedis, 188 cases of tinea corporis and cruris and 142 cases of pityriasis versicolor. RCM examination was performed to image the lesions. Aim: This study aimed to summarize the image characteristics of in vivo RCM examination on common dermatomycosis and retrospectively evaluate its accuracy as compared with microscopy results. Furthermore, we attempted to tackle the challenges of RCM diagnosis on common dermatomycosis. Results: Based on RCM images, 231 of 478 (48.3%) patients were detected with hyphae. Among all RCM confirmed cases, 58 out of 148 (39.2%) were tinea manus and pedis, 145 out of 188 (77.1%) were tinea corporis and cruris, and 28 out of 142 (19.7%) were pityriasis versicolor. The remaining patients (51.7%) could not be diagnosed by the dermatologist according to RCM. Hyphae structures were primarily identified during diagnoses of dermatomycosis by RCM. Conclusions: RCM is a novel optical imaging technique that confers high-resolution images of fungi. RCM has certain advantages in the diagnosis of tinea manus and pedis. RCM is not suitable for the diagnosis of pityriasis versicolor.

The Current Understanding of the Clinical Condition Bahaq (Pityriasis Versicolor) – Hypothesis and A Review of Evidences

Bahaq is a commonly encountered clinical condition of the skin. It is characterized by the presence of hypopigmented or hyperpigmented or erythematous macule which appears on the neck, chest, shoulder and arms. In classical literature, bahaq and its subtype bahaq abyad and bahaq aswad have been described. In a recent development, these Unani terminologies (bahaq abyad and bahaq aswad) have been correlated with the terminologies used in modern medicine for similar clinical presentation by the competent authority in India. The equivalent terms assigned for bahaq abyad as pityriasis alba and bahaq aswad as pityriasis nigra do not seem to be suitable. They lead to misdiagnosis and treatment failure. In this article, we have reviewed evidences from the literature to have current understanding of the clinical conditions bahaq abyad and bahaq aswad. The literature review showed that these two dermatological clinical conditions have an individual identity. They differ from each other in terms of clinical presentation, demographic characteristics, pathogenesis and treatment. Moreover, we have presented one case report of bahaq abyad and bahaq aswad each to have an understanding of its demographic characteristics, risk factors, clinical features and clinical course of the disease. We have diagnosed these cases as per descriptions mentioned in the classical literature and tried to correlate to the equivalent terms representing a similar clinical presentation in modern medicine. After a review of evidence, we hypothesize the most suitable equivalent terms for the clinical conditions bahaq abyad and bahaq aswad as pityriasis versicolor instead of bahaq abyad as pityriasis alba and bahaq aswad as pityriasis nigra. This research article may guide the Unani physicians in clinical practice for proper diagnosis, therapeutic approach, drugs selection and treatment of bahaq and its subtypes.

Identification of Malassezia Species Isolated from Pityriasis Versicolor by CHROMagar-Medium

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.

Epidermodysplasia Verruciformis: A Case Report and a Brief Review

Epidermodysplasia verruciformis is an uncommon disorder that is transmitted in an autosomal recessive manner. It is characterized by increased susceptibility to human papillomavirus infection, which presents with hypo- or hyperpigmented macular lesions, pityriasis versicolor-like lesions, and an early tendency to transform into skin cancer. We present a case of a 40-year-old male with complaints of verrucous lesions of the hands and feet. Histopathology was suggestive of EV.

Distribution and molecular characterization of Malassezia species isolated from students with pityriasis versicolor in Haiphong City, 2016 - 2017

This research aims to fnd out the Malassezia species in secondary school students with pityriasis versicolor in Hai Phong City, Vietnam. A total of 110 Malassezia fungal strains from 109 students were isolated from pityriasis versicolor patients in four secondary schools in Hai Phong City from August 2016 to December 2017. These samples were cultured on mDixon agar medium containing antibiotic at 32oC for 7 days. All Malassezia isolates were correctly identifed to the species level by CHROMagarTM Malassezia medium and molecular tools (PCR-RFLP and D1/D2 region sequencing). The results showed that M. furfur and M. japonica are two species that caused pityriasis versicolor at the rate of 96.4% and 3.6%, respectively. Most of these Malassezia isolates were isolated in the back, face, and neck. M. furfur was discovered in both areas, while M. japonica was found only in the urban area. M. furfur and M. japonica were two Malassezia species causing pityriasis versicolor in secondary school students in Hai Phong City of Northern Vietnam, in which M. furfur was more common than M. japonica, whereas other Malassezia species were not detected.