Pityriasis Versicolor Treatment
Tinea versicolor presents with hypopigmented, pink brown macules and patches on the trunk with fine scale. Versicolor means varied colors, and this tinea tends to be white, pink, and brown (Fig. 33-51). Tinea versicolor is found on the back, chest, abdomen, and upper arms, often in a capelike distribution. Tinea versicolor is caused by Malassezia furfur (Pityrosporum), a lipophilic yeast that can be normal human cutaneous flora. Tinea versicolor is also called pityriasis versicolor after the causative organism. Pityrosporum is also associated with seborrhea, and thus antidandruff shampoos are effective in treating this tinea. Pityrosporum spp. thrive on sebum and moisture and tend to grow on the skin in areas where sebaceous follicles secrete sebum. Topical and oral treatments are effective, but tinea versicolor tends to recur, especially during the warmer months. The diagnosis can usually be made with the clinical examination, and if there is any doubt, a KOH prep can be examined for...
Many clinical studies demonstrate that the colonisation of the skin and subsequent sensitization to Malassezia yeasts can trigger skin inflammation and play a role in the pathogenesis of AD. Malassezia yeasts are members of the normal human cutaneous flora but on the other hand these fungi are associated with different skin diseases such as pityriasis versicolor, Malassezia folliculitis and sebor-rhoeic dermatitis.
Mucocutaneous fungal infections are caused by dermatophytes (Microsporum, Epidermophyton, and Trichophyton) and yeasts. About 40 species in the three dermatophyte genera can cause tinea pedis and manus, tinea capitis, tinea corpo-ris, tinea cruris, and onychomycosis. Yeasts of Candida can cause diaper dermatitis, balanitis, vulvovaginitis, and thrush (Fig. 33-40). The yeastlike organism of Malassezia (Pityros-porum) causes tinea versicolor and contributes to seborrhea. Although tinea versicolor has the name tinea in it, it is not a true dermatophyte.
IgE antibodies to Malassezia furfur, M. sympo-dialis and Pityrosporum orbiculare in patients with atopic dermatitis, seborrheic eczema or pityriasis versicolor, and identification of respective allergens. Acta Derm Venereol 2000 80 357-61. Johansson C, Sandstrom MH, Bartosik J et al. Atopy patch test reactions to Malassezia allergens differentiate subgroups of atopic dermatitis patients. Br J Dermatol 2003 148 479-88. Arzumanyan VG, Serdyuk OA, Kozlova NN et al. IgE and IgG antibodies to Malassezia spp. yeast extract in patients with atopic dermatitis. Bull Exp Biol Med 2003 135 460-3. Clemmensen OJ, Hjorth N. Treatment of dermatitis of the head and neck with ketoconazole in patients with type I sensitivity to Pityrosporum orbiculare. Semin Dermatol 1983 2 26-9. Waersted A, Hjorth N. Pityrosporum orbiculare - a pathogenic factor in atopic dermatitis of the face, scalp and neck Acta Derm Venereol 1985 114 146-8.
The colonization of the skin with Malassezia was analysed in 112 individuals suffering from seborrhoeic dermatitis (20 of 39 were HIV-positive patients), pityriasis versicolor (18 patients), AD (18 patients), and 37 control patients without dermatological lesions. M. globosa was the most common species, isolated from 37.5 of the investigated individuals, followed by M. sympodi-alis in 31.3 , and M. furfur in 31.3 . In patients with pityriasis versicolor and in HIV-positive patients M. globosa was predominant in 67 and 85 of the cases. In non-HIV patients with AD or seborrhoeic dermatitis, M. furfur and M. restricta were isolated in 72 and 26 of the cases, respectively. It has been concluded that Malassezia species were present on the skin of patients with and without dermatological diseases. Malassezia globosa especially was found in a high frequency on the skin of patients with dermatological disorders suggesting a higher pathogenicity of this species.8
A disturbed Vayu driving Pitta and Kapha dosas into the skin was thought to bring on some skin diseases, whereas other skin diseases were viewed as the work of parasites. As a group, skin ailments were generally termed Kustha. The 7 Maha (or major) Kusthas appear to be variants of leprosy, a disease existing in India from ancient times. The 11 minor Kusthas were other skin diseases that are more difficult to equate with current cutaneous orders. However, it would seem that pityriasis versicolor, pemphigus, chilblains, moist eczema, dermatitis, scabies, and leukoderma were all represented.