Atrophying Pityriasis Versicolor: A Rare Presentation of a Common Dermatological Disorder and Literature Review.

Generalized tinea versicolor following initiation of ixekizumab therapy

Superficial Fungal Infections

Objective To estimate the performance of Wood's lamp examination in the diagnosis of superficial cutaneous fungal infections. Methods Totally, 129 patients, who were diagnosed with superficial cutaneous fungal infections according to clinical medical history and signs, were enrolled in this study. Wood's lamp examination of lesions was carried out. Cutaneous samples were obtained from the patients and subjected to microscopic examination and fungal culture. Results Wood's lamp examination was positive in 84% and 85.7% of patients with tinea versicolor and malassezia folliculitis, respectively; among these patients positive for Wood's lamp examination, 92.9% were positive for fungal culture, and 87.5% for microscopic examination. In patients clinically diagnosed with tinea manus and pedis, tinea corporis or tinea cruris, 8.3% were positive for Wood's lamp examination, while 85.4% were positive for fungal examination. There was a high consistency between Wood's lamp examination and fungal examination in patients with tinea versicolor and malassezia folliculitis, but not in those with tinea manus and pedis, tinea corporis or tinea cruris. Conclusions Wood's lamp examination shows a high specificity and sensitivity and is useful in the diagnosis of tinea versicolor and malassezia folliculitis, but seems unapplicable for the diagnosis of tinea manus and pedis, tinea corporis or tinea cruris.

Background:Malassezia species are lipophilic yeasts found on the skin surface of humans and other warm-blooded vertebrates. It is associated with various human diseases, especially pityriasis versicolor, which is a chronic superficial skin disorder.Objectives:The aim of the present study was to identify Malassezia species isolated from patients’ samples affected by pityriasis versicolor, using molecular methods in Kashan, Iran.Patients and Methods:A total of 140 subjects, suspected of having pityriasis versicolor from Kashan, were clinically diagnosed and then confirmed by direct microscopic examination. The scraped skin specimens were inoculated in modified Dixon’s medium. DNA was extracted from the colonies and PCR amplification was carried out for the 26s rDNA region. PCR products were used to further restriction fragment length polymorphism by CfoI enzyme.Results:Direct examination was positive in 93.3% of suspected pityriasis versicolor lesions. No statistically significant difference was observed in the frequency of Malassezia species between women and men. The highest prevalence of tinea versicolor was seen in patients 21–30 years-of-age. No difference could be seen in the frequency of Malassezia species depending on the age of the patients. In total, 65% of patients with pityriasis versicolor had hyperhidrosis. The most commonly isolated Malassezia species in the pityriasis versicolor lesions were; Malassezia globosa (66%), M. furfur (26%), M. restricta (3%), M. sympodialis (3%), and M. slooffiae (2%). Malassezia species were mainly isolated from the neck and chest.Conclusions:This study showed M. globosa to be the most common Malassezia species isolated from Malassezia skin disorders in Kashan, Iran. The PCR-RFLP method was useful in the rapid identification of the Malassezia species. By using these methods, the detection and identification of individual Malassezia species from clinical samples was substantially easier.

A total of 1150 clinically suspected cases of tinea versicolor were examined in Dammam Central Hospital in a geographic region where many predisposing factors exist. Saudi patients comprised 66.8% ...

Background:Malassezia is a lipid-dependent yeast known to cause Pityriasis versicolor, a chronic, recurrent superficial infection of skin and present as hypopigmented or hyperpigmented lesions on areas of skin. If not diagnosed and treated, it may lead to disfigurement of the areas involved and also result in deep invasive infections.Aim:The aim of the present study was to identify and speciate Malassezia in patients clinically suspected of having Pityriasis versicolor.Materials and Methods:Total 139 patients suspected of having Pityriasis versicolor were evaluated clinically and diagnosis was done by Wood's lamp examination, confirmed mycologically by using KOH, cultivation on Sabouraud's dextrose agar and modified Dixon agar at a tertiary care hospital in Mumbai. The total duration of study was 12 months.Results:Majority of the patients were males (59.71%) in the age group of 21-30 years (33.81%) who were students (30.21%) by profession. The incidence of Malassezia in Pityriasis versicolor was 50.35%. The most common isolate was M. globosa (48.57%), followed by M. furfur (34.28%). Majority of the patients had hypopigmented lesions, with M. globosa as the predominant isolate. Neck was the most common site affected; 88.48% were Wood's lamp positive of which 56.91% of Malassezia isolates grew on culture. KOH mount was positive in 82.01% of which 61.40% Malassezia isolates grew on culture.Conclusions:The procedure of culture and antifungal testing is required to be performed as different species of Malassezia are involved in Pityriasis versicolor and susceptibility is different among different species. Thus, it would help to prevent recurrences and any systemic complications.

Background: Acquired hypopigmentary disorders (AHDs) are those disorders that lead to a partial or complete deficiency of skin pigmentation. The diagnosis is not easy, especially in darker skin tones, where the psychosocial effects are significant. Proper and timely diagnosis depends on the combination of clinical observation, dermoscopy, and histopathology. The study aimed to evaluate the clinical, histopathological, and dermoscopic presentations of various acquired hypopigmentary disorders to enhance diagnostic accuracy and improve management in a tertiary care facility. Material and Methods: It is a prospective observational study that recruited 250 subjects with hypopigmented lesions at the Mahatma Gandhi Memorial Hospital, Warangal (April 2023-September 2024). The Patients were thoroughly examined by clinical examination, Wood's lamp, dermoscopy (ILLUCO IDS-1100), and skin biopsy, with histopathological confirmation by H and E and special stains (Masson-Fontana, Fite-Faraco). IBM SPSS software was used to perform statistical analysis, which included correlation coefficients. Results: The predominant diagnoses were Pityriasis versicolor (36.8%), followed by post-inflammatory hypopigmentation (25.6%), idiopathic guttate hypomelanosis (IGH) (18%), early vitiligo (12%), and Hansen disease (7.6%). Dermoscopy Pityriasis versicolor demonstrated non-uniform pigmentation with fine scales; IGH homogeneous white structureless areas with amoeboid/nebuloid borders; and vitiligo would have a reduced/absent pigment network with periflicular changes. The relationship among all three modalities was most strongly correlated in vitiligo (100%), then in IGH (95%), and in Pityriasis versicolor (90.9%). The study was conducted in one tertiary care setting and may not be generalisable to the community or primary care. No potential acquired hypopigmentary disorders were present in the disease spectrum, and the interobserver variation in dermoscopic interpretation was not formally evaluated. Conclusion: Dermoscopy is a valid and non-invasive complement to histopathology, with a significant impact on maintaining diagnostic accuracy in acquired hypopigmentary disorders. By combining these modalities, patient outcomes will improve, and the invasive procedure will be reduced. Keywords: Acquired hypopigmentary disorders, Dermoscopy, Histopathology, Vitiligo, Pityriasis versicolor, Idiopathic guttate hypomelanosis.

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.

Pityriasis versicolor is a common superficial fungal infection which is usually easily diagnosed with Wood's lamp examination and 10% potassium hydroxide mount. However, these modalities have varying sensitivity and specificity. This study aimed to ascertain the dermoscopic features of pityriasis versicolor lesionally as well as perilesionally using dermoscopy, a non-invasive diagnostic tool. In this cross-sectional study, consecutive patients with pityriasis versicolor underwent dermoscopic examination of lesions and 2 cm around lesions, noting lesional and perilesional features. Semi-objective grading of pigmentation, scaling, and vascularity was done. The association between parameters was determined using heat maps and violin plots with Kolmogorov-Smirnov test. Lesional analysis was performed since lesions at different sides showed disparate features. A total of 353 lesions from 233 patients (males = 150/233; 64.38% and females = 84/234; 36.05%) were studied. On lesional dermoscopy, pigmentary and scaling abnormalities were universal. 258/353 (73.1%) of lesions showed vascular abnormalities. Perilesionally, scaling (223/353; 63.17%) followed by pigmentation (205/353; 58.07%) and vascular changes (111/353; 31.44%) constituted the most common dermoscopic abnormalities and were noted in 294/353 (83.29%) of lesions overall. Increased disease duration corresponded with increased intensity of perilesional pigmentation alterations, perifollicular (P = 0.04), and follicular scales (P = 0.02). Awareness of dermoscopic features could improve the diagnostic accuracy in doubtful cases of pityriasis versicolor. Vascular findings are common and may point to an underlying inflammatory pathogenesis. Perilesional findings constitute early dermoscopic features of pityriasis versicolor and hint at the need for treatment beyond the confines of lesions. Larger follow-up studies and research into immunopathogenesis may be of further benefit.

BACKGROUND : Tinea (pityriasis) versicolor is a superficial infection of the stratum corneum by the lipophilic fungus known as Malassezia furfur . OBJECTIVE : To evaluate the efficacy and safety of a 400 mg single dose or 7-day 200 mg daily dose of itraconazole capsules in the treatment of mycologically confirmed pityriasis versicolor. METHODS : A total of 50 patients were entered into a randomized, open, clinical trial comparing a 400 mg single dose ( n = 24 for group 1) with a 7-day 200 mg daily dose ( n = 26 for group 2) of itraconazole. Clinical signs and symptoms and mycologic evaluation (potassium hydroxide preparation and Wood's lamp) were performed before treatment, and at weeks 3 and 6 after treatment. RESULTS : Both regimens of itraconazole were effective. Our results showed that there were no significant differences in efficacy and safety between the two treatment regimens (chi-square tests, p > 0.05). CONCLUSIONS : On the basis of these findings, a single dose of itraconazole 400 mg/day was as effective as the 7-day 200 mg daily dose in the treatment of pityriasis versicolor.

Tinea versicolor is a chronic superficial infection of the skin, caused by Malassezia furfur. The disease is recurrent and hard to eradicate with topical antifungal agents. In this study we compared the efficacy, safety and tolerability of three regimens of oral treatment for tinea versicolor: itraconazole 200 mg/day for 1 week, itraconazole 100 mg/ day for 2 weeks and ketoconazole 800 mg in 2 weekly doses of 400 mg. We randomly assigned 105 patients with extensive tinea versicolor to receive each of the three regimens and followed the patients for 16 weeks (a longer period than usual). At every visit, we checked the presence of tinea versicolor by direct KOH preparation and Wood's lamp, and the presence of signs and symptoms of infection were recorded. Of the 105 patients, 89 completed the study, and no major side-effects were noted with any of the treatment regimens. Our results show that there were no significant differences in efficacy (cure rate), safety and tolerability between the three treatment regimens. The maximal cure rate was achieved after 8 weeks from the start of treatment and decreased slightly afterwards. We also demonstrated a lack of correlation between mycological cure and hypopigmentation at the end of treatment (2 weeks) and the usefulness of Wood's lamp examination in detecting cure of tinea versicolor.

Superficial mycoses affect the nonliving, cornified layer of skin, hair and nails. Zoophilic organisms infect higher animals but may be sporadically transmitted to humans. While zoophilic superficial fungal infections have typically occurred from animal sources in rural areas, infections transmitted from domestic animals and pets have become increasingly common in urban and suburban areas. Direct microscopic examination of scales from the affected areas reveals multiple branched and septate hyphae (fungal elements) typical of the superficial fungal infections. The technique of direct microscopic examination depends largely on the dermatologic location of the superficial fungus and should only include keratinaceous (stratum corneum) material. Tinea versicolor is a chronically recurring superficial mycosis of the stratum corneum caused by Malassezia furfur and Pityrosporum species, and lipophilic yeasts are considered to be part of the endemic skin flora. In the case of superficial candidiasis involving the eyelids, conjunctiva and cornea, both local conditions and a generally lowered host resistance may be involved.

BACKGROUND : A number of effective topical therapies are available for the treatment of tinea versicolor (TV). However, topical antifungals are difficult to apply to a large body surface area and for this reason TV is perhaps more easily treated with systemic agents. METHODS : A total of 128 patients with TV, aged 15-55 years, were entered into a randomized, double-blind, clinical trial comparing the efficacy and tolerance of two regimens of oral treatment for TV. The patients were randomly divided in two groups: group 1 received two 150 mg capsules of fluconazole in a single dose repeated weekly for 2 weeks; and group 2 received two 200 mg tablets of ketoconazole in a single dose repeated weekly for 2 weeks. Diagnosis of TV was made clinically by direct KOH preparation and Wood's lamp examination. RESULTS : Of 128 patients, 100 completed the study and no major side-effects were noted between the two treatment regimens. Results of the study showed no significant differences in efficacy, safety and tolerability between the two treatment regimens. The maximal cure rate was achieved at 8 weeks from the start of treatment and decreased slightly afterwards. CONCLUSIONS : Fluconazole and ketoconazole demonstrated similar efficacy in the treatment of TV. We also demonstrated a lack of correlation between mycological cure and hypopigmentation at the end of treatment (2 weeks) and the usefulness of Wood's lamp examination in detecting cure of TV.

Although systemic therapies are recommended for severe or recalcitrant cases of pityriasis versicolor (PV), they are not free of important side effects and drug interactions. Photodynamic therapy (PDT) utilizes the action of singlet oxygen and free radicals produced by a light-activated photosensitizer to kill viruses, bacteria, or fungi. In this study, the effect of a PDT mediated by methylene blue (MB) in PV was evaluated. Five women with PV disseminated on the back and diagnosed by fresh microscopic analysis were treated with a solution of MB (2%) applied to the PV lesions for 3minutes. Next, a red LED lamp (λ=630±5nm, 37J/cm2 ), placed 100mm from the skin for 10minutes, was applied on the dyed PV lesions. Six sessions of MB/PDT were implemented with a 2-week interval in between. Wood's lamp examination was used to monitor fungal infection at each time point. Complete cure was observed in the five women at the 4weeks post-treatment follow-up. Fluoresce images from PV lesions by Wood's lamp allowed to evaluate whether the lesions were healed or not at each time point. No patient showed relapse at the 6-month follow-up. The patients did not have any adverse effect, and good cosmetic outcome was observed. Six sessions of MB/PDT spaced at 14-day intervals are sufficient for the treatment for PV in healthy patients.

Background: Pityriasis versicolor is a common superficial fungal infection caused by Malassezia species, presenting with hypo- or hyperpigmented scaly patches. Although systemic antifungal agents such as fluconazole and itraconazole are widely used, evidence regarding their comparative single-dose efficacy remains limited. Objective: To compare the efficacy of a single oral dose of fluconazole versus a single oral dose of itraconazole in the treatment of pityriasis versicolor. Study Design: Randomized controlled trial. Setting: Combined Military Hospital (CMH), Nowshera, Pakistan. Duration of Study: From 11 December 2024 to 11 May 2025. Methods: A total of 92 patients with clinically and microscopically confirmed pityriasis versicolor were enrolled through non-probability consecutive sampling and randomly allocated into two equal groups. Group A received a single oral dose of fluconazole 400 mg, while Group B received a single oral dose of itraconazole 400 mg. Diagnosis was confirmed using a Wood's lamp examination and a 10% KOH mount, which showed the characteristic "spaghetti and meatball" appearance. Treatment efficacy was defined as the absence of fungal elements on repeat KOH mount at 4 weeks post-treatment. Data were analyzed using SPSS version 25.0, with a chi-square test applied for comparison; p-value <0.05 was considered significant. Results: The mean age of participants was 33.11 ± 8.75 years in Group A and 32.00 ± 7.79 years in Group B, with no significant difference between groups. Fluconazole demonstrated significantly higher efficacy, with 82.6% (n = 38) of patients achieving clearance, compared to 60.9% (n = 28) in the itraconazole group (p = 0.02). Conclusion: A single oral dose of fluconazole was significantly more effective than a single oral dose of itraconazole in treating pityriasis versicolor. These findings support fluconazole as a superior first-line systemic treatment option for this condition.