Pityriasis Versicolor Patients Research Articles

Comparison of the Efficacies of Topical Liposomal Amphotericin B and Topical Clotrimazole in the Treatment of Pityriasis Versicolor.

Pityriasis versicolor (PV) often exhibits recurrence even despite treatment, and a standardized therapy with a complete cure rate remains elusive. Given the fungicidal property of amphotericin B, its potential for PV treatment warrants investigation. This study aimed to compare the efficacy of topical liposomal amphotericin B and clotrimazole cream in treating PV. A randomized controlled trial was conducted with 44 PV patients, aged 15 to 70 years, who were equally assigned to either the amphotericin or clotrimazole group. The trial was registered at the Iranian Registry of Clinical Trials on March 7th, 2022. PV diagnosis was confirmed in all patients through positive microscopic results. The amphotericin group received topical gel containing liposomal amphotericin B 0.4%, while the other group received topical cream containing clotrimazole 1%. Both treatments were applied twice daily to the affected skin lesions for 14 days. The primary outcomes assessed were mycologic cure, clinical cure, and complete cure at day 14 post-treatment. Both drugs demonstrated successful treatment outcomes, with comparable rates of mycologic cure (77.3%), clinical cure (63.6%), and complete combined cure (63.6%). There was no significant difference between the groups in terms of the degree of cure (P=0.75). Adjustments for age, sex, lesion extent, and lesion site yielded insignificant risk ratio and risk difference estimates for the complete cure rate (P>0.05).

Impacts of Clinical and Demographical Aspects on the Duration of Pytiriasis Versicolor

Background: Pityriasis versicolor (PV) or tinea versicolor is a superficial fungal infection characterized by macules on the skin. It is generally caused by the fungus Malassezia. PV is found throughout the world, especially in tropical countries. Generally, this infection is influenced by humidity, hyperhidrosis, and population density around the world. One of the ways to establish PV is through the KOH examination. Purpose: Evaluating the correlation between the clinical and demographic factors and the duration of illness of outpatient PV patients of the Mycology Division of Dermatology and Venereology Department at Dr. Soetomo General Academic Hospital from 2018 to 2020. Methods: This is an observational analytic study based on medical records at the outpatient clinic of Mycology Division of the Dermatology and Venereology Department of Dr. Soetomo General Academic Hospital. The data was collected in October 2021. The chi-square test is used to analyze the data in this study. Result: 216 PV patients’ data was collected. Most gender was male, most age group was 20-60, most weight group was 51 – 60 kg, most regional origin was from Surabaya, and most duration of infection was <3 months. In this study, topical and systemic treatment of this disease had a significant relationship with patients’ duration of illness (topical p=0.05; systemic p=0.026). Conclusion: Topical and systemic treatment of this disease has a significant relationship with the duration of illness in PV patients.

Differential lipase virulence in Malassezia furfur dimorphism isolated from pityriasis versicolor patients and healthy individuals.

Malassezia furfur is a member of the human skin microbiomes that can cause various skin diseases. Dimorphism plays a role as the yeast phase predominates during skin colonisation whereas mycelial forms are observed in the scales of patients with pityriasis versicolor (PV). However, due to their condition-dependence for growth, it is difficult to culture M. furfur and this is an additional challenge for studying the pathogenicity of this fungus. To describe different media suitable for culturing Malassezia from the yeast phase into mycelial forms, with a particular focus on nutritional supplements and pH conditions. Clinical M. furfur isolates from patients with PV and healthy individuals were used to investigate Malassezia dimorphism as well as the activity and expression of lipase enzymes. Our experimental media were significantly more likely to promote mycelial growth in strains from healthy individuals compared to those from patients with PV. Lipase activity was increased in the mycelial phase cells compared to yeast forms for all strains tested. Assessment of the relative transcriptional expression of lipase within M. furfur revealed that LIP-coding genes were upregulated in mycelium relative to yeast forms for the strains tested. However, the increases in LIP3, LIP5 and LIP6 gene expressions were significantly greater in strains from healthy individuals compared to those from patients with PV. Overall, this study validated effective growth conditions to study M. furfur virulence factors and demonstrated that lipase is associated with M. furfur dimorphism.

Comparison of virulence factors and susceptibility profiles of Malassezia furfur from pityriasis versicolor patients and bloodstream infections of preterm infants

In spite of the increasing medical interest in Malassezia yeasts, the virulence factors of Malassezia furfur causing bloodstream infections (BSI) were never investigated. Therefore, phospholipase (Pz), lipase (Lz), hemolysin (Hz), biofilm production, and in vitro antifungal susceptibility profiles were evaluated in M. furfur strains, isolated from both pityriasis versicolor (PV) patients (n=18; Group 1) or from preterm infants BSI (n=21; Group 2). All the test stains exhibited Pz activity, whereas 92.3% and 97.4% of strains exhibited Lz and Hz activities, respectively. Pz, Lz, and Hz activities were higher (i.e., lower values) within Group 1 strains (i.e., 0.48, 0.40, and 0.77) than those within Group 2 (i.e., 0.54, 0.54, and 0.81). The biofilm production was higher within Malassezia isolates from Group 2 (0.95±0.3) than from Group 1 (0.72±0.4). Itraconazole and posaconazole were the most active drugs against M. furfur, followed by amphotericin B and fluconazole. The minimum inhibitory concentrations (MIC) values varied according to the origin of M. furfur strains being statistically lower in M. furfur from Group 1 than from Group 2. This study suggests that M. furfur strains produce hydrolytic enzymes and biofilm when causing PV and BSI. Data show that the phospholipase activity, biofilm production, and a reduced antifungal susceptibility profile might favor M. furfur BSI, whereas lipase and hemolytic activities might display a synergic role in skin infection.

P127 Cytokine gene Polymorphism in superficial Malassezia associated skin diseases

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objectivesü To isolate and characterize Malassezia species from patients of Pityriasis Versicolor (PV), Atopic Dermatitis (AD), Seborrhoeic Dermatitis (SD), and healthy controls.ü To study single nucleotide polymorphism in IL-10 and IFN- γ genes of the host and its relation with susceptibility to Malassezia infection.MethodsIt was a prospective observational study done in University College of Medical Sciences and GTB Hospital, Delhi. Sample size comprised of 38 cases each of AD. Skin scrapings were used for fungal culture on Sabouraud Dextrose Agar (SDA) and Modified Dixon Agar (MDA) and isolates were identified as per conventional phenotypic methods. Genomic DNA was extracted from blood samples and Cytokine genotyping was carried out by Amplification Refractory Mutations System-Polymerase Chain Reaction (ARMS-PCR) with sequence-specific primers. Three SNPs (IL10-1082A/G; IL10-819/592C/T; IFN-g +874A/T) in two cytokine genes were assessed in all the patients and healthy controls. Chi-squared Test or Fisher's-Exact Test and Bonferroni's correction were used for statistical analysisResults Malassezia yeast was isolated in 94.7%, 63.1% each and 52.6% in PV, AD, SD, and healthy controls respectively. Malassezia globosa was the most commonly isolated species from both patient and healthy control. Malassezia sympodialis was the second most common followed by M. furfur and M. restricta. Association between specific cytokine gene polymorphism and clinical outcome was found to be significant in PV, AD, and SD group. IFN-γ +874 T allele and IFN-γ +874 A allele were significantly associated with PV and AD respectively. IFN-γ +874 AA genotype frequency was found to be higher in PV and AD patients than in controls. This finding suggests that PV and AD patients may produce a lower IFN-γ. IL10-819/592 C/T alleles were also significantly associated with PV. IL10-819/592 CT genotype frequency was found to be lower, and CC genotype frequency was found to be higher in PV patients as compared to healthy controls, suggesting that IL10 production may be higher in PV patients. AD patients were more likely to carry the IL10–1082 G allele and, it was significantly associated with this disease. Moreover, IL10-1082 AG genotype was significantly associated with AD and SD, which corresponds to high production of IL10.ConclusionThe identification of Malassezia yeast to a species level is of a great importance to determine which species are implicated in certain skin diseases.The use of phenotypic methods for identification of Malassezia species is a reliable, easily executed method, that is also inexpensive. Molecular methods are necessary to decrease the turnaround time, especially for slow-growing Malassezia species.Cytokine gene polymorphism studies in IL10 and IFN γ genes demonstrated susceptibility of host to Malassezia infections. Comparison with the serum cytokine levels will help in understanding the evolution of Malassezia infections in susceptible host.Population genetics studies require inclusion of a larger number of subjects to evaluate the probability or the frequency of occurrence of the genotype.

In Vitro Assessment of Azole and Amphotericin B Susceptibilities of Malassezia spp. Isolated from Healthy and Lesioned Skin.

Malassezia yeasts have recently gained medical importance as emerging pathogens associated with a wide range of dermatological and systemic infections. Since standardized methods for in vitro antifungal susceptibility testing have not yet been established for Malassezia spp., related diseases are always treated empirically. As a result, a high rate of recurrence and decreased antifungal susceptibility have appeared. Thus, the aims of the study were to assess and analyze the in vitro susceptibility of Malassezia isolated from pityriasis versicolor (PV) lesions and healthy controls. A total of 58 Malassezia strains isolated from PV patients and healthy controls were tested. In vitro antifungal susceptibility testing was conducted using the CLSI broth microdilution with some modifications. Candida spp. criteria established in accordance with CLSI guidelines were used for data interpretation. Ketoconazole and posaconazole seemed to be the most effective molecules against Malassezia species. However, considerable percentages of itraconazole, fluconazole, and amphotericin B ‘‘resistant’’ strains (27.6%, 29.3%, and 43.1%, respectively) were revealed in this study. Malassezia furfur, M. sympodialis, and M. globosa showed different susceptibility profiles to the drugs tested. These results emphasize the importance of accurately identifying and evaluating the antifungal susceptibility of Malassezia species in order to guide a specific and effective treatment regimen.

Virulence factors of Malassezia strains isolated from pityriasis versicolor patients and healthy individuals.

There is still little information on the virulence factors of Malassezia spp., despite their implication in severe diseases. Phospholipase, lipase, and hemolytic activities, biofilm formation and decreased antifungal susceptibility seem to contribute to their virulence in susceptible hosts.

COMPARATIVE STUDY OF EFFICACY OF COMBINED TREATMENT WITH KETOCONAZOLE 2% CREAM AND ADAPALENE 0.1% GEL VS. KETOCONAZOLE 2% CREAM MONOTHERAPY IN PITYRIASIS VERSICOLOR

Background: Pityriasis Versicolor (PV) is an infection of the superficial layers of skin caused by Malassezia yeasts. It is a non-contagious disease characterized by hypo and hyperpigmented macules on the body. Up to 40% of people face itching, decreased quality of life, social stigmatization, and embarrassment due to the lesions. Adapalene with Ketoconazole provides an efficient option for PV patients due to better toxicity profile and rapid action on the lesions.
 Objective: Comparison of efficacy of combined therapy with Ketoconazole 2% cream and adapalene 1% gel against Ketoconazole 2% cream monotherapy in Pityriasis Versicolor.
 Methods: Total 90 patients (45 in each group) were included in the study. Group-A was treated with combination of Ketoconazole 2% cream & adapalene 1% gel while group-B was given Ketoconazole 2% cream monotherapy. Study design was randomized controlled trial and SPSS version 26 was used for data analysis.
 Results: Mean age of the patients was 24.3±4.3 and 23.3±3.9 years in group-A and B, respectively. There were 30 males (66.7%) & 15 females (33.3%) in group-A while 35 males (77.8%) and 10 females (22.2%) in group-B. Mean duration of disease was 2.0±0.9 months in group-A & 2.3±1.2 months in group-B.The efficacy of combined therapy with Ketoconazole 2% cream & adapalene 1% gel was found to be better when compared with Ketoconazole 2% cream monotherapy in Pityriasis Versicolor. Difference between two groups (p=0.011) was statistically significant.
 Conclusion: It was concluded that adapalene 0.1% gel & ketoconazole 2% cream in combination is more effective than ketoconazole 2% cream monotherapy in the treatment of PV.
 Recommendation: It is recommended to use a combination of adapalene 0.1% gel & ketoconazole 2% cream than ketoconazole 2% cream monotherapy in the treatment of PV.
 

Epidemiology of Pityriasis versicolor in Tunisia: Clinical features and characterization of Malassezia species

Malassezia (M.) genus includes commensal yeasts of increasing medical importance, as they result in many diseases, ranging from pityriasis versicolor (PV) to systemic infections. Previous studies reported geographical variations in distribution of Malassezia species in PV lesions. The aims of the current study were to define the clinico-demographic features of PV in Tunisia, to characterize Malassezia isolates using phenotypic and molecular techniques and to find out any association between species and clinico-demographic parameters.In total, 120 PV patients were enrolled in this study. Skin scrapings were collected and inoculated on Sabouraud agar and modified Dixon medium. Malassezia species were identified using conventional phenotypic methods and 26 s rDNA PCR-RFLP. The highest prevalence of PV was observed among young adults’ group. The most affected body areas were the back and neck. In overall, 50.8% and 35% of PV cases had pruritus and history of recurrence respectively. The overall concordance between phenotypic and molecular methods was high (80.95%). The discordant results are rather due to the presence of multiple species in a single culture than true misidentification. Using PCR-RFLP, M. furfur was the most isolated species (38.7%) followed by M. globosa (37.7%), M. restricta and M. sympodialis. No statistically significant association was noted between Malassezia spp. and clinico-demographic characteristics. Unlike many reports from temperate climate countries, M. furfur and M. globosa along together were the most frequently isolated species in Tunisian PV patients. Although phenotypic methods remain simple and cost-effective, molecular techniques are considered as fast and accurate methods for diagnosis purposes.

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.

Wood’s lamp an antique but precious diagnostic tool: A descriptive observational study of fluorescence pattern with wood’s lamp in clinically diagnosed patients with pityriasis versicolor

Although Pityriasis Versicolor(PV) may be virtually recognized by their characteristic clinical appearance. It is very difficult to diagnose atypical pityriasis versicolor occurring in uncommon sites especially flexural areas and extremities. Uncommon variant type such as plaque type of PV is difficult to differentiate from morphologically similar clinical conditions. Recurrence correlates with the extent of the skin lesions. All these clinical difficulties is overwhelmed by the effective basic tool Wood’s lamp.This study was an observational descriptive study, totally comprised of 100 clinically diagnosed cases of PV attending Dermatology Outpatient Department over a period of 1 year (October 2019 to October 2020) at Rajah Muthaiah Medical College. Ethical clearance was sought from Institutional Ethical Committee. After obtaining written informed consent detailed history was taken in relation to age, sex, duration of illness, and recurrent infections. Clinical examination of lesion includes site, types of lesions, and scaling. All the PV patients were evaluated under Wood’s lamp examination.To study the fluorescence pattern in clinically suspected cases of Pityriasis Versicolor.Out of 100 cases categorized into new and recurrent of PV cases were studied. Patients presented with achromic lesions 76 (76%), chromic were 20 (20%), combined chromic and achromic skin lesions were 4 (4%). Wood’s lamp yellow fluorescence were observed in 66(86.8%) among 76 chromic PV cases, 18(90%) patients among achromic 20 cases and the all the four cases of combined variant of PV(4%). We observed yellow fluorescence under Wood’s lamp in 88 cases (88%) out of 100 cases.Wood’s lamp adds a diagnostic value to find out the extent of PV early, and provides a valuable therapeutic tool to choose the mode of antifungal therapy to avoid recurrence and hypopigmentation thereby ensure complete clearance of PV by follow up Wood’s lamp examination. It was also useful to differentiate the similar morphological conditions.

Retrospective Study of Self Esteem in Patients with Pityriasis Versicolor

Background: Pityriasis Versicolor (PV) is a fungal infection of the skin, caused by the Malassezia sp., a genus of fungi. Patients commonly present with bordered skin patches of white, grey, and sometimes brown on their skin surface. The prominent changing of skin colour in exposed areas of the skin may cause feelings of insecurity to the patients and become limelight for other people, impacting their self esteem. Purpose: To evaluate the self esteem profile in PV patients at the dermatovenereology outpatient clinic of Dr. Soetomo General Academic Teaching Hospital Surabaya. Methods: This was a retrospective descriptive study based on medical records of the dermatovenereology outpatient clinic of Dr. Soetomo General Academic Teaching Hospital Surabaya. The data were collected from June 2018 to May 2019. This research evaluates PV patients's profiles by age, sex, education level, occupation, residential environment, site of infection, duration of the infection, and self esteem. The patient's self esteem was assessed using the Rosenberg Self Esteem Scale (RSES). Result: Fiftythree PV patient’s self esteem values were successfully recorded. Of the 53 patients, the score was low in 3 people (5.67%), the normal score in 50 people (94.33%), and no one had a high score. Of the 3 people with low self esteem scores, 2 of them were men, consisting of 1 teenager and 2 adults, having basic education levels, who were students and housewives. The three patients had the infection for more than 3 months and they resided in Tambaksari, Wonocolo, and outside Surabaya. Conclusion: The majority of PV patients at the dermato-venereology outpatient clinic of Dr. Soetomo General Academic Teaching Hospital have normal self esteem scores.

Relationship between helicobacter pylori infection and pityriasis versicolor: can helicobacter pylori infection be a new etiologic factor for pityriasis versicolor?

Background/aim H. pylori has been found to be related to certain dermatological diseases. However, there is no data as yet to propose an association between H. pylori and pityriasis versicolor. In this study, we aimed to evaluate the association between H. pylori and pityriasis versicolor.Materials and methodsThis was a prospective study performed in the Gastroenterology and Dermatology and Venereology departments of the Health Sciences University, Ankara Training and Research Centre. A total of 57 consecutive patients (27 pityriasis versicolor, 30 telogen effluvium) were enrolled from the Department of Dermatology and Venereology. All patients were screened for H. pylori IgG and CagA. In addition, urea breath test was carried out to detect the existence of H. pylori infection.Results There were significantly higher rates of H. pylori positivity, H. pylori IgG in serum in the pityriasis versicolor group compared to the telogen effluvium group (P < 0.05). In addition, the number of patients with dyspeptic complaints was higher in the pityriasis versicolor group than in the telogen effluvium group. The odds ratio for dyspepsia, H. pylori positivity, and H. pylori IgG were 2.48, 1.67, and 1.78, respectively.Conclusion In this study, we found a statistically significant relationship between H. pylori infection and pityriasis versicolor. Therefore, H. pylori eradication could be considered in recurrent pityriasis versicolor patients with dyspepsia. New studies are required to clarify the effect of eradication treatment on the clinical course of pityriasis versicolor.

Epidemiological characterization of pityriasis versicolor and distribution of Malassezia species among students in Hai Phong city, Vietnam.

Background and Purpose: Pityriasis versicolor (PV) is a common fungal skin infection caused by Malassezia species. Previous studies have shown that the prevalence of PV is influenced by geographic factors. The aim of the current study was to find the epidemiological characteristics of PV and distribution of Malassezia species in the secondary school students living in Hai Phong city, Vietnam.Materials and Methods: This study was conducted on 1357 students within the age range of 10 - 16 years selected from four secondary schools in Hai Phong city. The students were screened for PV skin lesions from August 2016 to December 2017. The isolates of Malassezia from PV patients were analyzed by performing direct microscopy and culturing on modified Dixon agar plates, containing gentamicin, at 32oC for 7 days. In the next stage, the fungal strains obtained from patients with positive fungal cultures were identified using the CHROMagarTM Malassezia medium, polymerase chain reaction-restriction fragment length polymorphism techniques, and D1/D2 rDNA genome sequencing.Results: Pityriasis versicolor was diagnosed in 305 (22.48%) students and confirmed by clinical appearance and direct examination. A total of 293 (96.07%) samples grew on modified Dixon agar. With regard to demographic characteristics, 50.49% of the PV cases were female, and 57.38% of cases resided in urban areas. Furthermore, 88.52% of the subjects had the illness duration of more than 6 months. Hypopigmented and erythematous skin lesions were also observed in the research participants, with hypopigmentation being the most frequent condition (97.05%). Most of the Malassezia fungal strains were isolated from the back (39.56%), face (23.99%), and chest (16.51%). Malassezia furfur and M. japonica accounted for PV in 96.25% and 3.75% of the cases, respectively. Furthermore, Malassezia furfur was distributed in both rural and urban areas, while M. japonica was found only in the urban areas.Conclusion: The findings of the present study were indicative of the high prevalence of Malassezia yeasts, mostly M. furfur, among the students in Hai Phong city, Vietnam

Adapalene gel 0.1% vs ketoconazole cream 2% and their combination in treatment of pityriasis versicolor: A randomized clinical study.

Pityriasis versicolor (PV) is a chronic superficial fungal infection. Management using azole drugs leads to drug resistance. The present study aimed to compare the clinical outcome of 0.1% adapalene gel vs 2% ketoconazole cream and their combination in PV. This randomized double-blinded study was conducted on 90 PV patients divided into three equal groups. GI was treated with topical ketoconazole 2% cream twice daily and placebo, GII was treated with topical 0.1% adapalene gel twice daily and placebo and GIII was treated with topical combination of 0.1% adapalene gel (at night) and ketoconazole 2% cream (in the morning). All patients received medications for 4 weeks. Evaluation was done at 2 and 4 weeks and included clinical assessment, laboratory assessment, and patient satisfaction. We found that after 4 weeks of treatment, all groups showed significant improvement. There was better response in GIII in terms of lower rate of positive potassium hydroxide staining, higher rate of significantly improved cases and higher rate of well-satisfied patients. However, the difference fell short of statistical significance. We concluded that a combination of adapalene gel and ketoconazole cream is very effective in treatment of PV with no or mild side effects.

Therapeutic efficacy of topical luliconazole versus topical ketoconazole in the treatment of pityriasis versicolor patients: a hospital based comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; To evaluate the clinical efficacy of 1% topical luliconazole versus 2% topical ketoconazole in pityriasis versicolor patients.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Mycological examination of all the pityriasis versicolor patient was done by using skin scrapings were collected from the skin lesions to prepare for 10% KOH mount, which was examined under the microscope to note the findings as KOH mount positive or negative for Malassezia fungi. KOH mount positive or negative was noted at 0 days, 2 weeks and 4 weeks continued treatments with luliconazole and ketoconazole.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; At the first days, majorities of patients 46 (92%) of luliconazole group were positive for KOH mount. At 14 days treatment with luliconazole, patients had 11 (22%) positive for KOH mount. At the 28 days treatment with luliconazole, only 2 (4%) patients were positive and most of the patients 49 (98%) were negative for KOH mount. Similarly, in ketoconazole group patients, 47 (94%) patients were positive for KOH mount in beginning of treatment. At 14 days treatment with ketoconazole 16 (32%) patients were positive and 34 (68%) patients were negative for KOH mount. And at the 28 days with treatment of ketoconazole 13 (26%) patients were positive and most of the patients 37 (74%) were negative for ketoconazole.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Male population as well as age 26-35 years were more prone for pityriasis versicolor infection. On two weeks of treatment luliconazole and ketoconazole had near about similar efficacy against pityriasis versicolor. But, on continue 4 weeks of treatment regimens topical luliconazole had more clinically efficacious than ketoconazole against pityriasis versicolor.&lt;/p&gt;

Molecular epidemiology, in vitro susceptibility and exoenzyme screening of Malassezia clinical isolates.

Introduction. Malassezia folliculitis (MF) and pityriasis versicolor (PV) are common dermatoses caused by Malassezia species. Their molecular epidemiology, drug susceptibility and exoenzymes are rarely reported in China.Aim. To investigate the molecular epidemiology, drug susceptibility and enzymatic profile of Malassezia clinical isolates.Methodology. Malassezia strains were recovered from MF and PV patients and healthy subjects (HS) and identified by sequencing analysis. The minimum inhibitory concentrations (MICs) of nine antifungals (posaconazole, voriconazole, itraconazole, fluconazole, ketoconazole, miconazole, bifonazole, terbinafine and caspofungin) and tacrolimus, the interactions between three antifungals (itraconazole, ketoconazole and terbinafine) and tacrolimus, and the extracellular enzyme profile were evaluated using broth and checkerboard microdilution and the Api-Zym system, respectively.Results. Among 392 Malassezia isolates from 729 subjects (289 MF, 218 PV and 222 HS), Malassezia furfur and Malassezia globosa accounted for 67.86 and 18.88 %, respectively. M. furfur was the major species in MF and PV patients and HS. Among 60M. furfur and 50M. globosa strains, the MICs for itraconazole, posaconazole, voriconazole and ketoconazole were <1 μg ml-1. M. furfur was more susceptible to itraconazole, terbinafine and bifonazole but tolerant to miconazole compared with M. globosa (P<0.05). Synergistic effects between terbinafine and itraconazole or between tacrolimus and itraconazole, ketoconazole or terbinafine occurred in 6, 7, 6 and 9 out of 37 strains, respectively. Phosphatases, lipases and proteases were mainly secreted in 51 isolates.Conclusions. Itraconazole, posaconazole, voriconazole and ketoconazole are theagents against which there is greatest susceptibility. Synergistic effects between terbinafine and itraconazole or tacrolimas and antifungals may be irrelevant to clinical application. Overproduction of lipases could enhance the skin inhabitation of M. furfur.

Molecular Identification and Quantification of Malassezia Species Isolated from Pityriasis Versicolor.

Background:Pityriasis versicolor (PV) is the most common chronic superficial infection of the stratum corneum, reported in 40–60% of the tropical population. After the description of the new Malassezia species, only a few studies have been conducted from India.Aims:Molecular identification, quantification of Malassezia species implicated with PV and correlation to its clinical presentation.Materials and Methods:The subjects include 50 PV patients, who attended the dermatology outpatient department of our hospital and 50 healthy individuals. Same size area of the skin was sampled from lesional and non-lesional sites in the patient group and from forehead, cheek, and chest of healthy individuals. Malassezia spp. isolated were identified by conventional method and confirmed by ITS2 PCR-RFLP and sequencing of D1/D2 region of 26S rDNA.Results:Eighty percent of patients presented with hypopigmented lesions and 20% with hyperpigmented lesions. From PV lesions, the most frequently isolated species was M. furfur (50%), followed by M. globosa (27.3%), mixture of M. furfur and M. globosa (15.9%), M. sympodialis (4.5%), and M. slooffiae (2.3%). Higher Malassezia density was found in lesional area as compared to non-lesional area of PV patients and in healthy individuals (P 0.0001).Conclusion:Although M. furfur was the most prevalent species isolated from both patients and controls, significantly higher isolation of M. globosa from the lesional area compared to non-lesional area indicates its possible role along with M. furfur in causing PV.

Thioredoxin is a potential pathogenesis attribute of Malassezia globosa and Malassezia sympodialis in pityriasis versicolor

BackgroundThioredoxin (Trx) is a member of pan-allergen family which has been identified in some fungi. Due to cross-reactivity to human Trx, the Trx of Aspergillus fumigatus and Malassezia sympodialis (M. sympodialis) can lead to the exacerbation of severe atopic diseases. However, the role of Trx in pityriasis versicolor (PV) is unclear. PurposeTo evaluate the role of Trx protein of M. sympodialis and M. globosa in PV. MethodologyUsing RNA-seq technology, the MGL-1781 gene was found to be highly expressed in M. globosa isolated from PV patients. Based on the protein BLAST analysis, this gene was predicted to encode the hypothetical Trx protein of M. globosa. The expression level of the MGL-1781 gene along with the Trx encoding gene of M. sympodialis (Mala s 13) were quantified using real-time PCR assay among isolates from pityriasis versicolor (PV) patients and healthy controls. ResultsWe found that the expression of MGL_1781 and Mala s 13 genes were significantly different among M. globosa and M. sympodialis isolated from PV patients and healthy individuals. The expression mean of the MGL-1781 and Mala s 13 genes were 103.919 and 1074.365, respectively. ConclusionOur results indicated that the MGL-1781 and Mala s 13 genes may respectively contribute to the virulence of M. globosa and M. sympodialis in PV, which warrant further investigations in this area.

Phenotypic Identification and Molecular Characterization of Malassezia Spp. Isolated from Pityriasis Versicolor Patients with Special Emphasis to Risk Factors in Diyala Province, Iraq.

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.