Treatment Of Tinea Versicolor Research Articles

A Review on the Study of Pathogenesis and Herbal treatment of Tinea versicolor

Tinea Versicolor are fungal infections caused by micro-organism Malassezia furfur. The infections led to symptoms such as white and black patches onto the skin, however, the infections can be treated by using antifungal preparations. The disease is not severe but on long term, if left untreated, may lead to various skin disorders. In this article, a brief study of the disease as well as the nature of the micro-organism has been shown. Along with the full description of the disease such as pathophysiology and diagnosis, a novel approach for its treatment using the natural herbs has been discussed which may be the limelight of this paper. Herbs which are inhabitated in nature having anti-fungal activity has been thoroughly studied along with its legit researches and experiments.

A comparative study of oral Ketoconazole versus Itraconazole in the treatment of Tinea versicolor

Tinea (pityriasis) versicolor is a superficial fungal infection and one of the most commonly found pigmentary disorders of the skin caused by the yeast Malassezia. Multiple topical as well as systemic therapies are available for treatment. Systemic therapies are used for extensive disease, frequent relapse or where topical agents have failed. The aim that translates the rationale of the study was to compare the efficacy, safety, tolerability and cost effectiveness of oral ketoconazole dose 200mg daily for 7 days versus a single dose of 400 mg of itraconazole in the treatment of tinea versicolor. A total of 64 patients (aged 18-50 years) were selected for the study from the period of June 2019 to November 2019 in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Bangladesh. Cases having extensive involvement were diagnosed clinically and confirmed by wood's lamp and KOH microscopy was taken. Patients were randomly allocated into equal groups. Group A was given oral ketoconazole dose 200mg daily for 7 days and Group B has given a single dose of 400 mg of itraconazole. 47 (73.4%) male and 17(26.6%) female were included in the study. The mean age of group A was 29.2(SD±8.6) and in group B 28.2(SD±8.5) years. The mean duration of the disease in group A was 3.9(±2.7) months and 3.5(±2.2) months in group B. In group A clinical responders was found cure 25(78.1%), improvement 5(15.6%) and failure in 2(6.2%) and in group B it was found cure 22(68.8%), improvement 7(21.87%) and failure 3(9.4%) at one month. At two months in the group A clinical responder was found to cure 22(68.8%), improvement 5(15.6%), failure in 3(9.4%) and relapse 2(6.2%). In group B it was found cure 18(56.2%), improvement 6(18.75%), failure 4(12.5%) and relapse 4(12.5%). Both oral ketoconazole dose 200mg daily for 7 days versus single dose 400 mg of itraconazole can be effective in the treatment of tinea versicolor with extensive involvement.
 CBMJ 2020 July: Vol. 09 No. 02 P: 26-33

Comparison between the Efficacies of Clotrimazole in the Treatment of Both Forms of Tinea Versicolor

Tinea versicolor is a common skin disorder seen in the daily dermatological practice. Tinea versicolor is an endogenous opportunistic infection caused by Malassezia yeasts which are part of the normal flora that normally live on the skin. Several systemic and topical treatments have been used in the treatment of tinea versicolor but their use has been limited by their side effects or variable therapeutic response. Therefore, there is ongoing search for safer and more effective drugs. In this study, it was aimed to evaluate the safety and the efficacy of topical clotrimazole in the treatment of tinea versicolor. The study included 20 patients of tinea versicolor (10 hypo- and 10 hyperpigmented TVC) who were treated with clotrimazole 0.1% cream. All patients were selected from the outpatient clinics of Dermatology and Andrology Department of Benha University Hospitals. From this study we can conclude that clotrimazole is equally effective in both forms of tinea versicolor.

The Formulation of Lotion Preparations of Betel Leaf Extract (Piper betle)

Betel leaf ( Piper betle ) contains an essential oil that has extreme antiseptic power (bactericidal and fungicidal). Betel leaf ( Piper betle ) can be used in the treatment of Tinea versicolor or known in the community as panu . However, its use in the form of leaves is considered impractical by the public and also difficult to obtain. This research formulated betel leaf ( Piper betle ) into lotion preparations, so its use in the community can be more practical. This study aims to determine the type and concentration of the suspending agent used to produce lotion preparations from betel leaf extract ( Piper betle ), which has optimal physical quality. This research was an experimental study. The distillation of betel leaf ( Piper betle ) was carried out to get essential oils. The essential oils of betel leaf ( Piper betle ), which was used as an active substance in formulations, was 5%. Suspending agents that were used in this study were Arabic gum with concentrations of 10%, 15%, 20%, and CMC Na, with concentrations of 0.25%, 0.5%, and 1%. The formulation of lotion preparations included organoleptic observation, pH test, homogeneity test, and adhesion test. Based on the physical quality test of the lotion preparations that had been conducted, it can be concluded that the lotion preparations of betel leaf extract with 20% concentration of Arabic Gum suspending agent had physical qualities in accordance with lotion dosage criteria.

Perbedaan Zona Hambat Terhadap Jamur Malassezia Furfur Antara Pemberian Ekstrak Umbi Bawang Putih (Allium Sativum Linn) Dengan Ekstrak Kulit Umbi Bawang Putih (Allium Sativum Linn)

Tinea versicolor or pitiriasis versicolor is a skin disorder caused by Malassezia furfur infection which is a fungal infection on the skin of the chronic surface. Clinical features is in the form of fine spots that colored white to brown black, this infection is also called a skin fungus with blotches. Treatment of Tinea versicolor can use chemical or traditional medicine. Chemical treatments such as creams or ointments cause sticky taste, while one of the traditional medicine is the bulb and skin of the garlic bulb (Allium sativum Linn) containing allicin substances that are efficacious as an anti-fungal. This research is an experimental research with the aim to know the difference of inhibition zone to Malessezia furfur fungus. There are 3 treatments with 9 repetitions. The extraction method used is the soxhlet method. Anti-fungal activity test was done by using rating method, Saboroud Dextrose Agar (SDA) media which has been inoculated with suspension of Malassezia furfur with concentration 1.5x108 CFU/ml (Mc Farland standard). Result of data analysis obtained by ANOVA p = 0,000 < α = 0,05, that there is difference of inhibition zone from treatment of garlic bulb extract and skin of garlic bulb (Allium sativum Linn). It is indicated that there is effect of giving garlic bulb extract (Allium sativum Linn) and garlic bulb skin (Allium sativum Linn) to Malassezia furfur fungus. Further tests were performed to compare mean treatment i.e. HSD test. It was obtained sig (p) 0,016 > α 0,05 which means bulb extract and garlic bulb skin (Allium sativum Linn) have different effect. Keywords: Tinea versicolor, Malassezia furfur, garlic bulb.

Blad-containing oligomer: a novel fungicide used in crop protection as an alternative treatment for tinea pedis and tinea versicolor.

The lack of novel antifungal drugs and the increasing incidence and severity of fungal infections are major concerns worldwide. Herein, we tested the activity of the Blad-containing oligomer (BCO), a new antifungal molecule already in use for agriculture, on Malassezia spp. and dermatophytes, the causal agents of human tinea versicolor and tinea pedis. Given the lack of a standard method for Malassezia susceptibility testing and the plethora of published methods, we also developed an improved method for this genus. The efficacy of BCO was assessed in vitro and compared to that of the drugs currently utilized in the treatment of tinea versicolor (fluconazole and itraconazole) and tinea pedis (itraconazole and terbinafine). For dermatophytes, the standard microdilution broth-based method was used, with small adjustments, and several broth formulations and inocula sizes were tested to develop an improved susceptibility method for Malassezia spp. We successfully developed a microdilution broth-based method with considerable advantages over other available methods, and used it for all in vitro susceptibility tests of Malassezia spp. isolates. We report that, on a molar basis, BCO was more effective than fluconazole or itraconazole on most strains of Malassezia spp. isolated from clinical samples (n=29). By contrast, BCO was less effective than itraconazole or terbinafine on the common dermatophytes Trichophyton rubrum and Trichophyton interdigitale. These data place BCO as a promising drug for the treatment of Malassezia-associated skin diseases. Further in vivo studies are now required to ascertain its applicability in the clinical setting.

An open-label study of naftifine hydrochloride 1% gel in the treatment of tinea versicolor

Tinea versicolor (TV) is a superficial cutaneous fungal infection characterized by cutaneous pigment changes, pruritus, scaling, and erythema. This open-label, single-center pilot study evaluated the efficacy and safety of naftifine 1% gel applied twice daily for 2 weeks in 10 men and women (median age 38 years) with TV. Baseline mycology status was determined by potassium hydroxide (KOH) and microscopy and clinical symptom severity (CSS) scored by the investigator using a 0 to 9 scale (0=absent, 9=worst). Patients applied naftifine HCI 1% gel to the affected area twice daily for 14 days. They returned for follow-up efficacy and safety assessments at the end of treatment (week 2), 2 weeks after treatment (week 4), and 6 weeks after treatment (week 8). All patients had a positive mycology at baseline; one was KOH negative at week 2, two were negative at week 4, and five (50%) were negative at week 8. Mean investigator total CSS score decreased from a baseline value of 4.7 to 3.2 at week 2 (32% improvement), 2.6 at week 4 (45% improvement), and 2.7 at week 8 (43% improvement). The patients rated their symptoms to be improved at all follow-up visits. There were no treatment-related adverse events during the study. These results suggest that naftifine 1% gel is a safe and efficacious topical treatment for TV.

Effect of medium composition and light on root and rhinacanthin formation in Rhinacanthus nasutus cultures

Rhinacanthus nasutus (L.) Kurz (Acanthaceae) has long been used in Thai traditional medicine for treatment of tinea versicolor, ringworm, pruritic rash, and abscess. The active constituents are known as a group of naphthoquinone esters, rhinacanthins. This work focused on establishment of R. nasutus root cultures and determination of rhinacanthin production. Induction of R. nasutus root formation was accomplished on solid Gamborg’s B5 (B5) medium, supplied with 0.1 mg/L indole-3-butyric acid (IBA) and 20 g/L sucrose. The effects of explants (whole leaf explants and four-side excised leaf explants), light and medium composition on root and rhinacanthin formation were investigated. The root formation from the whole leaf explants was 10 times higher than that from the four-side excised leaf explants. In addition, light possessed an inhibitory effect on the root and rhinacanthin formation of R. nasutus. Medium manipulation found that Murashige and Skoog (MS) medium supplied with 3 mg/L IBA and 30 g/L sucrose was the most suitable for induction of the root formation. Unfortunately, the obtained root cultures produced only rhinacanthin-C in very low amount, 0.026 mg/g dry weight (DW), when they were transferred into the same MS liquid medium. With semisolid medium (4 g/L agar) of the same MS composition, however, the root cultures appeared to produce higher content of rhinacanthin-C, -D and -N (3.45, 0.07 and 0.07 mg/g DW, respectively). Our finding suggests that culturing in semisolid medium is capable of improving of rhinacanthin production in R. nasutus root cultures.

Flutrimazole shampoo 1%versus ketoconazole shampoo 2% in the treatment of pityriasis versicolor. A randomised double‐blind comparative trial

Flutrimazole is an imidazole derivative that has been proven to be efficient in superficial skin fungal infections. The aim of this randomised double-blind study was to compare for the first time, the efficiency and safety of flutrimazole 1% shampoo versus ketoconazole 2% shampoo in the treatment of tinea versicolor. Study population consisted of 60 patients with pityriasis versicolor diagnosed clinically and through direct microscopy and culture. Patients were randomly assigned to two groups: one instructed to apply flutrimazole shampoo 1% and one instructed to apply ketoconazole shampoo 2% both on head and body for 14 days. Patients were re-evaluated 14 days after the end of treatment clinically and through direct microscopy and culture. Twenty-one of 26 patients (80.8%) in the ketoconazole and 22 of 29 patients (75.9%) in the flutrimazole group had both visual healing and negative mycological evaluation. Comparison of the response between the two groups with the Yates' corrected chi-square was found statistically not significant (chi(2) = 0.19, d.f. = 1, P = 0.91). None of the patients in the two groups reported any adverse effects. Fourteen (53%) patients in the ketoconazole group and 23 (79%) in the flutrimazole group assessed the shampoos as cosmetically acceptable regarding texture, smell and foam properties. Flutrimazole shampoo 1% appears to present efficacy comparable with ketoconazole 2% in the treatment of tinea versicolor.

Oral Fluconazole in the Treatment of Tinea Versicolor

This study was designed to assess the efficacy, tolerability, and safety of oral fluconazole given at 300 mg once weekly for two weeks in the treatment of tinea versicolor. Enrolled into the study were 44 subjects with tinea versicolor, provisionally confirmed by the detection of fungal hyphae in KOH wet mounts and Wood's lamp examination. Four subjects were classified as dropouts because no information was obtained from them after the baseline visit. Subjects were treated for two weeks orally with fluconazole 300 mg weekly and followed at the 1st, 2nd, 4th and 12th weeks of treatment. The study included 40 subjects (26 males and 14 females, mean age 29 years, range 19-48 years). At the week 4 visit, 30 (75%) patients showed a complete cure and 31 (77.5%) patients showed mycologic cure. Ten (25%) patients had no significant response to therapy. At the final follow-up visit (week 12), none of the patients showing complete or mycologic cures exhibited a recurrence. No adverse effects were observed in any of the patients treated. We believe that, due to the low incidence of side effects, shorter treatment duration, and increased adaptation of the patients, fluconazole can be used in the treatment of tinea versicolor with confidence.

Artemisia sieberi lotion 5% compared with Clotrimazole lotion in the treatment of Tinea versicolor

To determine the effect of Artemisia sieberi lotion in signs & symptoms of Tinea versicolor, a randomized, double - blind clinical trial was performed comparing topical application of Artemisia sieberi lotion with Clotrimazole topical lotion, twice daily for 2 week. 60 patients suffering from Tinea versicolor completed the study. 29 patients were treated with Artemisia sieberi lotion and 31 pateints with Clotrimazole topical lotion. In our study, the most common site of infection were back (23.3%) & chest (21.6%). The clinical symptoms improved significantly at 2nd week (77.42%) and 2 week later (93.5%) in Artemisia sieberi group compared with Clotrimazole lotion (60.7% and 57.14%, respectively) In microscopic study, negative direct smear observed in Artemisia sieberi group was 87.1% in 2nd week and 100% in 4th week (P=0.001) (69% vs 61.5% in Clotrimazole group, P=0.001). Treatment-related adverse evonts were not reported in 2 groups. A twice-daily application of Artemisia sieberi lotion was effective in the treatment of Tinea versicolor.

Comparison of a single 400 mg dose versus a 7-day 200 mg daily dose of itraconazole in the treatment of tinea versicolor

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.

Ketoconazole 2% shampoo in the treatment of tinea versicolor: A multicenter, randomized, double-blind, placebo-controlled trial

Background: Tinea versicolor is a common superficial fungal infection caused by a lipophilic yeast. This chronically recurring opportunistic infection is especially prevalent in tropical and semitropical regions. The topical short-term application of ketoconazole 2% shampoo may provide effective and safe therapy for tinea versicolor. Objective: The purpose of this study was to evaluate the efficacy and safety of a single application (1 day) versus three daily applications (3 days) of ketoconazole 2% shampoo versus placebo shampoo in the treatment of mycologically confirmed tinea versicolor. Methods: Three hundred twelve patients were included in the primary analyses for this 31-day study. Global evaluation scores were measured on days 10 and 31 with a 5-point scale (1 = healed to 5 = worsening), and a cellophane tape test was done at baseline and days 3, 10, and 31. Efficacy was assessed by clinical response, defined as both a global evaluation score of 1 (healed) and a negative cellophane tape test on day 31. Signs and symptoms of tinea versicolor (scaling, itching, erythema, hypopigmentation, hyperpigmentation) also were evaluated at baseline, day 10, and day 31 with a 4-point scale (0 = absent to 3 = severe). Results: Both regimens of ketoconazole shampoo were significantly ( P < .001) more effective than placebo for rate of clinical response, global evaluation scores, and mycologic outcomes (cellophane tape test). The clinical response rates at day 31 were 73%, 69%, and 5% for the 3-day ketoconazole, 1-day ketoconazole, and placebo groups, respectively. The difference in the efficacy of the two ketoconazole treatment regimens was not statistically significant. There were no significant differences between any of the treatment groups in the number of patients who experienced adverse events. No serious adverse events occurred and no patient withdrew from the trial prematurely because of an adverse event. Conclusion: Ketoconazole 2% shampoo, used as a single application or daily for 3 days, is safe and highly effective in the treatment of tinea versicolor. (J Am Acad Dermatol 1998;39:944-50.)

Fluconazole in the treatment of tinea versicolor

Patients with tinea versicolor (TV, n= 603) aged 18–65 years entered into an open, randomized, multicenter study to investigate the efficacy and toleration of three dosage regimens of fluconazole. The study was conducted in 10 different centers in six cities in Egypt.The patients were randomly assigned to one of three groups:Group I: received single 150 mg fluconazole capsule repeated weekly for 4 weeks;Group II: received two 150 mg capsules of fluconazole in a single dose repeated weekly for 4 weeks;Group III: received two 150 mg capsules of fluconazole in a single dose that could be repeated 2 weeks later.Five visits were scheduled for each group and the last follow‐up visit was always 28 days after the last fluconazole dose. Response to treatment was assessed clinically and by microscopic examination of KOH mounts of skin scrapings, weekly and 28 days after the last fluconazole dose. The number of fluconazole doses administered was guided by clinical and mycologic response, and the dose was repeated only if the patient showed residual clinical lesions or positive microscopy for skin scrapings.Final evaluation was rated as cure (disappearance of lesions with no or slight color changes), improvement (no scales while color changes were much less but still obvious), and failure (no or slight changes from baseline). Mycologic assessment was rated as eradication, persistence or relapse. All adverse events were recorded during the treatment period.

Double-blind comparison of 2% ketoconazole cream and placebo in the treatment of tinea versicolor

Malassezia furfur (Pityrosporum orbiculare) was confirmed by microscopic potassium hydroxide (KOH) examination in 101 patients with recurring lesions of tinea versicolor. In a double-blind comparative study, patients were randomly assigned to once-daily ketoconazole 2% or placebo cream. At the end of treatment, 98% (p less than 0.0001) of the patients using ketoconazole and 28% of those using placebo responded clinically (healed or had mild residual disease). There was an overall 84% mycologic cure rate (negative KOH at treatment end) for patients using ketoconazole 2% cream and 10% for those using placebo cream (p less than 0.0001). Ketoconazole-treated patients who were cured at the end of treatment remained cured 8 weeks later. By contrast 75% of those responding to placebo had relapsed by the 8-week follow-up visit. Follow-up after 2 years revealed that 79% (38/48) of the patients treated with ketoconazole remained clear 12 or more months.

Double-blind efficacy study of selenium sulfide in tinea versicolor

Selenium sulfide (2.5%) lotion applied daily for 10 minutes for 7 consecutive days was found to be an effective therapeutic agent, significantly superior to the vehicle, in a double-blind study in the treatment of tinea versicolor. Mild transitory contact dermatitis of the primary irritant type occurred in all the treatment groups and was apparently due to the detergent base.

1% Sulconazole Cream v 2% Miconazole Cream in the Treatment of Tinea Versicolor

Sulconazole nitrate, a new imidazole derivative, was formulated at 1% concentration in a cream vehicle and compared with 2% miconazole nitrate cream in the treatment of tinea versicolor in a double-blind, multicenter, randomized, parallel clinical trial. At baseline, all of the 192 patients enrolled had a positive potassium hydroxide (KOH) preparation; itching was reported by 48% of the patients. The medications were applied twice daily for three weeks. Of 181 patients analyzed for efficacy at the end of the treatment trial, 93% of sulconazole-treated patients and 87% of miconazole-treated patients had become KOH negative. The complete clearing of tinea versicolor lesions occurred in 89% of sulconazole-treated patients and 82% of miconazole-treated patients. Both drugs were well tolerated with no systemic reactions reported. Drug-related adverse cutaneous reactions, predominantly transient itching, were reported in eight patients receiving sulconazole and in four patients receiving miconazole.

New therapeutic agent for tinea versicolor: 9-aminoacridinium 4-hexylresorcinolate.

The treatment of tinea versicolor in the past has been unsatisfactory. Recurrences were frequent despite prolonged daily applications of the medications available. A new compound, 9-aminoacridinium 4-hexylresorcinolate, in 3 topical vehicles (cream, lotion, and aerosol spray), has been evaluated by clinical and laboratory criteria in a series of 40 patients with this mycotic infection. Good to excellent results were obtained in 39 patients. In 32 of these, complete clearing occurred after a single course of 4 to 8 weeks; in 7 others it occurred after a second similar course. Only one patient had poor results, with prompt recurrences after repeated courses. No signs of primary irritation or allergic sensitization were observed in any case, and acceptance by patients was excellent.