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Tinea versicolor and Pityrosporum orbiculare: mycological investigations, experimental infections and epidemiological surveys.

In patients with tinea versicolor, Pityrosporum orbiculare was cultured from tinea versicolor lesions in 100%, from normal-looking skin in 80%, and from apparently healed lesions in 69%. P. orbiculare was isolated from normal skin in 85% of patients with seborrheic dermatitis and in 90% of volunteers. The best substrate for isolation of P. orbiculare was a peptone-glucose-yeast extract medium containing glycerol monostearate and Tween 80, overlaid with olive oil. Germ tubes were produced when P. orbiculare was incubated in an atmosphere containing air with 7% CO2. Cultures of P. orbiculare and P. ovale did not show any fluorescence in Wood's light. The in vitro activity of miconazole, clotrimazole, econazole, sodium omadine, and sodium thiosulphate against P. orbiculare was found to correlate to the good clinical effect of these drugs in tinea versicolor. In addition several substances used as solvents or in vehicles had an inhibitory activity against P. orbiculare in vitro. Inoculation with P. orbiculare under plastic occlusion on the glabrous follicle-rich inside of the rabbit ear resulted in a tinea versicolor-like lesion after I week in 3 of 4 animals. One week after inoculation with P. orbiculare under plastic occlusion, experimental infections similar to those found clinically in tinea versicolor were seen in 10 of 12 patients with a history of tinea versicolor and in 3 of 6 normal volunteers. It was not possible to produce experimental infections without occlusion. Spontaneous healing usually occurred. In a retrospective study of 232 patients and prospective survey of 48 patients regarding susceptibility factors in tinea versicolor a higher (10.4%) than expected (3.8%) connection to seborrheic dermatitis was found.

Adolescent

Cell-mediated immunity to Pityrosporum orbiculare in tinea versicolor.

Pityrosporum orbiculare, the presumed etiologic agent of tinea versicolor, was cultured in vitro and antigenic extracts prepared from the cultured organisms. Studies with lymphocytes from human cord blood and peripheral blood of guinea pigs demonstrated that such extracts were not mitogenic. Further studies in guinea pigs indicated that the animals could be sensitized by the injection of P. orbiculare extract in Freund's complete adjuvant and that this extract could elicit lymphocyte transformation and delayed skin test responses in sensitized animals. A group of 12 tinea versicolor patients and 15 normal subjects were studied in vitro for cell-mediated immunity to P. orbiculare extract. The majority of the subjects tested in both groups demonstrated positive lymphocyte transformation responses to this extract, as well as to standard mitogens and common microbial antigens. However, lymphocytes from tinea versicolor patients produced significantly less leukocyte migration inhibitory factor activity when stimulated by Candida albicans and P. orbiculare extracts than did lymphocytes from normal subjects. This was also true if only subjects with positive lymphocyte transformation responses to these antigens were considered. Leukocyte migration inhibitory factor responses to streptokinase/streptodornase were not significantly different between the two groups. Therefore, it appears that although both normal subjects and tinea versicolor patients demonstrate prior sensitization to antigens of P. orbiculare, the effector function of lymphocytes from most tinea versicolor patients appears to be impaired in that they produce subnormal amounts of the mediator leukocyte migration inhibitory factor when stimulated with antigenic extracts of this organism.

Animals

Experimental tinea versicolor in rabbits and humans with Pityrosporum orbiculare.

The purpose of this investigation was to produce experimental tinea versicolor in rabbits and humans with Pityrosporum orbiculare. Inoculation with P. orbiculare under plastic occlusion on the glabrous follicle-rich inside of the rabbit ear resulted in a tinea versicolor-like lesion after 1 week in 3 of 4 animals. One week after inoculation with P. orbiculare under plastic occlusion, experimental infections similar to those found clinically in tinea versicolor were seen in 10 of 12 patients with a history of tinea versicolor and in 3 of 6 normal volunteers. It was not possible to produce experimental infections without occlusion. Spontaneous healing usually occurred.

Animals

Treatment of "tinea pedis" with griseofulvin and topical antifungal cream.

A protocol for determining the antifungal efficacy of systemic or topical drugs in tinea pedis is presented. In this study, (1) no patient had concomitant onychomycosis; (2) the clinical types were separated into (a) plantar scaling, (b) intertriginous, and (c) vesicular instep; (3) the soles were treated for three months (time related to the shedding of all stratum corneum); (4) the follow-up period for soles was three months (related to characteristics of the drug and its depot effect on the target area, the horny layer); (5) the final evaluation related to the percentage of patients "clinically and mycologically cured" at the end of the follow-up period. With this protocol, ultramicrosize griseofulvin (Gris-PEG) alone, topical clotrimazole (Lotrimin) alone, and a combination of the two were tested in seventy-three patients with tinea pedis. The results were as follows: for plantar scaling type of tinea pedis, the combination was not better than griseofulvin alone; for intertriginous tinea pedis, the combination was definitely better than griseofulvin alone; and topical 1 percent clotrimazole was much less effective than griseofulvin.

Administration, Topical

Tinea capitis in Pondicherry (South India).

Amongst 125 cases of tinea capitis, representing 12-5% of dermatomycosis, about 9% showed kerion-like lesions and 13% had tinea corporis and/or tinea unguium. Eighty four percent cases were mycologically positive, yielding Trichophyton violaceum (84%) or T. tonsurans (16%).

Adolescent

Biochemical and physiological parameters on the healthy skin surface of persons with candidal intertrigo and of persons with tinea cruris.

Biochemical and physiological tests were carried out on the skin surface of 20 patients with candidal intertrigo and 27 patients with tinea cruris. In all patients the test areas were free of efflorescences. The same tests were performed in 39 and 27 resectively healthy test persons of the same age and sex. The following striking findings came to light: 1. There was a significant decrease in the percentage amount of squalene in the skin surface lipids of the moniliasis group as compared with the control group. 2. There was a significant decrease in the reducing substances in the so called water solubles obtained with the phenol sulfuric acid method in the moniliasis group. The same results were obtained when only those moniliasis patients who were definitely not suffering from diabetes mellitus were taken into account. This is presumably a question of a reduction in the bound carbohydrates. 3. There were significantly more amino acids extractable from the skin surface of the tinea cruris patients than of the control persons. These results point to important predisposing factors for the susceptibility to candidal intertrigo and tinea cruris respectively.

Adolescent

Photolocalized tinea facialis.

The case of a 34-year-old white woman with tinea facialis that persisted for nine months prior to diagnosis is presented. The confluent plaquelike erythematous eruption of the face with eyelid lichenification that flared outdoors was thought to represent polymorphic light eruption and was refractory to antibiotics, corticosteroids (topical and systemic), and antimalarials. A KOH preparation was positive when the dermatosis spilled onto the mandibular region, and restaining of the initial skin biopsy revealed fungal hyphae. Complete resolution was accomplished with griseofulvin and MicTin. Tinea cab be added to the list of infectious agents that have a photosensitivity component. The fungus possibly "photolocalizes" to sun-damaged areas, ie, areas of increased capillary permeability. This case illustrates the importance of including tinea in considering diagnoses of sun-exposed lesions of the face.

Administration, Topical

Nonfluorescent tinea capitis in Charleston, SC. A diagnostic problem.

Statistics gathered at the Medical University of South Carolina from 1973 to 1978 indicate a dramatic change in the etiologic agents of tinea capitis in Charleston since the 1950s. The preponderant agent is now Trichophyton tonsurans, which produces lesions that are not fluorescent in a Wood's lamp examination (long-wave ultraviolet). Trichophyton tonsurans caused 90.6% of 265 culture-proved cases of tinea capitis in the 1970s, but in the 1950s it was responsible for only 1.6% of 378 cases. The study emphasizes that cultures are necessary because the increase in nonfluorescent tinea capitis throughout the United States presents unsuspected diagnostic problems to physicians who are not aware of the change in etiologic agents.

Black People

[Miconazole per os in tinea and deep mycosis].

For the last 6 years we have been using Miconazole cream in the treatment of tinea and vaginal candidiasis. We think that it is at least as good as the best drugs for this purpose, but consider it difficult to decide about its superiority. Therefore we refrain from describing this part of our experience in detail. We have employed Miconazole "per os" at the daily doses of 24-28 mg./kg. in treating 3 cases of tinea corporis or cruris by "Trichophyton rubrum". Symptoms ceased in 3 days; mycologic examination turned negative in 2 weeks; treatment ended in apparent cure in 3 weeks. We have employed Miconazole "per venam" and "per os" in the treatment of: mycetomata (2) by "Streptomyces somaliensis", without success; mycetoma by "Madurella grisea" (1), without success; chromomycosis by a 5-flucytosine resistant strain of "Cladosporium carrionii" (1), without success; paracoccidioidosis (5) with lesions in mouth and lungs, with good results; leishmaniasis by "Leishmania brasiliensis" (1), without success; mucocutaneous disseminated candidiasis (1), with very good results. Tolerance has been excellent: but pruritus appeared from the third week with 600 or more mg. "per venam", in several patients. Doses varied between 10 and 50 mg./kg./day. One patient, who suffered with candidiasis, is taking 50 to 30 mg./kg./day since more than a year ago and, being a child, he is feeling well and growing to be normal. We recommend employing Miconazole against systemic canidiasis, sulpharesistant paracoccidioidosis and assaying it further in tinea (at least, in griseofulvin-resistant cases).

Administration, Oral

Autosomal recessive inheritance of susceptibility to tinea imbricata.

Familial distribution of chronic tinea imbricata in an untreated Melanesian population was consistent with a genetic predisposition to this disease. The pattern suggested that susceptibility to chronic Trichophyton concentricum infection is recessively inherited and controlled by genes at a single autosomal locus. In married couples there was no concordance of the disease above that expected by chance and the observed segregation of tinea imbricata accorded well with that predicted by the genetic hypothesis.

Adolescent

Follow-up study of patients treated by x-ray epilation for tinea capitis. Estimation of the dose to the thyroid and pituitary glands and other structures of the head and neck.

This study is a further investigation of radiation dose to various head structures in the children given X-ray therapy for tinea capitis (ringworm of the scalp). In this work, estimates of the dose to the thyroid and pituitary gland were obtained with lithium fluoride thermoluminescent dosemeters using a child's head phantom. Doses were also measured for the parotid gland and several skin sites where skin tumours developed in the irradiated cases. In a previous study, brain and scalp doses of 140 and 500-800 rad had been estimated for the treated group using this same head phantom. In this work dosemeters were also placed in the same brain locations so that comparisons could be obtained between the two studies. The thyroid dose was estimated to be 6 +/- 2 rad and the pituitary dose was 49 +/- 6 rad for the conventional tinea capitis treatment. The dose to the parotid gland was 39 rad and the dose to skin sites on the face and neck where tumours occurred ranged from 20 to 40 rad. The data for the thyroid adenoma response from this and other studies involving irradiation of children suggests a linear dose-response relationship within the first 30-40 years after exposure with a risk of about 0-04% per rad.

Adenoma

Topical clotrimazole in tinea pedis.

Clotrimazole is a new antifungal agent which is effective topically in dermatophytosis, cutaneous candidiasis, and tinea vesicolor. The authors performed a controlled double-blind clinical trial comparing topical clotrimazole with its vehicle in the treatment of 66 patients with dermatophytic infections of the skin of the feet. Clotrimazole proved to be effective in the treatment of tinea pedis of both the interdigital and the plantar hyperkeratotic types.

Administration, Topical

Topical undecylenic acid in tinea pedis: a new look.

One hundred and four patients with mycologically confirmed tinea pedis took part in a controlled clinical trial to determine the efficacy of undecylenic acid powder preparations in the treatment of their fungal infections. Clinical and mycological cures were obtained in 53% of those subjects treated with undecylenic acid powders as compared with 7% of those treated with the talc vehicle or left untreated. Undecylenic acid in a powder vehicle appears to be a safe and effective agent in the treatment of tinea pedis.

Administration, Topical

Tinea pedis in children.

Many children have dermatoses involving the feet. Such problems are often misdiagnosed as tinea pedis, which is relatively uncommon in this age group. On the other hand, tinea pedis should not be ignored as a diagnostic possibility just because of its infrequent occurrence. Six cases are reported to demonstrate that this diagnosis will be missed if appropriate laboratory studies are not done as a part of the evaluation of these dermatoses.

Child

Comparison of over-the-counter agents for tinea pedis.

To evaluate the relative effectiveness of the treatment of tinea pedis, we performed a double-blind study comparing undecylenic acid ointment, tolnaftate cream, and a placebo. Ninety patients with clinically and mycologically proven tinea pedis took part in this clinical trial. Our results showed both agents to be superior to the placebo, but there was no significant difference in effectiveness between the two active agents. We observed no side effects with the preparations used.

Clinical Trials as Topic

Tinea of the ear mimicking chondritis.

A case of tinea of the pinna, mistaken for chondritis, is presented. Chondritis should be added to the list of diseases that tinea infection may mimic.

Adult

A study of Tinea capitis in Libya (Benghazi).

Tinea capitis formed 20% of all superficial mycotic infections, which in turn represented 12% of all skin disease diagnosed at the skin outpatient department of Al-Jamaheria hospital in Benghazi. The majority (94%) of tinea capitis occurred in children. A sample of 200 cases cultured revealed Trichophyton schoenleinii to be the most prevalent species of dermatophyte (69.5%) followed by Microsporum audouinii. (23.8%).

Adolescent