RESUMO
A patient presented with Majocchi granuloma caused by T. rubrum. By the use of optical brighteners, fungal elements in the deep dermis could be detected more sensitive than with PAS staining. Healing was achieved by long-term use of oral terbinafine (250 mg per day 12 weeks, followed by 250 mg once per week for another 12 weeks).
Assuntos
Corantes Fluorescentes/análise , Foliculite/tratamento farmacológico , Foliculite/patologia , Folículo Piloso/química , Folículo Piloso/patologia , Naftalenos/uso terapêutico , Antifúngicos/uso terapêutico , Corantes Fluorescentes/química , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Orgânicos/análise , Compostos Orgânicos/química , Coloração e Rotulagem/métodos , Terbinafina , Resultado do TratamentoRESUMO
CASE REPORT: A 12-year-old with a functional circulatory disturbance had toe nail onychomycosis caused by Trichophyton rubrum. There were no other underlying diseases. THERAPY AND OUTCOME: Oral therapy with terbinafine 125 mg once weekly in addition to ciclopirox nail lacquer was ineffective. Two years later the disease worsened and A. versicolor was found in pure culture. A preparation of 10% terbinafine HCl in a 20% urea ointment (Onychomal®) applied daily for 4 weeks, then once weekly resulted in complete cure after 7 months.
Assuntos
Aspergilose/tratamento farmacológico , Dermatoses do Pé/tratamento farmacológico , Naftalenos/administração & dosagem , Onicomicose/tratamento farmacológico , Tinha/tratamento farmacológico , Ureia/administração & dosagem , Administração Tópica , Antifúngicos/administração & dosagem , Aspergilose/patologia , Criança , Quimioterapia Combinada/métodos , Feminino , Dermatoses do Pé/patologia , Humanos , Pomadas/administração & dosagem , Onicomicose/patologia , Terbinafina , Tinha/patologia , Resultado do TratamentoRESUMO
BACKGROUND: A dark colored pigmentation of nails can be due to a subungual malignant melanoma. There are, however, many other benign causes and this differentiation is an important challenge in dermatological practice. PROBLEM: When should nail pigmentation be clarified by histological investigations? MATERIAL AND METHODS: This article gives a survey of the literature on this topic and a review of own experiences with clinical case examples. The various causes of melanonychia are presented and criteria for the early recognition of melanoma of the nail matrix are formulated. RESULTS: The width and depth of color of longitudinal melanonychia do not allow any conclusions on the dignity. If the nail striation is proximally broader than distally, this is evidence of a proliferative event. Confirmation of a subungual hemorrhage does not exclude a malignancy per se. Also detection of pigmentation due to fungi does not exclude the additional presence of a subungual melanoma. A systematic clinical analysis using clear criteria leads to a working diagnosis and suitable treatment. CONCLUSION: An early and correct designation of nail pigmentation can avoid unnecessary nail interventions but can also be life saving.
Assuntos
Dermatomicoses/diagnóstico , Melanoma/diagnóstico , Doenças da Unha/diagnóstico , Unhas/patologia , Transtornos da Pigmentação/diagnóstico , Neoplasias Cutâneas/diagnóstico , Dermatomicoses/terapia , Diagnóstico Diferencial , Humanos , Melanoma/terapia , Doenças da Unha/terapia , Transtornos da Pigmentação/terapia , Neoplasias Cutâneas/terapiaRESUMO
Pityriasis versicolor (PV) is one of the most common infectious skin diseases, as well as the most common dermatosis associated with pigmentation alterations of the skin. PV is prevalent in 1% of the population living in temperate climate zones and more common during the summer. In tropical areas, PV is found in up to 50% of all patients consulting a dermatologist. Of the known Malassezia species, M. globosa is currently felt to play a key role in the pathogenesis of PV, as it is most commonly found in PV lesions. In addition, its round-shaped cells may contribute to the characteristic histology of the disease ("spaghetti and meatballs"). However, the clinical appearance of PV including hyper- and hypopigmentation, fluorescence of the lesions, as well as a lack of inflammation despite high fungal load cannot fully be explained by the presence of M. globosa, which is also found on healthy skin. In M. furfur a tryptophan-dependent metabolic pathway generates a number of indole pigments, which may be associated with the clinical appearance of PV. In the model organism Ustilago maydis it was shown that the formation of the indole compounds occurs spontaneously after initial conversion of tryptophan into indole pyruvate controlled by the key enzyme aminotransferase Tam 1. We review the present knowledge of PV and highlight the potential role of Tam1 in explaining the poorly understood aspects of the disease. Promising therapeutic results using the application of Tam1 inhibitors to treat PV support the enzyme's important role in the disease pathogenesis.
Assuntos
Antifúngicos/uso terapêutico , Tinha Versicolor/tratamento farmacológico , Tinha Versicolor/metabolismo , Triptofano Transaminase/antagonistas & inibidores , Triptofano Transaminase/metabolismo , Humanos , Tinha Versicolor/microbiologiaRESUMO
OBJECTIVE: Lipophilic Malassezia species may induce catheter-associated sepsis in newborns and immunocompromised patients receiving parenteral lipids. Therefore, we tested whether M. furfur and six other Malassezia species can use commercially available infusions as a lipid source. DESIGN: Prospective in vitro study. SETTING: Research laboratory in a university hospital. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: With the exception of M. restricta, all Malassezia species grow on lipid infusions. There are no substantial differences among the different brands. The most rapid growth is shown by M. furfur, which grows better on agar containing a 20% rather than a 10% lipid infusion. Growth of M. furdur and M. sympodialis can be reduced by infusions containing medium-chain triglycerides. Incubated in triglycerides, M. furfur is strongly suppressed by 50% medium-chain triglycerides and M. sympodialis by 8% medium-chain triglycerides. When medium-chain free fatty acids are added to triglycerides, both species can be suppressed by about 1% free fatty acids. CONCLUSION: Medium-chain triglycerides and medium-chain free fatty acids are toxic for Malassezia species. Commercially available infusions containing medium-chain triglycerides might be used to prevent systemic Malassezia infections.