Influence of systemic corticotherapy on the triggering of pityriasis versicolor.

Pityriasis versicolor is a frequent mycosis and the use of systemic corticotherapy is one of its predisposing factors. This is an observational, cross-sectional, analytical and comparative study, conducted from January 2012 to January 2013 in the following outpatient clinics: Dermatology Service, Cassiano Antonio Moraes Hospital (HUCAM), Vitória, ES, Brazil; Nephrology Service, HUCAM; and Leprosy Department, Maruípe Health Unit, Vitória, ES, Brazil. Patients, undergoing long-term systemic corticotherapy (or not), were assessed with respect to the presence of pityriasis versicolor. If there was mycosis, a direct mycological examination would be carried out. The spss 17.0 software was used for the statistical analysis. From the total of 100 patients, nine had pityriasis versicolor, being eight from the corticotherapy group and one from the group with no use of corticosteroids. Regarding the patients with mycosis, the prevalent age ranged from 20 to 39 years, with six patients; six were women; seven mixed race; eight were undergoing long-term systemic corticotherapy; seven were taking low-dose systemic corticosteroids; four had leucocytosis; five had normal total cholesterol and triglycerides; and four had normal glycaemia. There was increased frequency of pityriasis versicolor in the group undergoing systemic corticotherapy with statistical significance, corroborating the only study on the topic (1962).

Pityriasis versicolor during anti-TNF-α monoclonal antibody therapy: therapeutic considerations.

Anecdotal reports have shown that tumour necrosis factor (TNF)-α inhibition may cause unchecked superficial infection with the microorganisms responsible for pityriasis versicolor (PV). We observed several cases of PV, which is frequently resistant to topical therapies, in psoriatic patients undergoing anti-TNF-α monoclonal antibody therapy. To evaluate the incidence and the therapeutic management of PV in this group of individuals, between 1 January and 27 December 2010, we examined 153 psoriatic patients for the hypopigmented/hyperpigmented macular and scaling lesions associated with PV. All patients positive for PV were given topical therapy with miconazole nitrate cream twice daily for 28 days, after which they were re-evaluated. In patients non-responsive to topical therapy, we started systemic therapy with fluconazole, 300 mg week(-1) for 3 weeks. We diagnosed seven cases of PV. At the end of topical treatment, complete healing of lesions was observed in only one patient. In the other six patients, systemic treatment led to complete resolution of the infection. Although the onset of PV during anti-TNF-α therapy is seldom reported, it is not likely to be rare, but rather under-reported because of its limited pathological significance. In our opinion, the therapeutic management of this condition deserves greater consideration, as the use of topical treatments alone is largely ineffective compared with systemic treatment.

[Etanercept and infections]. / Etanercept e infecciones.

The biological treatments for psoriasis, mainly the tumor necrosis factor-alpha inhibitors (TNF-alpha), have demonstrated their efficacy and safety beginning with the clinical trials up to their subsequent marketing. However, pharmacovigilance studies have detected a mild increase in infections. For the management of infectious risk in patients with psoriasis being treated with etanercept or other anti-TNF medications, an evaluation should be made of the adequacy of its use in patients infected by HCV, HBV, HIV, with localized or generalized infections, with risk of sepsis (carriers of intravenous catheter and indwelling urinary catheter) or with underlying disorders that could predispose them to infections (diabetes, hemodialysis). If a patient under treatment with etanercept presents an infection, if the infection is serious, treatment should be discontinued and if it is mild, the patient should be closely monitored and treatment interrupted if decided based on the evolution. Long experience on the use of etanercept in different diseases has made it possible to state that it has a good safety profile in regards to infections, if precautions are taken in regards to tuberculosis and the concomitance of other active infections during the treatment.

[Pseudoatrophic pityriasis versicolor]. / Pitiriasis versicolor pseudoatrófica.

The pseudoatrophic pityriasis versicolor is an atypical form of this disease with cutaneous atrophy provoked by the prolonged application of topical corticosteroids. The term "pseudoatrophic" is indicative of its reversible character.

Tinea versicolor and body lotions.

A woman complained she had caught her "white spots" from an American sun lotion. The daughter also had them. The mother's spots showed malassezia furfur. The daughter, by a curious coincidence, had developed vitiligo at the same time. As a comfort it was agreed that the sun lotion should be examined for fungal contamination. Scrapings from lesions of patients with tinea versicolor show a typical appearance of malassezia furfur. Roberts (9) cultured specimens from 27 patients and isolated Pitysporum orbiculare in 25.