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.

A sensitive new microculture method for diagnosis of cutaneous leishmaniasis.

A sensitive microcapillary culture method (MCM) was developed for rapid diagnosis of cutaneous leishmaniasis (CL). The MCM is superior to the traditional culture method (TCM) as determined by the smaller inoculum size, the higher sensitivity for detection of promastigotes, and the more rapid time for emergence of promastigotes. With lesion amastigote loads from grade III to 0, the positive rates and the periods for promastigote emergence were 3-4-fold higher and faster with the MCM than with the TCM, e.g., 83-97% positive in 4-7 days versus 20-40% positive in 15-30 days (P = 0.0001). The higher Pco(2) and lower Po(2) and pH presumably encourage a rapid amastigote-to-promastigote differentiation and/or the survival or growth of the latter. This MCM has the advantage of simplicity, and may be suitable for diagnostic use and for parasite retrieval in many other endemic sites where parasites are known to be difficult to grow.

Clinical features, epidemiology, and efficacy and safety of intralesional antimony treatment of cutaneous leishmaniasis: recent experience in Turkey.

A total of 1,030 patients, 40.2% men and 59.8% women, identified during the period of October 1998 to November 2002 as having cutaneous leishmaniasis (CL), were studied; 1,431 lesions were identified in the 1,030 patients. One lesion was present in 80.7% of the patients. The size of the lesions (longest axis) was 13.6 mm (standard, 12.1 mm; range 3-150 mm). Most of the lesions were of the papular type (51.2%), although several atypical clinical presentations of CL were observed. The duration of the disease ranged between 1 and 72 mo (mean duration, 10.8 mo). The clinical suspicion of CL was confirmed by the observation of amastigotes on lesion tissue samples stained by Giemsa. The test was positive in 851 of 1,030 patients (82.6%). Intralesional meglumine antimonate solution (85 mg Sb/ml, 0.2-1 ml, depending on the size of the lesion) weekly until complete cure or up to 20 wk was used for first-line therapy of 890 patients (86.4%). We found that this regimen of intralesional Sb has an efficacy of 97.2% with a low relapse rate of 3.9% and no serious adverse side effects.

Pemphigus in the Mediterranean region of Turkey: a study of 148 cases.

BACKGROUND: The purpose of this study was to describe the epidemiological and clinical features, course, response to treatment, and prognosis of pemphigus in the Mediterranean region of Turkey. METHODS: All patients with confirmed pemphigus were prospectively enrolled in two major dermatology departments in the cities of Adana and Antalya in the Mediterranean region between March 1998 and March 2004. Details including demography, findings of clinical examinations, treatment, course, and prognosis were recorded. RESULTS: One hundred and forty-eight patients with pemphigus were diagnosed during the 6-year period, with a prevalence of 1.46 and an annual incidence of 0.24 per 100,000 in this region. There was a female predominance with a male to female ratio of 1:1.4. Pemphigus vulgaris (PV) was the most common clinical subtype, identified in 123 patients (83%). The mean age of onset was 43. In 101 (82%) patients with PV, disease began as persistent oral ulcers. The majority of the patients with PV could be managed with middle or high-dose steroids (60-140 mg/day). Complete clinical remission was obtained in 41 (39.4%) patients. The mortality rate was 4.8%. CONCLUSIONS: A moderately high incidence of pemphigus was found in the Mediterranean region of Turkey as compared with that encountered in other countries. The commonest clinical subtype was PV with a 9.5-fold higher incidence than pemphigus foliaceus. It is more frequent in middle-aged people and has a female predominance. Although a relatively higher dose of steroid was needed to control the PV, the disease completely remitted in a significant proportion of the patients.

Comparison of conventional and polymerase chain reaction diagnostic techniques for leishmaniasis in the endemic region of Adana, Turkey.

BACKGROUND: Cutaneous leishmaniasis (CL) has long been reported in the Cukurova region. We have compared the sensitivity of the conventional methods of diagnosis by microscopy and cultivation of lesion aspirates against polymerase chain reaction (PCR) amplification of parasite-specific DNA from these samples. METHODS: The samples (n = 25) were obtained from patients clinically diagnosed with CL at the regional dermatology clinic. Aliquots of the samples were stained with Giemsa for microscopy and cultured in Novy-Nicolle-McNeal (NNN) blood agar for promastigote growth. The remainder were subjected to DNA extraction for PCR amplification of the conserved region of kinetoplast minicircle DNA. PCR products of the expected size (120 bp) were observed after agarose gel electrophoresis, followed by staining with ethidium bromide. RESULTS: The positive rates from 25 samples were 44%, 68%, and 100% for cultivation, microscopy, and PCR, respectively. CONCLUSIONS: The PCR method used appears to be the most sensitive for the diagnosis of CL in this region.