Versicolor versicolor (synonym: pityriasis versicolor) (Pytiriasls versicolor) - low contagious chronic illness people of predominantly young and middle age, characterized by damage to the stratum corneum of the epidermis and very mild inflammatory reaction and caused by the lipophilic yeast-like fungus Pityrosporum cibiculare.
ICD-10 code
B36.0 Tinea versicolor
Causes of pityriasis versicolor
The causative agent of the disease is Mallasseria furfur. Lichen versicolor occurs as a result of transformation of the saprophilic form into a pathogenic one or infection from the outside. The development of pityriasis versicolor is facilitated by weakening immune system, increased sweating, endocrine disorders. The occurrence of the disease is facilitated by changes in physical and chemical properties water-lipid mantle of the skin and keratin of the stratum corneum. They may be due increased sweating, seborrhea, as well as some endocrine disorders (Cushing's syndrome, diabetes mellitus, obesity, hyperthyroidism, etc.). The disease occurs in all geographical areas, but more often in regions with a hot climate and high humidity.
It has been established that the pathogen's lipoxygenase oxidizes unsaturated fatty acid sebum into dicarbonate. As a result, melanocyte tyrosinase is inhibited and melanin synthesis in the lesion is reduced. The disease often occurs in HIV-infected patients.
Symptoms of versicolor
Both men and women suffer from tinea versicolor.
The rashes are often localized on the chest, back, and armpits; from here the rash spreads to the shoulders, sides of the torso, and abdomen. The disease pityriasis versicolor begins with the appearance of pinkish, scaly spots that quickly turn brown.
As a result of peripheral growth, the initial elements turn into round, sharply defined spots up to 1 cm in diameter. The spots can merge and form large lesions that occupy the entire back, torso and chest. The elements have scalloped outlines, with isolated spots scattered around their periphery. The color of the rash varies widely from pale cream to dark brown. The surface of the rash is covered with pityriasis-like scales, formed as a result of the fungus loosening the stratum corneum of the epidermis. At frequent washing the scales are hardly noticeable, but when scraped, mealy peeling easily occurs (Beignet's symptom). There are forms similar to erythrasma, urticaria, reminiscent of vitiligo. Subjective sensations are usually absent.
After artificial ultraviolet irradiation White pseudochromic spots remain in the area of the rash. The course of the disease is long and can last for many years.
Diagnosis of lichen versicolor
The diagnosis of "lichen versicolor" is established on the basis of the characteristic clinical picture and laboratory test data. To confirm the diagnosis, the Balzer test is used: lesions and adjacent areas of healthy skin are smeared with 5% iodine tincture (at a lower concentration, the test may be questionable) - the rash due to the loosened stratum corneum is colored more intensely than the surrounding healthy skin . During fluorescent examination using a Wood's lamp, a yellow glow is observed in the lesions. In the rays fluorescent lamp lesions glow golden yellow. The morphology of the pathogen is very characteristic when microscopic examination scales from lesions (short, wide, curved pseudomycelium and single or large spores arranged in clusters).
Pityriasis versicolor (lichen versicolor) — fungal disease skin.
Code by international classification diseases ICD-10:
Causes
Diagnostics
Diagnosis based on characteristic clinical symptoms and a positive iodine test. In doubtful cases, a microscopic examination of skin flakes is performed to detect the pathogen. Differential diagnosis carried out in some cases with syphilitic roseola, which does not peel off, does not merge into solid foci, the iodine test is negative, and serological reactions to syphilis are positive; there may be other manifestations of syphilis. Pseudo-leukoderma must be differentiated from true syphilitic leukoderma, in which small round (0.5 - 1 cm) or marbled hypopigmented spots without clear boundaries are located on the slightly pigmented skin of the back and non-lateral surfaces of the neck, sometimes spreading to the skin of the back; positive serological reactions and other signs of syphilis make it possible to distinguish it from pseudoleukoderma.
Treatment
Treatment. Rubbing Andriasyan liquid (urotropine - 5 g, 8% solution acetic acid- 35 ml, glycerin - 10 ml), 2 - 5% salicylic - resorcinol alcohol, Wilkinson ointment, 10% sulfur ointment, mycozolon, treatment according to the Demyanovich method (see Scabies) and others antifungal agents for 3 - 7 days, after which a general hygienic bath with soap, washcloth. To prevent relapse of the disease, it is advisable to treat everything skin. IN for cosmetic purposes to eliminate pseudoleukoderma after antifungal treatment ultraviolet irradiation is indicated.
Diagnosis code according to ICD-10. B36.0
Tinea versicolor (pityriasis versicolor, tinea versicolor) is a superficial fungal skin disease that belongs to the group of keratomycosis.
Etiology and epidemiology
The disease is widespread, but is most common in regions with hot and humid climates. Mostly young and middle-aged people are affected; children and the elderly are extremely rare.
The causative agents of pityriasis versicolor are dimorphic lipophilic yeasts of the genus Malassezia - representatives of typical skin microflora. The most frequently found are Malassezia globosa, M.sympodialis and M.furfur, and less frequently – M.slooffiae, M.restricta and M.obtusa. It has been found that about 90% healthy people are carriers of the saprophytic form of the fungus. Under the influence of predisposing factors of an endogenous and/or exogenous nature, the pathogen is transformed from a non-pathogenic form of budding blastospore into a pathogenic mycelial one.
The contagiousness of the disease is low. Predisposing factors may include increased sweating, changes in the chemical composition of sweat, and a decrease in physiological peeling of the epidermis. Tinea versicolor is more likely to develop in people with concomitant diseases: endocrine pathology, chronic diseases lungs and gastrointestinal tract, vegetative-vascular disorders, immunodeficiencies of various nature, etc. Nutritional deficiency, intake of oral contraceptives, systemic glucocorticosteroid drugs and immunosuppressants. There may be a genetic (multifactorial) predisposition to the development of the disease. May participate in pathogenesis immune factors, however, they are difficult to interpret. Patients with lichen versicolor do not have cell-mediated immunodeficiency to mycelial antigens of Malassezia spp.
Classification
Absent.
Clinical picture (symptoms) of pityriasis versicolor
The rashes are most often localized on the skin of the torso and upper limbs, the skin of the scalp and penis may be affected.
Atypical localizations of pityriasis versicolor include: face, ears, behind-the-ear folds, hands, shins, groin and axillary area, nipple and periareolar region. In children, the disease often begins on the scalp, but the hair is not affected. Tinea versicolor is not observed on the palms, soles and mucous membranes. There is a tropism of the pathogen to areas of the skin that have a large number of sebaceous glands.
The disease is initially characterized by the appearance of small spots without inflammation, blurred, first pink, then yellowish-pink, later brown or red-brown; on their surface there is a fine-plate peeling, similar to bran (pityriasis versicolor), easily determined by scraping. The spots are often multiple and can merge to form large lesions with polycyclic outlines; the size of the spots varies from a few millimeters to several centimeters. Sometimes, when examining large lesions, mild atrophy can be determined in their center. As a result of central involution, the lesions can take on a ring-shaped form. There are usually no subjective sensations, but sometimes mild itching may occur. After tanning, as a result of increased peeling, depigmented areas of skin remain in the affected areas.
Highlight special shape disease – tinea versicolor alba, or pityriasis versicolor. In this case, complete depigmentation may occur in the absence of any peeling. Depigmentation in in this case is not directly related to the shielding properties of fungal colonies and can occur on areas of the skin that have not been exposed to solar radiation.
Diagnosis of pityriasis versicolor
The diagnosis in most cases is established on the basis of a typical clinical picture: characteristic rashes on the skin of the trunk and upper extremities.
In case of erased forms and/or atypical localization, the diagnosis is established based on the results of examination in the rays of a Wood's fluorescent lamp based on the characteristic yellow or golden-brown glow. Glow in the rays of a Wood's lamp is observed mainly in cases where the etiological agent is M. furfur (about 1/3 of cases).
Microscopic examination of scales treated with a 10-20% solution of potassium hydroxide (KOH) with a 20-minute exposure reveals elements of the fungus (short curved filaments of mycelium (hyphae) from 2 to 4 microns in diameter and large round and oval spores with a double-circuit shell in in the form of clusters resembling bunches of grapes).
When making a diagnosis, the Balzer test (iodine test) can be used: when the areas are lubricated with 5% tincture of iodine, the spots of pityriasis versicolor become stained with iodine more intensely due to the impregnation of the pityriasis scales.
Balzer test
Histological examination of the affected areas of the skin using the PHIK reaction can detect mycelium and rounded spores of the fungus in the stratum corneum of the epidermis.
Differential diagnosis
Differentiate the disease in acute stage follows with pink lichen of Zhiber, syphilitic roseola, seborrheic dermatitis, eczematids, erythrasma; with a long course - with pigmentation observed after the resolution of various dermatoses, Becker's nevus. In the presence of depigmented spots - with syphilitic leukoderma, dry streptoderma, vitiligo, depigmented eczematids.
Treatment of pityriasis versicolor
Treatment Goals
- clinical cure;
General notes on therapy
Treatment pityriasis versicolor based on application antifungal drugs local and systemic action, as well as keratolytic agents.
Indications for hospitalization
None
Treatment regimens for lichen versicolor:
External therapy
For limited forms of the disease:
- bifonazole, 1% cream or 1% solution
- ketoconazole, cream (B) 1
- clotrimazole, cream or solution
- miconazole, cream
- terbinafine, cream and solution
- oxiconazole, cream
In case of damage to the scalp:
- ketoconazole, shampoo
Systemic therapy
With widespread and atypical forms versicolor versicolor, as well as ineffectiveness local therapy for limited damage, systemic antimycotic drugs are prescribed:
- ketoconazole 200 mg
- itraconazole 200 mg
- fluconazole 300 mg
Requirements for treatment results
- complete resolution of clinical manifestations;
- negative results of microscopic examination.
Tactics in the absence of treatment effect
- corrective pathogenetic therapy(immunomodulators, normalizing agents endocrine pathology and etc.);
- replacement of antimycotic agent.
Prevention of pityriasis versicolor
During treatment, it is necessary to disinfect the patient’s clothes, hats, underwear and bed linen by boiling in a 1% soap-soda solution and ironing 5 times with a hot iron while wet on both sides. Treatment should also be recommended to family members if they are diagnosed with the disease.
In order to prevent multicolored lichen in persons predisposed to relapses of the disease, it is advisable to take ketoconazole at a dose of 400 mg per month or 200 mg three days in a row for a month or itraconazole 400 mg once a month for 6 months.
IF YOU HAVE ANY QUESTIONS ABOUT THIS DISEASE, CONTACT DOCTOR DERMATOVENEROLOGIST KH.M. ADAEV:
WHATSAPP 8 989 933 87 34
EMAIL: [email protected]
INSTAGRAM @DERMATOLOG_95
Tinea versicolor(pityriasis versicolor, solar fungus, Latin tinea versicolor, pityriasis versicolor) is an infectious (fungal) skin disease, which is characterized by damage only to the stratum corneum of the epidermis, the absence of inflammatory phenomena and very low contagiousness (infectiousness).
What causes pityriasis versicolor:
The causative agent of lichen versicolor- Pityrpsporum orbiculare or Malassezia furfur - located in the stratum corneum of the epidermis and the mouths of the follicles. When microscopying the affected scales, the fungus looks like short, rather thick, curved mycelial filaments and clusters of round spores with a double-circuit shell located in clusters. Obtaining a culture of the fungus is extremely difficult and has only been possible in isolated cases.
Pathogenesis (what happens?) during Lichen versicolor:
It is believed that increased sweating, chemical composition sweat, disturbance of physiological peeling of the stratum corneum, individual skin predisposition.
There is an opinion that the disease is more common in people suffering from pulmonary tuberculosis. However, this point of view is not shared by everyone. Young men and women are more often affected. In children, especially under 7 years of age, pityriasis versicolor is rare. It can occur in weakened children suffering diabetes mellitus, tuberculosis, vegetative neurosis with increased sweating in the prepubertal and pubertal periods.
The contagiousness of the disease is insignificant.
Symptoms of Versicolor:
On the affected areas of the skin, non-inflammatory yellowish-brownish-pink spots form, starting from the mouth hair follicles and gradually increasing in size. Merging with each other, they occupy large areas of the skin, having micro-scalloped edges. Gradually, the color of the spots becomes darkish-brown, sometimes they take on a “coffee with milk” color. This change in shades of color served as the basis for the name of the disease (“variegated lichen”). The spots do not protrude above the skin level, are usually not subjectively disturbing (sometimes there is slight itching), and are accompanied by mealy peeling (hence the other name - pityriasis versicolor), easily revealed by scraping.
Spots of multi-colored lichen are usually located without any symmetry. Favorite localization is on the skin of the chest and back, less often elements are noted on the skin of the neck, abdomen, lateral surfaces of the torso, and the outer surface of the shoulders. IN Lately When using a mercury-quartz lamp with uveolar glass (Wood's lamp) to diagnose the disease, spots of multi-colored lichen began to be found quite often (especially with a widespread process) on the skin of the scalp, but without damage to the hair. Perhaps this is one of the reasons for frequent relapses of the disease, despite the apparent success of therapy. In the presence of multi-colored lichen in children in preschool age or in adolescents during puberty, a feature is the extensive distribution - on the neck, chest, in armpits ah, on the stomach, back, in the upper and lower limbs, on the scalp. The course of the disease is long (months and years). After clinical cure, relapses often occur. It should be borne in mind that the sun's rays can lead to rapid healing; then on the ground former rashes lichen versicolor, the skin does not tan and white spots (pseudo-leukoderma) appear in these areas.
Diagnosis of Lichen versicolor:
The diagnosis is not difficult and is often established on the basis of a characteristic clinical picture. If it is difficult to diagnose, resort to auxiliary methods. In these cases use iodine test Balzer: when lubricating the skin 5% alcohol solution With iodine, the affected areas, where the stratum corneum is loosened, are colored more intensely than healthy areas of the skin. Instead of iodine, a 1-2% solution of aniline dyes is sometimes used. You can use the “chips” phenomenon (Besnier’s symptom): when you scrape noggem spots, as a result of loosening the stratum corneum, the upper layers of scales peel off. To identify clinically hidden lesions, a mercury-quartz lamp is used, the rays of which are passed through glass impregnated with nickel salts (Wood filter). The study is carried out in a darkened room, where pityriasis versicolor spots fluoresce with dark brown or reddish-yellow light. Detection of clinically asymptomatic lesions, including on the scalp, allows for more rational treatment and in some cases protect against relapses. The diagnosis can also be confirmed by the detection of fungal elements during microscopic examination of scales treated with a 20-30% solution of caustic alkali (KOH or NaOH).
Pityriasis versicolor sometimes has to be differentiated from syphilitic roseola (pink roseola, does not peel off, disappears with pressure; other symptoms of syphilis and positive serological reactions are taken into account), Zhiber's pityriasis rosea (pink spots are located along Langer's skin tension lines, have a diamond-shaped or slightly elongated shape and in the center they peel off in a peculiar way like tissue paper - “medallions”). The secondary, or false, leukoderma formed after treatment of pityriasis versicolor is differentiated from true syphilitic leukoderma, in which confluent hypopigmented spots are not formed, the lesion has the character of a lace mesh, is located mainly on the skin of the neck, armpits and lateral surfaces of the body with positive serological reactions in the blood and other manifestations of secondary recurrent syphilis.
Treatment for Lichen Versicolor:
Of course, before starting treatment, it is necessary to correctly establish the diagnosis, which is not possible without a visit to a specialist (dermatologist). With self-medication and unsystematic symptomatic treatment Relapses of the disease will be common. At the same time, in each specific case, the doctor will select the medications and procedures you need. And now, within the framework of this article, we invite you to familiarize yourself with the main directions of treatment for this pathology, which existed previously and exist now.
Treatment of versicolor was carried out with a variety of drugs. Numerous schemes suggest the use of Andriasyan's liquid, 2-5% salicylic-resorcinol alcohol, Wilkinson's ointment, 10% sulfur ointment, mycozolon, treatment according to the Demyanovich method and other antifungal agents for 3-7 days, after which a general hygienic bath with soap is prescribed, with a washcloth. The main principle of these treatment regimens is to cause accelerated exfoliation of the stratum corneum of the epidermis. To prevent relapse of the disease, treatment of the entire skin is recommended. For cosmetic purposes, ultraviolet irradiation is recommended to eliminate pseudoleukoderma after antifungal treatment.
Recently, new, more effective schemes therapy for versicolor versicolor, which allows for a more reliable effect with a low probability of relapse. The only one effective approach The treatment for multicolored lichen is etiotropic therapy - therapy aimed at the causative agent of the disease. From the arsenal of drugs with different chemical structures and mechanisms of action, it is quite possible to select effective drug, which is capable of accumulating precisely in the stratum corneum of the skin (in which the fungal process develops), does not penetrate into the deeper layers of the skin and exhibits antifungal activity without affecting the proliferation (renewal process) of the epidermis (stratum corneum). But do not forget, treatment should always be prescribed by a doctor (dermatologist)!
Prevention of versicolor versicolor:
If a patient is diagnosed with lichen versicolor, it is necessary to examine all family members clinically and using a fluorescent llama. It is recommended not to wear underwear made of synthetic fabrics, frequent water treatments, lubrication once a week 1-3% salicylic alcohol. Treatment is being carried out increased sweating.
How to avoid contracting tinea versicolor while on vacation?
By following the simple tips below, you can avoid infection and save good mood and peace of mind:
- do not sunbathe immediately after swimming, wait until the skin dries;
- use sunscreen with an SPF filter, tan in doses;
- do not sunbathe on unspoiled beaches;
- use personal beach towels, wash them more often;
- take a shower after the beach and outdoor recreation;
- Observe personal hygiene rules and do not use other people’s things.
Prevention of re-infection with the causative agent of lichen versicolor includes an extensive complex of general hygiene procedures: hardening, regular water-salt or water-vinegar rubdowns, treatment of excessive sweating. In spring, it is recommended to wipe the skin with 2% salicylic alcohol for a month.
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