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Pityriasis versicolor: photo, treatment


Pityriasis versicolor Color, or scaly, is a fungal infection of the skin, which, as a rule, develops during the period of active sun. Therefore, the people of this disease is sometimes called "solar fungus." Pityriasis versicolor is a fairly common pathology that occurs almost everywhere, but most often it is detected in residents of countries with a hot climate. This form of superficial mycosis is characterized by the appearance of spotty, slightly scaly yellowish, brownish or whitish lesions on the body, having various sizes and shapes.

The causative agent of this form of dermatomycosis is a lipophilic yeast-like fungus Pityrosporum orbiculare, belonging to the class of imperfect fungi. In the course of its vital activity, it is able to form wide, short filaments of mycelium and round contour controversy. This pathogen parasitizes on human skin (in the stratum corneum of the epidermis) in both saprophytic and pathogenic forms. When penetrating into the mouth of the oily hair follicles, Pityrosporum orbiculare begins to multiply rapidly, forming colonies, presented in the form of yellow-brown spots. These are the initial elements of pityriasis versicolor, which in the process of peripheral growth turn into sharply delineated rounded spots, reaching 1 cm in diameter. In the process of merging, they form fairly large foci, which sometimes exceed the size of the male palm.

It should be noted that the contagiousness of the pathogen of multi-colored depriving is negligible.

Causes of tinea versicolor

According to statistics, pityriasis versicolor is most common in young patients (including children over 7 years old).

Pityriasis versicolor photo The main risk factors that provoke the development of this pathology include:

  • Increased sweating;
  • The specific chemical composition of sweat;
  • Acidity of the skin, favorable for active reproduction of the pathogen;
  • Chronic pathology of the digestive tract;
  • Endocrine diseases;
  • Immunodeficiency state;
  • Pregnancy.
  • Genetic predisposition;
  • Lymphogranulomatosis;
  • Tuberculosis .
  • Diabetes;
  • Cushing's syndrome.

According to experts, the transmission of the pathogen of chromophytosis can occur by contact-household way (through bedding, as well as when wearing clothes of a sick person). However, the yeast-like fungus Pityrosporum orbiculare is a saprophytic inhabitant of the skin, and therefore most people are its permanent carriers.

The mechanism of development of scaly depriving

Characteristic symptoms of the disease occur in a patient when a yeast-like fungus, penetrating into the mouths of the greasy hair follicles, begins to actively grow and multiply. Because of this, the work of cells responsible for the production of melanin (an amorphous dark pigment that stains the skin under the influence of sunlight) is disrupted. This is due to the fact that a harmful fungus in the process of its vital activity produces an acid that reduces tyrosinase activity, and, as a result, the ability of myelocytes to pigment. That is why hypopigmented (not tanned) areas appear on the skin of patients suffering from chromophytosis.

However, some authors have a different opinion on this matter. They claim that loosening of the stratum corneum that occurs in the outbreaks of the fungal lesion prevents the penetration of ultraviolet rays into the deep epidermal layers. Therefore, after water procedures and removal of peeled skin scales, the affected lesions become brighter than healthy skin.

Symptoms of pityriasis lichen

Symptoms of pityriasis lichen When activating the pathogen, it is most often localized on the upper torso (in the back, chest and shoulders). Less commonly, they may occur in the groin or on the scalp. At the earliest stages of the disease, yellowish spots appear at the sites of the mouths of the hair follicles, which after some time transform into primary morphological elements. They are presented in the form of yellowish-brownish, yellow-pink, light and dark brown weakly scaly small spots of a non-inflammatory nature.

In the event that the patient is not prescribed timely and adequate treatment, after a while the spots begin to merge into larger foci with small-fringed margins, which occupy rather large areas of the skin. Then they become dark brown, or acquire the color of "coffee with milk." Because of this change in shades, pityriasis versicolor is sometimes called variegated. As a rule, lichen-free spots do not protrude above the surface of healthy skin and do not cause any subjective sensations (very rarely, patients complain of a slight itch). With a slight scraping of the formations, a weak, peeling-like peeling is noted (Benye's symptom), for which this ringworm got its name. After sunburn in these places remain hypopigmented areas (pseudo-leukoderm).

Forms of the pathological process

Color, or scaly, can occur in three main forms.

1. Most often in the dermatological practice is found erythematous form. It is characterized by the appearance on the body of patients with brown or “coffee with milk” stains of a non-inflammatory nature.

In the early stages of the disease, the spots are small in size, but over time they gradually increase, and on their surface there is a slight, scaly, peeling. Most often, such formations are localized on the chest or on the back, less often - on the stomach and shoulders. In children, fungal lesions may occur on the scalp. They stand out against the background of healthy skin when treated with an alcohol solution of iodine. As a rule, seasonality is characteristic for this form of pathology. The disease is exacerbated in the fall and spring.

2. The second form of pityriasis lichen is the follicular form. In this condition, papules and pustules that reach 3 mm in diameter appear on the inflamed skin area. Often, patients complain of severe itching in the affected area. Most often, the follicular form of chromophytosis develops on the background of diabetes mellitus or is a consequence of hormonal treatment.

3. The invert form of pityriasis versicolor is a pathological condition in which the lesions of the fungal lesion are localized in the natural skin folds.

в клинической практике иногда (очень редко) встречаются случаи поражения липофильным дрожжеподобным грибком Pityrosporum orbiculare внутренних органов. Note: In clinical practice, sometimes (very rarely) there are cases of lesions of the internal organs with the lipophilic yeast-like fungus Pityrosporum orbiculare. This disease can develop in premature babies who are bottle-fed using Intralipid (fat emulsion). In such cases, a fungal infection causes bronchopneumonia or pulmonary vasculitis. According to scientists, intralipid, which is a source of essential fatty acids for a child, creates a favorable environment for the spread of the pathogen in the body.

It should be noted that in patients with pityriasis versicolor immunological disorders are very poorly expressed. With a long course of the disease, the production of cytokines produced by lymphocytes is disturbed and the compliment system is activated.

Atypical for chinexia

In clinical practice, there were cases of atypical localization of fungal lesions. So, in 1977, a case was described when a 16-year-old patient with increased perspiration, along with typical eruptions of cholitivus lichen were found on the soles. It should be noted that even after the treatment (four months later), brownish patches of a non-inflammatory nature were found on the heels and in the transitional fold from the sole to the fingers.

Diagnosis of chinexia

Diagnosis of this form of ringworm, as a rule, does not cause difficulties. First of all, the patient undergoes a thorough examination. The diagnosis of "pityriasis versicolor" is made with a positive symptom of Bénier (the presence of scaly peeling in the seborrheic zones).

As an auxiliary technique, Balzer's iodine test is assigned, and a study is also carried out using a Wood's fluorescent lamp (the appearance of brown, greenish-yellow or golden-yellow glow in the affected skin).

The pathogen of tinea versicolor easily detected by culture and microscopic examination.

What you need to pay attention to?

There are several points that in the process of diagnosis the attending physician should pay attention to. First of all, in patients who have been exposed to ultraviolet radiation and have already undergone treatment, Balzer’s test will give a negative result.

Further: it is imperative to carefully examine the scalp of the patient, since if at this site a specialist does not notice the existing lesions, there is a high probability of a relapse of the disease. It is recommended to use a Wood lamp for this.

It is necessary to take into account the fact that the pinkish-brown spots on the white skin are almost not noticeable, and therefore, during a cursory examination, they can be overlooked, and only in the summer, after sunbathing, they begin to catch the eye.

Finally, in people who are not immunocompromised, isolated skin formations usually do not exceed 1-1.5 centimeters in diameter, while in patients with severe immunodeficiency they can exceed 5 centimeters in diameter. In HIV-infected and AIDS patients, the elements of multi-colored lichen are more intense pigmentation, and may also have a disseminated (widespread) character. As a rule, in patients with immune status, pityriasis versicolor manifests itself as seborrheic or atopic dermatitis . Also on the skin of patients can form multiple inflammations of the hair follicle with symptoms of the necrotic component.

What diseases can be confused with scaly deprive?

Due to the fact that this form of ringworm has similar symptoms with other diseases, a differential diagnosis is required before starting treatment.

1. Differential diagnostics of chives with syphilitic roseola and leucoderma.

With a positive result of the classic Wasserman serological reaction, immunofluorescence reaction and immobilization reaction of pale treponema, the diagnosis of syphilis is confirmed. At the same time, roseola of secondary syphilis has a brighter shade than the foci of chives, it does not peel off, disappears when diascopy, does not fluoresce in the light of the Wood lamp and gives a negative test of Balzer. Despite the fact that, like a pityriasis versicolor, it is localized only on the body, it is not typical for the merging of elements. In syphilitic roseola, the spots do not flake off, have a vascular origin and do not cause subjective sensations.

Syphilitic leucoderma is also not characterized by fusion of hyper-pigmented spots.

2. Differential diagnosis of pityriasis versicolor with pink lichen of Jiber.

With the development of Gibert's disease, lichen-free spots have round or oval outlines with a peeling in the center, resembling a medallion, and also the presence of a “maternal plaque” is characteristic of this pathology. In this case, the eruptions are localized strictly symmetrically along the Langer lines, there is a flake collar around the central plaque, and this secondary form of the pathology is characterized by the presence of numerous secondary lesions.

Read more about pink lichen here: Pink lichen: photos, symptoms and treatment

3. Differential diagnosis of chives with folliculitis.

It should be noted that the same yeast fungus that provokes the development of pityriasis versicolor is the causative agent of hair follicle infection. However, in this case, separately located itchy eruptions appear in the upper torso in the form of red or pink nodules and plaques. As a rule, women and middle-aged men are more likely to suffer from folliculitis. Long-term antibiotic therapy, treatment with corticosteroids or diabetes can provoke the development of the pathological process. Very often, skin rashes appear on the forehead, imitating persistent acne . This form of ringworm is characteristic of tropical countries.

Tinea versicolor treatment

Due to the fact that pityriasis versicolor develops due to the transformation of a saprophytic form of a lipophilic yeast-like fungus into a pathogenic one, it should be clarified before starting treatment of the disease what provoked such a condition. It is necessary to take into account the fact that this form of ringworm can be a marker of rheumatism, pulmonary tuberculosis, diabetes mellitus and AIDS infection. That is why all patients suffering from pityriasis versicolor, to exclude the above pathologies must undergo appropriate diagnostic examinations. However, the symptoms of multi-colored lichen can be observed in cancer patients undergoing chemotherapy, but at the end of the course of treatment, all skin manifestations disappear spontaneously.

Since the pityriasis versicolor affects only the superficial (horny) layer of the epidermis, its treatment involves the prescription of drugs for external use. In this case, patients are shown to use keratolytic and fungicidal preparations, combination drugs and drugs containing zinc pyrithione.

It should be emphasized that in the appointment of treatment takes into account the extent and localization of lesions. More recently, to suppress the aggressiveness of the pathogen, patients were advised to use an alcohol solution of resorcinol or salicylic alcohol. Now it is mandatory for patients to use antimycotic drugs from the group of azoles. Under their influence, within a day, dehydration and vacuolation of the pathogen cytoplasm occur, and after 48 hours its cell wall completely dissolves. That is why today experts prefer specific antifungal treatment.

In the treatment of pityriasis lichen used funds to combat fungal skin diseases, which are produced in the form of a spray, solution or powder. They are recommended to be applied on the affected areas, slightly rubbing. It should be noted that the fungicidal drugs have a great effect on keratinized skin, maintaining its effectiveness for 72 hours.

Well-proven drugs, which include zinc pyrithione, which has antimicrobial, cytostatic and antifungal effects. After treatment, they are recommended to be taken for prevention.

With the defeat of pityriasis versicolor of the scalp, the use of special therapeutic shampoos, which include antifungal agents and tar, relieves swelling, infiltration, erythema and desquamation.

Patients with a common form of pityriasis versicolor, not responding to local treatment, are prescribed systemic therapy. To improve adsorption, systemic antimycotics such as intraconazole, ketoconazole, or fluconazole are recommended. It should be noted that a particular drug is prescribed purely individually, taking into account the general condition of the patient. Therefore, experts urge not to self-medicate.

Within 12 hours after carrying out medical procedures, water procedures are contraindicated to patients (during this time, the drug must accumulate in the skin), and many dermatologists, in order to prevent a recurrence of the disease, are advised to change clothes for a month each month.

такое последствие псевдолейкодермы, как гиперпигментация остается на коже человека после лечения достаточно длительное время. Note: such a consequence of pseudo-leukoderma, as hyperpigmentation, remains on the human skin after treatment for a sufficiently long time.

Traditional methods of treatment of chinexia

For the treatment of pityriasis lichen, folk healers recommend the use of St. John's wort, sea buckthorn and peach oil, as well as rosehip oil. Another very effective means of coping with this form of ringworm is natural apple cider vinegar. They should lubricate the lesions seven to eight times a day once or twice a week.

The decoction of the roots and seeds of horse sorrel has proven itself well. They need to wipe off lichen spots.

Not bad helps external means, prepared from crushed oxalic leaves and stems, with the addition of sour cream or cream.

All the clothes of the patient at the end of the treatment process, traditional healers recommend thoroughly laundering and ironing.

Methods of prophylaxis of scaly depriving

  1. If a family member has a case of dermatomycosis, which provokes the development of chirimatosis, a diagnostic examination with a Wood luminescent lamp and a visual clinical examination of all members of his family are shown.
  2. In the summer, people with sweating are advised to regularly wipe the skin with acidified water or salicylic alcohol in order to prevent it, and also use an antifungal spray or solution once every 2-3 weeks and constantly remember about the means of correcting sweating.
  3. All clothes (including hats), as well as bed linen should be boiled in a soap-soda solution and ironed with a hot iron.

| 12th April 2014 | | 17,794 | Skin diseases
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