OBJECTIVE: The study aimed to assess the efficacy and safety of Senna alata (akapulko) plant extracts compared with topical antifungals in the treatment of superficial fungal skin infections.

METHODS: A systematic review and meta-analysis of randomized controlled trials that studied patients with diagnosed cutaneous tinea or dermatophytosis (excluding hair and nail), tinea versicolor, or cutaneous candidiasis, via microscopy or culture, and compared the efficacy and safety of S. alata (akapulko) extract versus topical antifungals. Two authors independently screened titles and abstracts of merged search results from electronic databases (The Cochrane Skin Group Specialized Register, CENTRAL, MEDLINE, EMBASE (January 1990 to December 2011), Health Research and Development Information Network (HERDIN), and reference lists of articles), assessed eligibility, assessed the risk of bias using the domains in the Cochrane Risk Bias tool and collected data using a pretested Data extraction form (DEF). Meta-analyses were performed when feasible.

RESULTS: We included seven RCTs in the review. There is low certainty of evidence that S. alata 50% lotion is as efficacious as sodium thiosulfate 25% lotion (RR 0.91, 95% CI, 0.79 to 1.04; 4 RCTs, n=216; p=0.15; I2=52%) and high quality evidence that S. alata cream is as efficacious as ketoconazole (RR 0.95, 95% CI, 0.82 to 1.09; 1 RCT, n=40; p=0.44) and terbinafine cream (RR 0.93, 95% CI, 0.86 to 1.01; 1 RCT, n=150; p=0.09) in mycologic cure. For adverse effects, there is very low certainty of evidence of increased harm with S. alata 50% lotion compared to sodium thiosulfate 25% lotion (RR 1.26, 95% CI, 0.46, 3.44; 2 RCTs, n=120; p=0.65; I2=19%). Adverse effects were few and mild.

CONCLUSION: S. Alata 50% lotion may be as efficacious as sodium thiosulfate 25% lotion and is as efficacious as ketoconazole 2% and terbinafine 1% creams. There is insufficient evidence to compare the safety of S. alata 50% lotion with sodium thiosulfate 25% lotion.

No abstract available.
Atrophy ; Pityriasis* ; Tinea Versicolor*

Background: Pityriasis versicolor is a common fungal infection of the superficial skin layer caused by Malassezia furfur, a normal commensal in the skin. Keratolytic agents are popular, cheap, and readily available over-the-counter treatments for pityriasis versicolor. Conventional antifungal agents are more expensive, requiring prescription, and may induce resistant strains. However, evidence of their comparative safety and efficacy is still lacking. Objectives: To assess the efficacy and safety of synthetic antifungals compared to keratolytic agents in the topical treatment of pityriasis versicolor through a systematic review. Methods: We searched the following databases: MEDLINE (from 1966) through PubMed, CENTRAL (Issue 9 of 12, September 2021), EMBASE (from 1974), LILACS (from 1987); Herdin (from 1970), www.clinicaltrials.gov, www. isrctn.com, www.trialregister.nl. We contacted researchers in the field, hand searched relevant conference abstracts, and the Journal of the Philippine Dermatological Society 1992-2019. We included all randomized controlled trials involving patients with diagnosed active pityriasis versicolor where topical antifungal was compared with a topical keratolytic for treatment. Two review authors independently applied eligibility criteria, assessed risk of bias using the Cochrane collaboration tool, and extracted data from included studies. We used RevMan 5.3 to pool dichotomous outcomes using risk ratios (RR) and continuous outcomes using the mean difference (MD), using random-effects meta-analysis. We tested for statistical heterogeneity using both the Chi² test and the I² test. We presented results using forest plots with 95% confidence intervals. We planned to create a funnel plot to determine publication bias but were unable to due to few studies. A Summary of Findings table was created using GRADE profile software for the primary outcomes. Results: We included 8 RCTs with a total of 617 participants that compared azole preparations (ketoconazole, bifonazole and econazole) versus keratolytic agents (selenium sulfide, adapalene, salicylic-benzoic acid). Pooled data showed that azoles did not significantly differ from keratolytic agents for clinical cure (RR 0.99, 0.88, 1.12; 4 RCTs, N=274, I2=55%; very low-quality evidence), and adverse events (0.59 [0.17, 2.06]; very low-quality evidence) based on 6 RCTs (N=536). There were two patients given a keratolytic agent (selenium sulfide shampoo) who had acute dermatitis and discontinued treatment. Conclusion It is uncertain whether topical azoles are as effective as keratolytic agents in clinical clearance and occurrence of adverse events in patients with pityriasis versicolor. A wider search of grey literature and local studies are warranted. Larger RCTs with low risk of bias are recommended.
Azoles ; Tinea Versicolor

Background: Carica papaya latex has been found to have antifungal properties rendering an alternative treatment for fungal infections, i.e. pityriasis versicolor. It has remarkable mycelial inhibition, and static effect on fungal growth in cultures. Its keratolytic effect can remove diseased skin cells, and enhance drug penetration. Moreover, it is organic, locally available, and relatively inexpensive. Objective: To compare the efficacy and safety of 1.5% Carica papaya latex cream vs. 2% ketoconazole cream in the treatment of pityriasis versicolor among Filipinos. Methods: A single-center, parallel group, triple-blind, randomized controlled trial in the Dermatology out-patient clinic of Makati Medical Center was conducted. Sixty-four patients with pityriasis versicolor were randomly allocated to the two treatment groups, and received either 1.5% Carica papaya latex cream or 2% ketoconazole cream that they used twice daily for four weeks or until cured. The participants, researcher, and assessor were blinded to the treatment assignments. Therapeutic response was assessed at weeks 1, 2, 3 and 4 based on clinical and mycologic cure. Adverse events were identified. Patients’ assessment of their improvement was done at the end of the treatment. Results: All 64 subjects in both treatment groups (100% in the Carica papaya and 100% in the ketoconazole group) achieved clinical and mycologic cure within the four-week study period. The adverse reactions noted (pruritus and erythema for Carica papaya latex cream, and pruritus for ketoconazole cream) were mild, did not cause disruption of daily activities, and spontaneously resolved. Conclusion 1.5% Carica papaya latex cream is an effective and safe alternative treatment to the first line therapy, ketoconazole cream, for pityriasis versicolor.
Carica ; Tinea Versicolor

Background: Pityriasis versicolor is a common fungal infection of the superficial skin layer caused by Malassezia furfur, a normal commensal in the skin. Keratolytic agents are popular, cheap, and readily available over-the-counter treatments for pityriasis versicolor. Conventional antifungal agents are more expensive, requiring prescription, and may induce resistant strains. However, evidence of their comparative safety and efficacy is still lacking. Objectives: To assess the efficacy and safety of synthetic antifungals compared to keratolytic agents in the topical treatment of pityriasis versicolor through a systematic review. Methods: We searched the following databases: MEDLINE (from 1966) through PubMed, CENTRAL (Issue 9 of 12, September 2021), EMBASE (from 1974), LILACS (from 1987); Herdin (from 1970), www.clinicaltrials.gov, www. isrctn.com, www.trialregister.nl. We contacted researchers in the field, hand searched relevant conference abstracts, and the Journal of the Philippine Dermatological Society 1992-2019. We included all randomized controlled trials involving patients with diagnosed active pityriasis versicolor where topical antifungal was compared with a topical keratolytic for treatment. Two review authors independently applied eligibility criteria, assessed risk of bias using the Cochrane collaboration tool, and extracted data from included studies. We used RevMan 5.3 to pool dichotomous outcomes using risk ratios (RR) and continuous outcomes using the mean difference (MD), using random-effects meta-analysis. We tested for statistical heterogeneity using both the Chi² test and the I² test. We presented results using forest plots with 95% confidence intervals. We planned to create a funnel plot to determine publication bias but were unable to due to few studies. A Summary of Findings table was created using GRADE profile software for the primary outcomes. Results: We included 8 RCTs with a total of 617 participants that compared azole preparations (ketoconazole, bifonazole and econazole) versus keratolytic agents (selenium sulfide, adapalene, salicylic-benzoic acid). Pooled data showed that azoles did not significantly differ from keratolytic agents for clinical cure (RR 0.99, 0.88, 1.12; 4 RCTs, N=274, I2=55%; very low-quality evidence), and adverse events (0.59 [0.17, 2.06]; very low-quality evidence) based on 6 RCTs (N=536). There were two patients given a keratolytic agent (selenium sulfide shampoo) who had acute dermatitis and discontinued treatment. Conclusion It is uncertain whether topical azoles are as effective as keratolytic agents in clinical clearance and occurrence of adverse events in patients with pityriasis versicolor. A wider search of grey literature and local studies are warranted. Larger RCTs with low risk of bias are recommended.
Azoles ; Tinea Versicolor

No available abstract.
Alopecia* ; Pityriasis* ; Scalp* ; Tinea Versicolor*

Electron microscopic examination of specimens from lesions of eight patients with hyperpigmented and six patients with hypopigmented tinea versicolor and from unaffected skin in each patient was performed. The results are summarized as follows; 1. In hyperpigmented lesions, melanosomes are larger and more singly dispersed than in unaffected skin. 2. In hypopigmented lesions, melanosomes are smaller and less singly diepersed than in unaffected skin. 3. Number of total melanosomes in hyperpigmented and hypopigmented lesions was not different from in unaffected skin.
Humans ; Melanosomes* ; Skin ; Tinea Versicolor* ; Tinea*

No abstract available.
Humans ; Pityriasis* ; Tinea Versicolor* ; Treatment Outcome*

BACKGROUND: The genus Mulassezia. was recently revised into seven species, M. furfur, M pachydermatis, M sympodialis, M. globosa, M. obtusa, M. restricta and M. slooffiae. Some of the Malassezia species were known to be the etiological agent of pityriasis versicolor. OBJECTIVE: The study was done to place the Malassezia strains cultured from the lesions of pityrisis versicolor into one of The revised species and to elucidate the relationship between certain species and pityriasis versicolor. METHODS: The scales from the lesions of twenty cases of pityrisis versicolor were cultured on Leeming & Notmans media. The obtained strains were placed into one of seven species by their colony morphologies, microscopic morphologies and physiological characteristics. RESULTS: The strains obtained from twenty cases of pityriasis ver sicolor could be placed into one of four species as following incidences. 1 case of M. furfur, 3 cases of M. sympodialis, 15 cases of M globosa, 1 case of M. obtusa, M, globoso occupied the most commonly isolated species cultured from the lesions of pityriasis versicolor. CONCLUSION: The results suggested that M. globosa could be consider ed as a main etiological agent of pityriasis versicolor among the Malassezia species.
Incidence ; Malassezia* ; Pityriasis* ; Tinea Versicolor* ; Weights and Measures

Seventeen volunteers with cutaneous dermatophytosis were enrolled in a clinical trial to evaluate the effectiveness of oral ketoconazole. The group included six patients with tinea cruris(6 malcs), four with tinea corporis, including one with tinea faciai, (3 males, 1 female), three with tinea versicolor(3 males) and four with tinea capitis(3 males, 1 female). The oral ketoconazole was taken within 10 minutes after a meal. The patients under the age of 10 received 100mg of ketoconazole per day, whereas those aged over 11 received 200mg of ketoconazole until the skin lesions are cured. Seventeen patients had complete clinical and mycologic cure, one responded clinically. It required one to four weeks to become culturally negative for tinea cruris, four to seven weeks for tinea corporis, three to eight weeks for tinea capitis. For tinea versicolor it required three to five weeks to become negative by scotch tape method. Adverse reactions to ketoconazole were absent and no patients required discontinuation of the drug. The results indicate that ketoconazole is a safe and effective drug for the treatment of dermatophytosis.
Humans ; Ketoconazole* ; Male ; Meals ; Skin ; Tinea Capitis ; Tinea Versicolor ; Tinea* ; Volunteers