In most instances, Cryptococcosis is a systemic disease caused by the yeast-like fungus Cryptococcus neoformans through respiratory tract. The organism is worldwide in its distribution, is saprophytic, and is found in soil and in pigeon excretion. Primary cutaneous cryptococcosis is rare; skin lesion is the sole manifestation of the disease without preceding generalized or cerebrospinal involvement. We report a case of primary cutaneous crytococcosis. The patient was a 53-year-old female, who had had an erythematous ulcerated lesion with swollen border on the dorsum of right wrist. Histopathologic examination showed typical spores with capsules. Other physical examinations and laboratory findings were within normal limit. The lesion was successfully treated with oral itraconazole (200mg/dayx7weeks).
Capsules ; Columbidae ; Cryptococcosis* ; Cryptococcus neoformans ; Female ; Fungi ; Humans ; Itraconazole* ; Middle Aged ; Physical Examination ; Respiratory System ; Skin ; Soil ; Spores ; Ulcer ; Wrist

Tricosporon(T.) cutaneum is a member of the subfamily Trichosporideae in the family of Cryptococcaceae. It is now regarded as the same species as Trichosporon beigelii. It is widely distributed in soil, and is sometimes a part of the normal flora of the human skin, nail and mouth. It also may rarely colonize the throat and lower gastointestinal tract in hospitalized patients. T. cutaneum may cause white piedra in immunologically normal patients, a disease characterized by surface hard nodules along the hair shaft, however, skin infection by this organism is rare, T. cutaneum is referred to by Emmons as the agent of subcutaneous and systemic fungal infection. We report a case of subcutaneous infection with T. cutaneum in a kidney transplanted patient.
Colon ; Hair ; Humans ; Kidney Transplantation ; Kidney* ; Mouth ; Pharynx ; Piedra ; Skin ; Soil ; Trichosporon*

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

Microsporum canis is known to be the main causative agent of tines capitis and tinea corporis in children. Contrary to Trichophyton rubrum and Trichophyton mentagrophytes var. interdigitale, it very rarely infects the nail. In the reported cases of tinea unguium due to Microsporum canis, fingernails were usually affected. We report a patient with tinea unguium of thumb and big toe nails caused by Microsporum canis.
Child ; Humans ; Microsporum* ; Nails ; Onychomycosis* ; Thumb ; Tinea* ; Toes ; Trichophyton

Chronic dermatophyte infection rarely fails to respond to topical or systemic antifungal therapy. Such refractory condition relates to many factors and one of them is the decreased response of delayed type hypersensitivity. A plausible mechanism by which the delayed hypersensitivity response may cause dermatophyte inhibition has been proposed already. Our patient had skin rashes for 6 years. It was diagnosed as tinea corporis and treated with various systemic antifungal agents, such as griseofulvin, itraconazole, fluconazole, terbinafine and topical forms of econazole and terbinafine. But the skin lesions did not resolve completely and reaggravated frequently. Numerous verrucae planar were found on face, neck and both extremities. Trichophyton rubrum was identified by fungus culture study. Laboratory examination showed no response against multi-CMI test, DPCP sensitization and prick test for trichophytons. We challenged the therapy with the combined antifungal agents and immune stimulatory drugs. This case is thought to be a chronic dermatophyte infection due to the defects in the both cell mediated immunity and immediate type hypersensitivity which is crucial for the host defence mechanisms against fungal infection.
Antifungal Agents* ; Arthrodermataceae* ; Econazole ; Exanthema ; Extremities ; Fluconazole ; Fungi ; Griseofulvin ; Humans ; Hypersensitivity ; Hypersensitivity, Delayed ; Immunity, Cellular ; Itraconazole ; Neck ; Skin ; Tinea ; Trichophyton ; Warts

Tinea capitis is a dermatophytosis of the scalp and associated hairs that is caused by the species of genera Mecrosporum and Trichophyton. It commonly affects children. Black dot ringworm (BDR) can be caused by Trichophyton tonsurans and Trichophyton violaceum. We report a 82-year-old woman with diffuse hair loss and black dots on the frontal scalp, and an erythematous annular scaly patches on the forehead. Endothrix invasion of the hair was shown on the 20% KOH mount. In fungus culture, slow growing violaceous verrucous colonies were obtained from the scalp and face. Microscopic findings revealed irregular branching hyphae and numerous chlamydospores. Histologic findings of the scalp showed numerous PAS positive fungal elements in the hair. Griseofulvin was administrated at the dose of daily 1000mg for 3 weeks, but no clinical and mycological improvement were obtained and tenderness and pustules were developed. Terbinafine at the dose of daily 250mg was administrated for 6 weeks, and clinical and mycologic improvement were obtained and damaged scalp hairs were replaced by intact hair shaft. There has been no recurrence for 8 months. To our best knowledge, this is the first case of BDR caused by T. violaceum in the Korean literature.
Aged, 80 and over ; Child ; Female ; Forehead ; Fungi ; Griseofulvin ; Hair ; Humans ; Hyphae ; Recurrence ; Scalp ; Tinea Capitis ; Tinea* ; Trichophyton*

BACKGROUND: Clinical concern and incidence of mycotic keratitis in ophthalmic practice has been increasing. OBJECTIVE: The purpose of this study was to investigate clinical and mycological feature of mycotic keratitis. METHODS: We evaluated the clinical and mycological aspect of mycotic keratitis in 14 patients from October 1993 to March 1997 in Dongguk Unversity Hospital. RESULTS AND CONCLUSION: Mycotic keratitis showed high incidence in fifth (42.9%), sixth (35.7%), and fourth decade (14.3%). The ratio of male to female patient was 1:3.6. The seasonal prevalence was highest in autumn. A scratch or abrasion from vegetation was the most common type of the eye trauma in mycotic keratitis. The positive rate of KOH examination and culture was 92.9%, respectively. The common causative organisms of mycotic keratitis were Fusarium sp. (38.5%) and Alternaria sp. (38.5%), followed by Curvularia sp. (7.7%), Aspergillus flavus (7.7%) and Acremonium sp. (7.7%).
Acremonium ; Alternaria ; Aspergillus flavus ; Female ; Fusarium ; Humans ; Incidence ; Keratitis* ; Male ; Prevalence ; Seasons

BACKGROUND: Steroid acne is a folliculitis that can result from a systemic or topical administration of steroid and has been described as showing similar clinical pictures to Malassezia folliculitis, but there have been few reports about the incidence of Malassezia in steroid acne and other acneiform eruptions. OBJECTIVE: Our purpose was to describe the incidences of Malassezia in acneiform eruptions and to discuss about the relationship between clinical steroid acne and Malassezia folliculitis. METHODS: The history, clinical features, direct microscopy, histopathological analysis, and therapeutic results of 125 cases with steroid acne or other acneiform eruptions were described and compared. RESULTS: Over 80% of patients with acneiform eruption receiving systemic steroid revealed significant numbers of Malassezia in the lesional follicle. CONCLUSION: Steroid acne and other acneiform eruptions showing discrete follicular papules and/or pustules localized to the upper trunk or acneiform facial skin lesions associated with multiple acneiform lesions on the body in the summer period should be suspected as Malassezia folliculitis.
Acne Vulgaris* ; Acneiform Eruptions* ; Administration, Topical ; Folliculitis ; Humans ; Incidence* ; Malassezia* ; Microscopy ; Skin

The cause of seborrheic dermatitis is unknown, although many attempts have been made to relate it to infection with bacteria or with ,Malassezia furfur. Recently, there have been many studies concerning the efficacy of anti-fungal agents against seborrheic dermatitis. In this occasion, I introduce the result of studies concerning the efficacy of antimycotic drugs against dandruff and seborrheic dermatitis in Japan and in our outpatient clinic of dermatology. I also report the results of our laboratory studies concerning the mechanism of seborrheic dermatitis. We produced the animal models of seborrheic dermatitis. Lesions in immunized guinea pigs developed faster than those of non immunized guinea pigs. The anti-Malassezia IgY seems to delay the development of the lesion. Malassezia spores were detected from lesional skin by direct light microscopy method in our outpatient clinic. Approximately 85% of the facial sites and 75% of the scalp sites were positive in total. One of our clinical studies was a double-blind, comparative study conducted at 8 institutions on the usefulness of shampoo containing 0.75% miconazole nitrate (MZS) for the treatment of dandruff. Shampoo vehicle (BSS) without the reagent served as the control. MZS was evaluated as useful in 34 of the 58, and BSS in 19 of the 50 subjects, thus MZS was significantly more useful than BSS (p=0.020). The other clinical study concerned on the efficacy of ketoconazole cream used in 168 patients for the treatment of seborrheic dermatitis. This study was done as an open trial by multiple institutes. Approximately 80% evaluated as effective, in total. In 23 valuable cases, fungus disappeared in 16 cases (69.6%). It is concluded that anti-fungal agents have potential value as a new therapeutic agent -an alterative to steroids- for the treatment of seborrheic dermatitis.
Academies and Institutes ; Ambulatory Care Facilities ; Animals ; Bacteria ; Dandruff ; Dermatitis, Seborrheic* ; Dermatology ; Fungi ; Guinea Pigs ; Humans ; Japan ; Ketoconazole ; Malassezia ; Miconazole ; Microscopy ; Models, Animal ; Scalp ; Skin ; Spores

The lipophilic yeast Pityrosporum ovale (Malassezia sp.) is a member of the normal human cutaneous flora in adults but also associated with several skin diseases. Treatment of P. ovale related diseases include topical and systemic antifungal therapy In pityriasis versicolor, under the influence of predisposing factors, P. ovale changes from the round blastospore form to the mycelial form. Pityriasis versicolor may be treated with topical treatment. However, with more extensive lesions, in patients with recurrence of the disease or patients not responding to topical therapy short term treatment with oral antifungal drugs is very effective. Recurrence is a great problem in pityriasis versicolor with a recurrence rate of 60% within 1 year. To avoid this oral ketoconazole 400mg once monthly or 200mg on 3 consecutive days every months have a documented effect. Pityrosporum folliculitis is a chronic disease characterized by pruritic follicular papules and pustules located primarily on the upper trunk, neck and upper arms. In direct microscopy clusters of round budding yeast cells are found. The same treatments used for pityriasis versicolor are effective in the treatment of Pityrosporum folliculitis. However, the treatment period has to be prolonged. With topical therapy 3 to 4 weeks of daily treatment and then prophylactic therapy once or twice weekly is often necessary to first clear the disease and then to avoid recurrence. However, due to the presence of P. ovale deep down in the follicle several patients will not be completely cleared with topical therapy and systemic therapy may be necessary. There are now many studies indicating that J9 ovale plays an important role in seborrheic dermatitis. Many of these are treatment studies showing a good effect of antimycotics parallelled by a reduction in number of organisms. Severe seborrheic dermatitis often difficult to treat is associated with AIDS. In peripheral blood from a high number of patients with seborrheic dermatitis we found an increase in number of natural killer T-cells and decreased PHA and Con-A stimulation. Secondary we found low serum IgG antibody titres in patients compared to controls. Other studies have found a reduced lymphocyte stimulation reaction when lymphocytes from patients with seborrheic dermatitis were stimulated with a P. ovale extract. Additionally, IL-2 and IFN gamma pruduction by lymphocytes from patients was markedly depressed and IL-10 sythesis were increased after stimulation with p. ovale extract. Several studies have clearly documented that antifungal therapy is very effective in the treatment of seborrheic dermatitis.
Adult ; Arm ; Causality ; Chronic Disease ; Dermatitis, Seborrheic ; Folliculitis ; Humans ; Immunoglobulin G ; Interleukin-10 ; Interleukin-2 ; Ketoconazole ; Lymphocyte Activation ; Lymphocytes ; Malassezia ; Microscopy ; Natural Killer T-Cells ; Neck ; Recurrence ; Saccharomycetales ; Skin Diseases ; Skin* ; Tinea Versicolor ; Yeasts