impaginato piccolo - Società Italiana di Parassitologia (SoIPa)

Parassitologia 50: 93-95, 2008
Uncommon cases of pityriasis versicolor
C. Romano
Dermatologic Section of the Department of Clinical Medicine and Immunological Science. University of Siena, Italy
Abstract. Malassezia may play a role in several dermatoses. It is responsible for foliculitis and mainly for
pityriasis versicolor. Pityriasis versicolor is the most known dermatitis because of its clinical aspects and frequently
for its poor response to the therapy, mainly in chronic forms. The clinical aspects of uncommon and
rare forms of pityriasis versicolor have been reported. The data related to the patients observed in the last
thirty years in Siena are reported. In addition, a study was carried out in Pisa by Professor F. Mancianti to
identify species of Malassezia isolated in 37 patients.
Key words: Pityriasis versicolor, mycoses, Malassezia
Malassezia is responsible for pityriasis versicolor (PV)
and folliculitis, and it is hypothesized that play a role in
the pathogenesis of seborrhoeic dermatitis (SD), and
atopic dermatitis (AD). Nevertheless the most frequent
dermatological disease caused by this mycete is certainly
the pityriasis versicolor, which commonly manifests
with hyperpigmented or achromic macules, according
to the season. Lesions are most frequent on the seborrhoeic
areas, such as the upper trunk, neck and upperarms.
Besides the typical manifestations, there are
those ones which are uncommon due to their clinical
aspects (pityriasis versicolor atrophicans and pityriasis
versicolor rubra) or due to their sites (pytiriasis versicolor
areolar e periareolar, penile, in the groins, perianal,
palmar and plantar areas). There are even forms
thet affect almost all body surface.
Crowson and coll. reported twelve clinical cases in
which lesions characterized as patches, macules, and
atrophic plaques prompted clinical differential diagnosis
with atrophy due to intralesional steroid therapy,
collagen diseases or parapsoriasis. However, histologic
examination showed hyphae and spores in the corneum
layer, variable epidermal and dermal atrophies, reteridge
effacement, subepidermal fibroplasia, pigment
incontinence and elastolysis.This form was defined
atrophying pitiriasis versicolor (1, 2).
Pitiriasis versicolor rubra clinically presented as soybean-sized,
red colored macule. At first it was primarily
reported by Horiuchi, and recently six cases attributed
to Malassezia sympodialis have been described.
Rudolph and coll. described two patients who had
some lightly pigmented, scaling, mildly pruritic eruptions
in the groins, axillae, and perianal regions. The
differential diagnosis included erythrasma, SD and dermatophyte
infections. The authors have stressed a new
nomenclature, “inverse tinea versicolor”, due to the
highly atypical site.
Correspondence: Clara Romano
Dept. of Clinical Medicine and Immunological Science,
Section of Dermatology, University of Siena,
Policlinico le Scotte, Viale Bracci 53100 Siena, Italy.
e-mail: romanoclara@unisi.it
Anthony reported circular areas roughly hypopigmented,
unilateral or bilateral with thin scales localized in
the areolae or in the periareolae.
Schosser and coll. reported the case of man who had a
brownish, scaly lesion on the nipple microscopically
diagnosed as areolar and periareolar PV.
Kamalam showed similar lesions in the penis, in the
groins, in the perianal, palmar and plantar areas.
Blumenthal described multiple hypopigmented and
scaly macular lesions over the penis of a patient who
has also been treated during the last five years with triamcinolone
acetonide and prednisolone acetate for
neurodermatitis, which was not the correct diagnosis.
Unusual extensive forms affecting almost the entire
body surface are generally the prerogative of the
immunodepressed patients: long-term systemic corticosteroid
or estrogen-progestin use, chemotherapy or
disorders affecting endocrine systems (fig. 1).
The rare cases of pityriasis versicolor observed in Siena
in the last thirty years are briefly documented. There are
two cases of pityriasis versicolor atrophycans and many
cases of unusual extensive forms or in uncommon sites
(Tab.1 and Tab. 2). In all reported cases the diagnosis
was based on microscopic examination (fig. 2).
Fig. 1. Many hyperpigmented macules on the trunk in patient
with hypothyroidism.