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  • 1
    Electronic Resource
    Electronic Resource
    In vitro susceptibility of the seven Malassezia species to ketoconazole, voriconazole, itraconazole and terbinafine (2000)
    Oxford, UK : Blackwell Science Ltd
    British journal of dermatology 142 (2000), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Fifty-five strains, either authentic or ex-type, of seven Malassezia species were investigated for in vitro susceptibility to various concentrations (0·03–64·0 µg/mL) of three azole drugs, ketoconazole, voriconazole and itraconazole, as well as the allylamine terbinafine, using the agar dilution method. All strains of the seven Malassezia species were susceptible to the three azole drugs at low concentrations. M. furfur, M. sympodialis, M. slooffiae, M. pachydermatis, M. globosa, M. obtusa and M. restricta were most sensitive to ketoconazole and itraconazole, with minimum inhibitory concentrations (MICs) ranging from ≤ 0·03 to 0·125 μg/mL. The recently introduced antifungal, voriconazole, was also very effective, with MIC80 values ≤ 0·03 μg/mL for 80% of strains. MICs of terbinafine against the seven Malassezia species ranged from ≤ 0·03 to 64·0 μg/mL. There were variations in susceptibility of the seven Malassezia species to ketoconazole, voriconazole, itraconazole and terbinafine. Strains of M. furfur, M. globosa and M. obtusa were more tolerant to terbinafine than the remaining Malassezia species; M. sympodialis was highly susceptible. M. furfur strains tested with terbinafine ranged from highly susceptible to relatively resistant. Correct identification of Malassezia species could facilitate selection of appropriate antifungal therapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2133.2000.03294.x
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  • 2
    Electronic Resource
    Electronic Resource
    A multicentre (double-blind) comparative study to assess the safety and efficacy of fluconazole and griseofulvin in the treatment of tinea corporis and tinea cruris (1997)
    Oxford, UK : Blackwell Publishing Ltd
    British journal of dermatology 136 (1997), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In a double-blind, parallel group study we compared fluconazole 150mg once weekly with griseofulvin 500 mg once daily for 4–6 weeks in the treatment of tinea corporis or tinea cruris. Eighty-four of 114 patients (74%) (39% after 3 weeks) were clinically cured in the fluconazole group compared with 72 of 116 (62%) (39% after 3 weeks) in tbe griseofulvin group (P = 0·06). In tbe fluconazole group 78% were mycological cured compared with 80% in the griseofulvin group. In the fluconazole group nine patients (7·5%) had treatment related adverse events and in tbe griseofulvin group 15 patients (12·5%) had adverse events. Fluconazole 150 mg once weekly for 6 weeks is botb clinically and mycologically effective in the treatment of tinea corporis and tinea cruris and few side-effects were reported.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2133.1997.6181600.x
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  • 3
    Electronic Resource
    Electronic Resource
    Genetic predisposition – understanding underlying mechanisms of onychomycosis (2005)
    Oxford, UK : Blackwell Science Ltd
    Journal of the European Academy of Dermatology and Venereology 19 (2005), S. 0 
    Details
    ISSN: 1468-3083
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  There are numerous factors that predispose to onychomycosis including genetic predisposition, diabetes mellitus, immunosuppression, vascular disease and psoriasis.Objectives  The aims of this workshop were to discuss current knowledge of genetic risk factors and the approaches that should be used to investigate underlying mechanisms.Results  The high prevalence of onychomycosis within certain families was initially attributed to intrafamilial transmission. However, the low prevalence of infection in people marrying into infected families together with the high prevalence among their offspring suggested a genetic basis.The state-of-the-art pedigree study by Zaias et al. suggested that Trichophyton rubrum infection shows an autosomal dominant pattern of inheritance. A consensus was reached that epidemiological and genetic studies are required to investigate this issue further.For epidemiological studies, families in which two or three generations are infected with T. rubrum should be selected. Patients with T. rubrum on different body sites should be included, and the presence of associated diseases or other common features in these individuals should be investigated to identify trigger factors.Conclusion  Genetic studies should explore the mode of inheritance of onychomycosis and look for the disease gene(s). Serum samples from patients and age–sex matched controls must be analysed centrally.The results of these studies will make it possible to develop therapeutic, preventive and prophylatic measures and to provide patients and their families with information.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1468-3083.2005.01283.x
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  • 4
    Electronic Resource
    Electronic Resource
    Clinical trial design – towards better practices (2005)
    Oxford, UK : Blackwell Science Ltd
    Journal of the European Academy of Dermatology and Venereology 19 (2005), S. 0 
    Details
    ISSN: 1468-3083
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objectives  To review methodological approaches used in recent publications in onychomycosis clinical research. To identify key methodological criteria to ensure conclusive and reliable clinical results.Methods  A Medline search for recent articles on onychomycosis treatment revealed considerable variation in inclusion criteria, definitions and methodology, rendering comparisons difficult.Results  Careful diagnosis at trial entry is critical and predisposing factors affecting overall results are rarely considered at enrolment. Clear definitions are required, notably for the terms mycological, clinical and total cure.A consensus was reached that only studies that are evidence-based, controlled and double-blind with less than 10–15% of patients lost to follow-up should be accepted.Results should be interpreted with caution if a given treatment is found to be less effective than previously reported, even if the results are published in a recognized journal.It was agreed that an explanatory/pilot study should be done initially to determine whether there is a reason to believe that a new therapy is effective. If promising results are obtained, a double-blind, randomized study comparing the new therapy with either an existing therapy (preferably) or a placebo may be initiated.Conclusions  Sample size, and inclusion and exclusion criteria should be clearly determined. Efficacy criteria should include mycological, clinical and total cure rates. Finally, studies of toenail and fingernail onychomycosis must last at least 18 and 9 months, respectively.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1468-3083.2005.01286.x
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  • 5
    Electronic Resource
    Electronic Resource
    Cell-mediated immunity to Malassezia furfur in patients with seborrhoeic dermatitis and pityriasis versicolor (1999)
    Oxford BSL : Blackwell Science Ltd
    Clinical and experimental dermatology 24 (1999), S. 0 
    Details
    ISSN: 1365-2230
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The lymphocyte transformation response to Malassezia furfur, Candida albicans, phytohaemagglutinin, concanavlin A and tuberculin purified protein derivative of 12 patients with pityriasis versicolor, 15 patients with seborrhoeic dermatitis and matched controls, was studied. Patients with pityriasis versicolor showed a significantly lower response to M. furfur than patients with seborrhoeic dermatitis and controls.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2230.1999.00512.x
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  • 6
    Electronic Resource
    Electronic Resource
    Levels of terbinafine in plasma, stratum corneum, dermis–epidermis (without stratum corneum), sebum, hair and nails during and after 250 mg terbinafine orally once daily for 7 and 14 days (1994)
    Oxford, UK : Blackwell Publishing Ltd
    Clinical and experimental dermatology 19 (1994), S. 0 
    Details
    ISSN: 1365-2230
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In earlier skin pharmacokinetic studies we have shown that terbinafine is rapidly delivered to the stratum corneum, nails and hair both through sebum and by direct diffusion through dermis epidermis. In the present study the skin pharmacokinetic profile of terbinafine was studied in two groups of eight human male volunteers during and after 250 mg orally once daily for 7 and 14 days. In the 7-day study high terbinafine levels were found in sebum (19.0 μg/g) and stratum corneum (2.5 μg/g), and a concentration in stratum corneum above the minimal inhibitory concentration for most dermatophytes was still found 48 days after the last day of medication. Terbinafine was found in peripheral nail clippings after 7 days of medication and the concentration was, in the 7-day study, 0.5 μg/g 1 day after stopping medication; it was still 0.2 μg/g 90 days after stopping treatment. The results in the 14–day study were in parallel with, but higher than, in the 7-day study. The elimination of terbinafine from several compartments is biphasic, with a faster initial elimination followed by a slower secondary elimination. For nails, the elimination is slower compared with the other compartments. The results indicate that terbinafine may be effective in short-term treatment of several dermatophytoses. The concentration of 0.2 μg/g of terbinafine found in nails 90 days after stopping medication, following 7 days of treatment, indicates that the duration of therapy, even in tinea ungium, may be shorter than is currently the case.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2230.1994.tb01138.x
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  • 7
    Electronic Resource
    Electronic Resource
    Levels of fluconazole in serum, stratum corneum, epidermis-dermis (without stratum corneum) and eccrine sweat (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Clinical and experimental dermatology 18 (1993), S. 0 
    Details
    ISSN: 1365-2230
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The distribution in the skin of orally active antifungals and other drugs claimed to be active in the treatment of skin diseases is of major importance, but to date has been studied only rarely. In the present study the distribution of fluconazole in stratum corneum, epidermis dermis (without stratum corneum), eccrine sweat and serum was studied in human male volunteers after dosages of 50 mg daily for 12 days and 150 mg once weekly for 2 weeks. In the present study high levels of fluconazole were found especially in the stratum corneum. At a dose of 50 mg once daily the concentration of fluconazole after 12 days was 73·0 μg/g and 7 days after cessation of treatment the concentration was still 5·8 μg/g. At the 150 mg once a week dose the concentration 7 days after the second dose was still 7·1 μg/g in stratum corneum indicating that medication once a week may be effective in the treatment of dermatomycoses. High concentrations, all above the serum concentrations, were also seen in sweat and epidermis/dermis. These results indicate that fluconazole is delivered to the stratum corneum, where it is accumulated, through sweat and by direct diffusion through the dermis-epidermis. These pharmacokinetic results indicate that the drug should be very effective in the treatment of dermatomycoses. An extremely high concentration of the drug in the stratum corneum combined with concentrations from 2·93 to 4·62 μg/g in the rest of the epidermis and dermis is important in the treatment of these diseases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2230.1993.tb00987.x
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  • 8
    Electronic Resource
    Electronic Resource
    An immunological study in patients with seborrhoeic dermatitis (1991)
    Oxford, UK : Blackwell Publishing Ltd
    Clinical and experimental dermatology 16 (1991), S. 0 
    Details
    ISSN: 1365-2230
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The humoral and cellular immune-status was studied in 30 patients with seborrhoeic dermatititis. Increased frequencies of natural killer cells were found in 46% of patients. Furthermore, subnormal mitogen stimulation responses were demonstrated in 13 patients, whereas two individuals were found to have very high numbers of activated T lymphocytes in peripheral blood. Higher-than-normal total serum IgG and IgA was observed in 14 and 11 patients, respectively. For nine of 12 patients with skin lesions, dermal perivascular cell infiltrates were seen. The majority of the infiltrating cells reacted with anti-CD4 antibodies. HLA-DR-expressing keratinocytes were found in two biopsies. The study suggests that patients with seborrhoeic dermatitis may have depressed T-cell function. This could have a bearing on their susceptibility to the Pityrosporum ovale-associated dermatitis. The very high frequencies of activated T cells observed in the peripheral blood of two otherwise healthy seborrhoeic individuals suggests that intermittent systemic immune activation may occur.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2230.1991.tb00395.x
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  • 9
    Electronic Resource
    Electronic Resource
    Atopy patch test reactions to Malassezia allergens differentiate subgroups of atopic dermatitis patients (2003)
    Oxford, UK : Blackwell Science Ltd
    British journal of dermatology 148 (2003), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary Background The yeast Malassezia is considered to be one of the factors that can contribute to atopic dermatitis (AD). Objectives To investigate the reactivity to Malassezia allergens, measured as specific serum IgE, positive skin prick test and positive atopy patch test (APT), in adult patients with AD. Methods In total, 132 adult patients with AD, 14 with seborrhoeic dermatitis (SD) and 33 healthy controls were investigated for their reactions to M. sympodialis extract and three recombinant Malassezia allergens (rMal s 1, rMal s 5 and rMal s 6). Results Sixty-seven per cent of the AD patients, but only one of the SD patients and none of the healthy controls, showed a positive reaction to at least one of the Malassezia allergens (extract and/or recombinant allergens) in at least one of the tests. The levels of M. sympodialis-specific IgE in serum correlated with the total serum IgE levels. Elevated serum levels of M. sympodialis-specific IgE were found in 55% and positive APT reactions in 41% of the AD patients with head and neck dermatitis. A relatively high proportion of patients without head and neck dermatitis and patients with low total serum IgE levels had a positive APT for M. sympodialis, despite lower proportions of individuals with M. sympodialis-specific IgE among these groups of patients. Conclusions These results support that Malassezia can play a role in eliciting and maintaining eczema in patients with AD. The addition of an APT to the test battery used in this study reveals a previously overlooked impact of Malassezia hypersensitivity in certain subgroups of AD patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2133.2003.05093.x
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  • 10
    Electronic Resource
    Electronic Resource
    Seborrhoeic dermatitis and Pityrosporum (Malassezia) folliculitis: characterization of inflammatory cells and mediators in the skin by immunohistochemistry (2001)
    Oxford, UK : Blackwell Science Ltd
    British journal of dermatology 144 (2001), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  The fact that Pityrosporum ovale plays a part in seborrhoeic dermatitis is well established but the mechanism of this relationship has not been established. Objectives  To compare the number and type of inflammatory cells and mediators in skin biopsies from normal and lesional skin from the trunk and scalp in patients with seborrhoeic dermatitis, Pityrosporum (Malassezia) folliculitis and in normal skin from healthy controls. Methods  The skin biopsies were stained using the labelled Streptavidin–biotin method. The following markers were studied: CD4, CD8, CD68, HLA-DR, NK1, CD16, C1q, C3c, IgG, CD54 (ICAM-1), interleukin (IL) -1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12, tumour necrosis factor-α and interferon-γ. Results  HLA-DR+ cells were seen in the highest number, and were higher in lesional skin compared with normal skin from both patients and healthy volunteers. ICAM-1 expression was also increased in lesional skin. C1q and the interleukins showed an increased cellular and intercellular staining in patients compared with healthy controls and the intercellular staining was often more intense in lesions compared with non-lesional skin. Staining was often more intense when Malassezia (Pityrosporum ovale) yeast cells were present. Conclusions  An increase in NK1+ and CD16+ cells in combination with complement activation indicates that an irritant non-immunogenic stimulation of the immune system is important. The result with the interleukins showed both an increase in the production of inflammatory interleukins as well as in the regulatory interleukins for both TH1 and TH2 cells. Similarities to the immune response described for Candida albicans infections indicate the role of Malassezia in the skin response in seborrhoeic dermatitis and Pityrosporum folliculitis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2133.2001.04082.x
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