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Background: Luliconazole (LLCZ) is an imidazole antifungal agent widely used in Japan for treatment of tinea, cutaneous candidiasis, and pityriaisis versicolor, etc. Theoretically, its potent antifungal activity should make it a viable option for various conditions of dermatophytoses, but there has been no studies to support the notion thus far. Objective: This prompted the authors to investigate the distribution of minimum inhibitory concentration (MIC) of luliconazole by carrying out in vitro antifungal susceptibility test on Trichophyton (T.) species clinically isolated from Korean subjects with tinea pedis. Methods: In vitro antifungal susceptibility test, with broth macrodilution method of luliconazole and terbinafine hydrochloride (TBF) as reference drug on two clinically isolated Trichophton species (22strains of T. rubrum, 5 of T. mentagrophytes), was carried out. Results: The range of MIC for LLCZ on the total of 27 strains was 0.0110~0.0140 μg/mL (geometric mean: 0.0027 μg/mL), and the range for TBF was 0.0120~0.0250 μg/mL (geometric mean: 0.0042μg/mL). Additionally, the geometric mean for MIC of LLCZ on T. mentagrophytes was 0.0125 μg/mL,and on T. rubrum, it was 0.0019 μg/mL. No strain showed resistance in vitro. Conclusions: The authors hence demonstrated that antifungal activity of LLCZ in vitro against Trichophyton species clinically isolated from Korean subjects is quite superior. These findings emphasize the usefulness of LLCZ, a promising new imidazole, for the topical management of dermatophytoses.
Background: Pityriasis versicolor is often found following pathologic transformation of Malassezia fungi from yeast to mycelial forms by a poorly understood mechanism and is characterized by squamous skin lesions manifesting hyper- or hypo-pigmentation. Itraconazole is a synthetic oral antifungal agent of triazole family, which acts as a selective inhibitor of the cytochrome P-450-dependent synthesis of ergosterol and is reported to demonstrate a potent antifungal efficacy against Malassezia yeasts. Object: The present clinical study was designed to evaluate the therapeutic efficacy of one-week regimen of itraconazole by studying 20 patients with pityriasis versicolor, who were diagnosed both clinically and mycologically. In addition, we wished to identify Malassezia species from skin lesions of pityriasis versicolor and examine the possible correlation of a certain Malassezia(M.) species and pityriasis versicolor. Methods: Twenty patients (ages, 18 to 49) were included in the study, following the diagnosis of pityriasis versicolor, which was based on clinical examinations and mycological studies (microscopy and culture). Patients received a single 200 mg dose of itraconazole (Sporanox^�) capsules daily with a full meal for one week. For all patients, clinical examinations and culture and microscopic studies were done before treatment, at the end of treatment, and 4 weeks later. Scales obtained from skin lesions were studied by Parker-KOH smear examination and culture studies to identify Malassezia yeasts. Cultures were done using agar media of Leeming & Notman. Results: By comparing skin lesions before and immediately after treatment, marked improvement was observed in 7 patients (35%) and moderate improvement in 12 patients (60%) among a total of 20 patients, and 1 patient (5%) showed no response. On the other hand, by comparing skin lesions examined before treatment and 4 weeks after completing medication, complete cure was observed in 13 cases (65%), marked improvement in 5 (25%), and moderate improvement in 2(10%). With culture studies before treatment, M. globosa, M. furfur, and M. restricta were isolated as a major fungal species in 18, 1, and 1 patients, respectively. Conclusion: The result suggested that administration of a single dose of 200 mg itraconazole(Sporanox^�) capsules daily for a week is a very effective treatment for pityriasis versicolor and also indicated that pityriasis versicolor is very closely related with the infection of M. globosa. [Kor J Med Mycol 4(2): 124-130]
The yeasts of the genus Malassezia, of which type species is Malassezia furfur (Robin) Baillon 1889, are dimorphic and lipophilic and are members of the normal cutaneous flora in humans Early taxonomic descriptions of Malassezia yeasts were limited by the failure of investigators to culture this fungus and were based solely on micromorphological descriptions of the organism in skin samples. The culture could be possible only after the lipophilic nature of this fungus was demonstrated and the question of dimorphism was solved. Malassezia has been the genus name formally accepted for both phases of growth, mycelia(Malassezia) and yeasts(Pityrosporum). Variations in the morphology of Malassezia species were noted even some of the sallies descriptions of the organism in the skin. Stable morphological, physiological and immunological variants have been claimed and the taxonomic status of these has been becoming realized with the application of molecular techniques. Recently, the genus Malassezia was revised using morphology, ultrastructure, physiology and molecular biology by Gue'ho or α1. As a result the genus has been enlarged to include seven species comprising M. furfur, M. pachydermatis, M. sympodialis, M. globosa, M. obtuse, Ml restricta and M. slooffiae. Malassezia yeasts reside predominantly in regions of high sebum excretion as members of the microbiological flora of the skin. Malassezia yeasts are also implicated in various diseases, including pityriasis versicolor, Malassezia folliculitis, seborrheic dermatitis and systemic fungal infections.