Pityriasis versicolor

Multicolored lichen (synonym: pityriasis versicolor) is a low-contagious, chronic disease of people mostly young and middle-aged, characterized by the defeat of the stratum corneum of the epidermis and a very weak inflammatory reaction and caused by the lipophilic yeast-like fungus Pityrosporum cibiculare.

Causes of colorful lichen

The causative agent of the disease is Mallasseria furfur. Multicolored lichen occurs as a result of transformation of the saprophilic form into a pathogenic form or infection from the outside. The development of multi-colored hair loss is facilitated by the weakening of the immune system, increased sweating, endocrine disorders. The appearance of the disease is facilitated by a change in the physico-chemical properties of the water-lipid mantle of the skin and keratin of the stratum corneum. They can be caused by increased sweating, seborrhea, as well as some endocrine disorders (Itenko-Cushing's syndrome, diabetes mellitus, obesity, hyperthyroidism, etc.). The disease occurs in all geographical areas, but more often in regions with hot climates and high humidity.

It was found that the lipoxygenase of the pathogen oxidizes the unsaturated fatty acids of sebum in dicarboxylic acids. As a result, there is an inhibition of melanocyte tyrosinase and a decrease in melanin synthesis in the lesion site. The disease is often found in HIV-infected patients.

[1]

Symptoms of colorful lichen

Multicolored deprive suffer both men and women.

Rashes are often localized on the chest, back, axillary fossa; hence the rash spreads over the shoulders, the lateral surfaces of the trunk, the abdomen. The disease of multi-colored lichen begins with the appearance of pinkish, rapidly acquiring brown staining stains.

As a result of peripheral growth, the initial elements turn into rounded, sharply defined spots up to 1 cm in diameter. Spots can merge and form large foci that occupy the entire back, trunk and chest. Elements have scalloped outlines, isolated spots are scattered around their periphery. The color of the rashes varies widely from pale cream to dark brown. The surface of the eruptions is covered with frigid scales formed as a result of loosening of the horny layer of the epidermis by the fungus. With frequent washing, the scales are not noticeable, however, when scraping, it becomes easy to develop mucous peeling (Benje's symptom). There are forms similar to erythrasma, hives, reminiscent of vitiligo. Subjective sensations are usually absent.

After artificial ultraviolet irradiation, white pseudochromic spots remain in the rash area. The course of the disease is long, can last for many years.

Diagnosis of a multicolored lichen

The diagnosis of "colorful lichen" is established on the basis of a characteristic clinical picture and laboratory data. To confirm the diagnosis, use the Balzer test: lesions and adjacent areas of healthy skin are lubricated with 5% iodine tincture (at a lower concentration, the sample may be doubtful) - rashes due to loosened The horny layer is colored more intensively than the surrounding healthy skin. In a luminescent study using a Wood lamp in the lesions, a yellow glow is observed. In the rays of a fluorescent lamp, the lesion centers glow in a golden yellow color. The morphology of the pathogen is especially characteristic when microscopic examination of scales from lesions (short, wide, curved pseudomycelia and single or clustered large spores).

[2], [3]

Differential diagnosis

In the presence of hypopigmental spots, the disease of multi-colored lichen should be distinguished from vitiligo, white lichen, syphilitic leukoderma. The scaly spot is differentiated from teardrop-shaped psoriasis, pink lichen, seborrheic dermatitis,

[4], [5], [6], [7]

Treatment of colorful lichen

Keratolytic and fungicidal agents are widely used. With limited rashes, 5% salicylic alcohol is used, sulfuric (3%) - salicylic (5%) ointment 2 times a day for 5-7 days, the Demjanovich method (6% hydrochloric acid and 60% solution of sodium thiosulfate). Assign antifungal ointments - zalain, clotrimazole, nizoral, etc.

The wipes are produced twice a day. In case of distributed and torpid cases, ingestion of systemic antimycotics, such as infaconazole (tecnazol, orgunal, etc.) at a dose of 200 mg per day for 7 days is indicated. Currently, in the treatment of varicoloured lichen from local antimycotics, the most commonly used is lamilic spray, since it can handle large and hard-to-reach skin areas.

Prevention of varicolored lichen consists of disinfection of the bed linen and the correction of sweating.