Case and Research Letters
Psoriasis and Pitiriasis Versicolor: Together But Separate
Psoriasis y pitiriasis versicolor: juntas pero no revueltas
Servicio de Dermatología, Hospital Parc Taulí, Universidad Autónoma de Barcelona, Sabadell, Barcelona, Spain
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What Do They Mean?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "315" "paginaFinal" => "316" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Constricciones de Pohl-Pinkus en tricoscopia. ¿Qué indican?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 563 "Ancho" => 750 "Tamanyo" => 68095 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Image of the border of the alopecic plaque acquired using a DermLite II Hybrid dermatoscope (3Gen Inc., CA, USA). 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Romaní, A. Casulleras" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Romaní" "email" => array:1 [ 0 => "jromani@tauli.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Casulleras" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Parc Taulí, Universidad Autónoma de Barcelona, Sabadell, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Psoriasis y pitiriasis versicolor: juntas pero no revueltas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 559 "Ancho" => 750 "Tamanyo" => 48046 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reddish-brown, desquamative, confluent macular plaques covering large areas of the trunk, indicative of pityriasis versicolor (blue arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is a dermatosis, the pathogenesis of which is characterized by activation of the helper T cell (T<span class="elsevierStyleInf">H</span>) subpopulations T<span class="elsevierStyleInf">H</span>1 and T<span class="elsevierStyleInf">H</span>17 and the expression of inflammatory mediators such as interleukins and antimicrobial peptides involved in fighting infection.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1,2</span></a> In contrast to atopic dermatitis, the likelihood of superinfection of psoriasis plaques is low.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> However infectious triggers, such as streptococcal pharyngeal infection, are common in certain forms of psoriasis.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 50-year-old man with a history of psoriasis vulgaris since youth was seen at our clinic for a rash affecting the trunk and arms. The clinical examination revealed 2 distinct dermatoses: reddish-brown, desquamative, confluent macular plaques that covered large areas of the trunk and were indicative of pityriasis versicolor (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, blue arrows); and erythematous, keratotic plaques suggestive of psoriasis vulgaris (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>, red arrows). As shown in the images, the 2 dermatoses coexisted, but the pityriasis versicolor lesions spared the psoriasis plaques, with a margin of 5<span class="elsevierStyleHsp" style=""></span>mm to 10<span class="elsevierStyleHsp" style=""></span>mm.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The presumptive diagnoses of pityriasis versicolor and psoriasis vulgaris were confirmed by direct microscopic examination of a potassium hydroxide preparation and by histopathology of a skin biopsy of an adjacent keratotic plaque, respectively. Periodic acid–Schiff (PAS) staining revealed no fungal elements in the stratum corneum of the biopsied psoriasis lesion.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was treated with a combination of oral itraconazole (100<span class="elsevierStyleHsp" style=""></span>mg/d for 7 days) and narrowband ultraviolet B phototherapy, and achieved remission of both dermatoses 1 month after treatment.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Reports have described the colonization of psoriasis lesions by <span class="elsevierStyleItalic">Malassezia</span> species, which have been proposed to trigger lymphocyte activation, as described for other microorganisms.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">4–6</span></a> In some reported cases, <span class="elsevierStyleItalic">Malassezia</span> infection appears to trigger psoriasis via the Koebner phenomenon and the 2 dermatoses co-occur,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> albeit without sparing the areas affected by the concomitant dermatosis, as was observed in our patient. It is likely that psoriasis can co-occur with <span class="elsevierStyleItalic">Malassezia</span> colonization, which in some cases acts as a trigger and in others is merely an innocent bystander, depending on the equilibrium between the host's immune response and the microorganism's ability to produce a mycelium and proliferate. Likewise, different <span class="elsevierStyleItalic">Malassezia</span> species may provoke distinct immune responses, and associated Koebner responses of greater or lesser intensity.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> The present case supports the theory that psoriasis is the result of aberrant activation of immunological pathways originally expressed in the human species for the control of infection.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> The T<span class="elsevierStyleInf">H</span>17/interleukin 17 axis, which is activated in psoriasis, is a component of the immune system that is crucial in the defense against fungal infections.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> Although our patient presented both dermatoses concomitantly, the psoriasis lesions were strikingly separated from the pityriasis versicolor lesions. The interaction between the skin microbiome and the immune system is an attractive theory to account for the appearance of certain dermatoses, including psoriasis.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">11,12</span></a> While dysbiosis can lead to activation of the cutaneous immune system, even in the absence of clinical infection, in our patient the psoriasis was very clearly delimited from the pityriasis versicolor.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Romaní J, Casulleras A. Psoriasis y pitiriasis versicolor: juntas pero no revueltas. Actas Dermosifiliogr. 2019;110:317–318.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 559 "Ancho" => 750 "Tamanyo" => 48046 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Reddish-brown, desquamative, confluent macular plaques covering large areas of the trunk, indicative of pityriasis versicolor (blue arrows).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 554 "Ancho" => 750 "Tamanyo" => 58038 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Erythematous, keratotic plaques suggestive of psoriasis vulgaris (red arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cathelicidin LL-37: A defense molecule with a potential role in psoriasis pathogenesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 6 | 20 |
| 2024 October | 142 | 52 | 194 |
| 2024 September | 158 | 43 | 201 |
| 2024 August | 144 | 72 | 216 |
| 2024 July | 175 | 57 | 232 |
| 2024 June | 163 | 48 | 211 |
| 2024 May | 145 | 63 | 208 |
| 2024 April | 132 | 51 | 183 |
| 2024 March | 162 | 48 | 210 |
| 2024 February | 157 | 58 | 215 |
| 2024 January | 165 | 42 | 207 |
| 2023 December | 147 | 40 | 187 |
| 2023 November | 196 | 52 | 248 |
| 2023 October | 216 | 46 | 262 |
| 2023 September | 217 | 55 | 272 |
| 2023 August | 222 | 31 | 253 |
| 2023 July | 176 | 69 | 245 |
| 2023 June | 130 | 38 | 168 |
| 2023 May | 133 | 34 | 167 |
| 2023 April | 117 | 42 | 159 |
| 2023 March | 139 | 47 | 186 |
| 2023 February | 166 | 29 | 195 |
| 2023 January | 121 | 36 | 157 |
| 2022 December | 107 | 58 | 165 |
| 2022 November | 114 | 26 | 140 |
| 2022 October | 84 | 22 | 106 |
| 2022 September | 107 | 39 | 146 |
| 2022 August | 58 | 31 | 89 |
| 2022 July | 34 | 31 | 65 |
| 2022 June | 52 | 23 | 75 |
| 2022 May | 81 | 41 | 122 |
| 2022 April | 119 | 26 | 145 |
| 2022 March | 142 | 39 | 181 |
| 2022 February | 117 | 22 | 139 |
| 2022 January | 161 | 25 | 186 |
| 2021 December | 104 | 41 | 145 |
| 2021 November | 148 | 35 | 183 |
| 2021 October | 156 | 64 | 220 |
| 2021 September | 124 | 47 | 171 |
| 2021 August | 129 | 34 | 163 |
| 2021 July | 114 | 22 | 136 |
| 2021 June | 99 | 25 | 124 |
| 2021 May | 111 | 50 | 161 |
| 2021 April | 191 | 68 | 259 |
| 2021 March | 148 | 42 | 190 |
| 2021 February | 114 | 26 | 140 |
| 2021 January | 115 | 16 | 131 |
| 2020 December | 91 | 20 | 111 |
| 2020 November | 80 | 21 | 101 |
| 2020 October | 50 | 15 | 65 |
| 2020 September | 58 | 11 | 69 |
| 2020 August | 58 | 18 | 76 |
| 2020 July | 40 | 19 | 59 |
| 2020 June | 46 | 18 | 64 |
| 2020 May | 59 | 17 | 76 |
| 2020 April | 21 | 9 | 30 |
| 2020 March | 16 | 9 | 25 |
| 2020 February | 2 | 0 | 2 |
| 2019 May | 3 | 0 | 3 |
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