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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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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 17 | 7 | 24 |
| 2024 Octubre | 142 | 52 | 194 |
| 2024 Septiembre | 158 | 43 | 201 |
| 2024 Agosto | 144 | 72 | 216 |
| 2024 Julio | 175 | 57 | 232 |
| 2024 Junio | 163 | 48 | 211 |
| 2024 Mayo | 145 | 63 | 208 |
| 2024 Abril | 132 | 51 | 183 |
| 2024 Marzo | 162 | 48 | 210 |
| 2024 Febrero | 157 | 58 | 215 |
| 2024 Enero | 165 | 42 | 207 |
| 2023 Diciembre | 147 | 40 | 187 |
| 2023 Noviembre | 196 | 52 | 248 |
| 2023 Octubre | 216 | 46 | 262 |
| 2023 Septiembre | 217 | 55 | 272 |
| 2023 Agosto | 222 | 31 | 253 |
| 2023 Julio | 176 | 69 | 245 |
| 2023 Junio | 130 | 38 | 168 |
| 2023 Mayo | 133 | 34 | 167 |
| 2023 Abril | 117 | 42 | 159 |
| 2023 Marzo | 139 | 47 | 186 |
| 2023 Febrero | 166 | 29 | 195 |
| 2023 Enero | 121 | 36 | 157 |
| 2022 Diciembre | 107 | 58 | 165 |
| 2022 Noviembre | 114 | 26 | 140 |
| 2022 Octubre | 84 | 22 | 106 |
| 2022 Septiembre | 107 | 39 | 146 |
| 2022 Agosto | 58 | 31 | 89 |
| 2022 Julio | 34 | 31 | 65 |
| 2022 Junio | 52 | 23 | 75 |
| 2022 Mayo | 81 | 41 | 122 |
| 2022 Abril | 119 | 26 | 145 |
| 2022 Marzo | 142 | 39 | 181 |
| 2022 Febrero | 117 | 22 | 139 |
| 2022 Enero | 161 | 25 | 186 |
| 2021 Diciembre | 104 | 41 | 145 |
| 2021 Noviembre | 148 | 35 | 183 |
| 2021 Octubre | 156 | 64 | 220 |
| 2021 Septiembre | 124 | 47 | 171 |
| 2021 Agosto | 129 | 34 | 163 |
| 2021 Julio | 114 | 22 | 136 |
| 2021 Junio | 99 | 25 | 124 |
| 2021 Mayo | 111 | 50 | 161 |
| 2021 Abril | 191 | 68 | 259 |
| 2021 Marzo | 148 | 42 | 190 |
| 2021 Febrero | 114 | 26 | 140 |
| 2021 Enero | 115 | 16 | 131 |
| 2020 Diciembre | 91 | 20 | 111 |
| 2020 Noviembre | 80 | 21 | 101 |
| 2020 Octubre | 50 | 15 | 65 |
| 2020 Septiembre | 58 | 11 | 69 |
| 2020 Agosto | 58 | 18 | 76 |
| 2020 Julio | 40 | 19 | 59 |
| 2020 Junio | 46 | 18 | 64 |
| 2020 Mayo | 59 | 17 | 76 |
| 2020 Abril | 21 | 9 | 30 |
| 2020 Marzo | 16 | 9 | 25 |
| 2020 Febrero | 2 | 0 | 2 |
| 2019 Mayo | 3 | 0 | 3 |
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