Review literature Management pitiriasis versicolor

Review literature
Management pitiriasis versicolor
dr. MOH. IFNUDIN. SpKK.

INTRODUCTIONPitiriasis versicolor is a chronic superficial fungal disease in stratumkorneum the skin caused by a yeast called Malassezia furfur lifofilik (Pityrosporum ovale or Pityrosporum orbiculare). Synonyms is Tinea versicolor, dermatomikosis fururasea, kromifitosis, tinea flava, liver spots.Mushrooms are part of the normal flora of human skin with the largest colony in the scalp area, ektremitas top and folding of the body and can not attack the hair, nails and mucosa.The disease was first recognized in 1846 by Eichtedt and Sluyter in 1847 which states that the disorder is caused by the fungus Malassezia in 1889 called Malassezia furfur fungus is the cause which is the proper name for the fungi that cause disease. Synonyms Pityrosporum orbiculare and Pityrosporum ovale is a variant of breeding M. furfur. The term tinea versicolor is a misnomer because the disease is first suspected to be caused by dermatofita.Clinical symptoms pitiriasis versicolor is very easy to diagnose lesions premises color depending on the individuals affected by abnormal pigmentation. There are two clinical forms that can be found in the form of macular and papular forms.In the form of macular derived from multiple small lesions, which continues to expand with skuama thin on top. Some lesions may merge into one large shape. While the form of papular usually around hair follicles (follicular fairy).Martin AG dividing M. infection furfur in 3 clinical symptoms namely papolosquamosa lesions, folliculitis and tinea versicolor inversaThe main complaint because the patient usually a cosmetic problem, where in the fungus infected skin color changes occur because of disorders of pigmentation.Disorders of pigmentation disebabka because of fungus or product that can filter out the sunlight and affect the process of melanin formation.Pitiriasis versicolor can attack almost any age, especially in adolescents, most aged 16-40 years. There is no difference between men and women. The disease is spread throughout the world, especially in subtropical and tropical regions, including Indonesia. The incidence of pityriasis versicolor in Indonesia, an accurate yet exist. Diperkirakana Only 50% of the population in tropical countries affected by this disease.
DIAGNOSISTo determine pitiriasis versicolor diagnosis based on typical clinical symptoms, Wood's lamp examination and direct examination of preparations from scrapings of the lesion. In the Wood lamp examination pitiriasis versicolor lesions appear golden brown. The advantages of using wood lamps can also determine the lesion boundary is not clearly visible on naked eye examination.Examination preparation done directly with 10-30% KOH solution is mixed premises superkrom parker ink permanent blue-black with a ratio of 9:1 will give a picture of blue mold element. Taking keroken materials by using scalpel and glass objects and glass cover, or can use also an easier method that is transparent cellulose tape and attached to the lesion suspected of being infected. M.furfur. A positive result if found elements - elements that mold the form of short and thick hyphae and spores clustered large image resembles dermatofita diagnosis of infection and candida, a negative microscopic examination can rule out the diagnosis.M. furfur is not easy to be left in artificial media, so this procedure is not a routine procedure performed. Can be cultured with a medium fat (Sabouroud Dextrose for coated olive oil) or Tween media.
Diagnosis APPEALDermtitis SeborroikIn this disease yellowish red lesions skuama premises which are soft and oily on the area - an area predisposition (Sebooroik area).Pitiriasis roseaSymptoms are more acute with the rapid spread and there is a larger initial lesion ("Herald spots").Syphilis Stage IIStage syphilis lesion is more pale with a diameter of less than 1 cm with a spread on the chest, legs and extremities of the flexor. It was also found enlarged lymph comprehensive and serological tests for syphilis are positive.Morbus Hensen Type BBIn the lesions there is a section that is misbehaving taste (hypo or anesthesia), nerve enlargement also occurs edge.EritrasmaCan be very similar to pitirasis versicolor and may also occur simultaneously. Wood's lamp examination premises appear red brick ("Congo red").VitiligoVitiligo lesions in white like chalk or milk with varying shapes and sizes. The distribution of lesions is usually symmetrical. With found mildew causes on examination keroken can get rid of this disorder.
MANAGEMENTManagement pitirisasis versicolor can be topically or systemically. Can also be preventive treatment for patients with recurrence rate is as high as about 60% in one year and 80% in two years. For topical treatment can be given:1. Selenium sulfide suspensionUsed at a concentration of 2.5% with topically once daily on the affected areas, left for 10 minutes and rinsed with a bunch of water immediately afterwards. This method is repeated every day for 7 days. Disadvantages of this treatment is the presence of strong smelling and feeling the heat so the skin after topical drug treatment should sihindarkan lesions in the genital area. Sanchez et al. found 17% of the 52 patients who smeared pitiriasis versicolor selenium sulfide shampoo experience side effects such as contact dermatitis.2. Zinc PyrithioneA material that has the effect of anti-fungal and anti bacterial which are usually present in a mixture of shampoo, proved very effective for such lipophilic yeast M.furfur. shampoos containing these ingredients is applied to the skin lesions once a day, allowed to stand for 5 minutes, then rinsed and siulang every day for 2 weeks.3. Sodium hiposulfit 20-25%Applied 2 times daily for 2-4 weeks. Can also be used Tinver lotion containing 25% sodium thiosulfit salsilat acid 1% and 10% alcohol in the same way4. Propyleneglicol 50% in aquaApplied to the lesion 2 times a day forever 2 weeks. Can be used on an extensive body lesions degan risk of skin irritation is mild with good results and low prices.5. Materials keratolikCan be used in the form of cream, ointment, or a mixture lotio shampoos with acid concentrations between 3-6% salsilat eg Whitfield ointment, ointment 3-10. Applied twice daily for 2 weeks. It can also be used soap containing salicylic acid.6. Antifungal drugUsed in a cream or solusio, which includes all classes imidasol, alllamines, siklopiroks, halloprogin and tolnaftate / tolsiklat. Applied twice daily for 2-4 weeks to eliminate pitiriasis versicolor lesions, but at a cost of more expensive and no more effective than other materials. Imidasol Group is a topical 2 times a day that is klotrimasol, mikonasol, Ekonasol and some are applied only once a day that is Tiokonasol, Ketokonasol, Bifonasol, Okdikonasol.7. Retinoic acid creamApplied twice daily for 2 weeks to recover. This material is good for pitiriasis versicolor lesions are dark in color because mempuyai mangambat freezing effect of melanin, so good for people who are very ashamed of the lesion pitiriasis versikoler.Faergement advise in choosing a topical treatment pitiriasis versicolor, especially with large lesions should be used solusio form or shampoo because it is more easily applied than cream or ointment form. In addition to topical treatment, management of pitiriasis versicolor can also be a systemic treatment. Indications versicolor is a systemic treatment:1. Lesions P. versicolor resistant to topical treatment.2. Patients who frequently relapse3. Pitiriasis versicolor lesions are extensive.Systemic drugs used were:1. KetoconzoleIs an oral antifungal medication is effective and has a broad spectrum antifungal. With a dose of 200 mg daily for 5 days - 5 weeks (- average 10 days) has a cure rate to 90%. Many other regimens that are used with a higher cure rate, but using larger doses and longer periods. With that brief treatment of the risk effect of drugs on the liver have a low risk.2. ItraconazoleIs a new azole derivative effective in the treatment pitiriasis versicolor. The recommended dose is 200 mg once daily for 5 days. Mikrologis healing can be seen after 3-4 weeks.In patients who have lesions that have important depigmentasi lesions are reminded that it will persist for several months after treatment was stopped, so the patient does not feel that the treatment failed. Changes in the nature M.furfur from saprophyte to pathogen depends on several predisposing factors that are difficult kekronisan eliminated that cause this disease. For such patients can be considered prophylactic treatment to prevent recurrence. The recommended way is to use a tablet ketokonazole with a dose of 200 mg for three consecutive days - joined every month or 400 mg once every month for one year.
SUMMARYPitiriasis versicolor is a superficial fungal disease is chronic in the skin caused strarumkorneum dimorphic lipophilic yeast called Malassezia furfur.Diagnosis of this disorder based on clinical symptoms, Wood's lamp examination, and inspection microscope with 10-30% KOH plus Parker ink superkhrom permanent blue-black lesions on keroken material.The management of this disorder can by using materials and topical or system. Need treatment of prevention in patients who frequently relapse.
Literature1. Rippon JW. Medical mycology: Superficial infection. 3rd ed. Philadelpia: WB Sauders Co., 1988: 154-92. Hay RJ. Robert SOB, McKenzie DWR. Mycology. In Champion RH, et a, eds. Texs Book of Dermatology. London: Blackwell Scietific Publication, 1992:1176-86.3. Martin AG, Kobayasi YS. Yeat infection: Candidiasis, pityriasis (Tinea) versicolor In: Fitzpatrick TB, Eisen AZ, Wolff K, et al, eds. Dermatology in General Medicine. McGraw Hill Inc, 1993: 2452-65.4. Arndt K. Manual of Dermatology theapeutics with essential of diagnosis. 5th ed. Boston: Little Brown and Company, 1995: 84-6.5. Parto Suwiryo S, Danukusuma The topic, pitiriasis versicolor. In: Budimulja U, Kuswadji, Basuki S, et al, eds. Diagnosis and conduct implementation dermatokismosis, Jakarta: BP FKUI, 1992: 65-9


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