Pityriasis versicolor – mechanism of development and approaches to therapy

The main aspects of the etiopathogenesis of pityriasis versicolor are presented in the article. The characteristics of the fungi of the genus Malassezia and their pathogenicity factors are given in detail, the conditions leading to the activation of fungi and the development of clinical manifestations, including relapse are also defined. Significant attention is paid to the issues of external therapy of pityriasis versicolor taking into actuality data from clinical recommendations. Pityriasis versicolor is a chronic superficial fungal infection of the skin, which is caused by the activation of lipid-dependent yeast-like fungi of the genus Malassezia. Despite the accepted scientific opinion about the lack of contagiousness (fungi of the genus Malassezia are representatives of the normobiota of the skin of most people), the disease is found everywhere. M. furfur, M. globosa and M. sympodialis most often cause clinical manifestations on the skin with pityriasis versicolor of the almost 20 species of fungi of the genus Malassezia. Decrease in local and general immunological reactivity of the macroorganism is of decisive importance in the development of the pathological process in pityriasis versicolor, which is accompanied by the formation of hyphal forms of Malassezia and is a favorable factor for their uncontrolled spread on the surface of the epidermis. Due to the specific metabolism of Malassezia, the pathogenetic basis for pityriasis versicolor is an increase in the permeability of the epidermal barrier and disruption of the normal function of keratinocytes. Various antifungal agents are used in the treatment of pityriasis versicolor with varying degrees of success and subsequent relapse rates. The article discusses clinical cases using sertaconazole nitrate 2% in the form of a cream in the treatment of pityriasis versicolor.

1. Łabędź N, Navarrete-Dechent C, Kubisiak-Rzepczyk H, Bowszyc-Dmochowska M, Pogorzelska-Antkowiak A, Pietkiewicz P. Pityriasis Versicolor-A Narrative Review on the Diagnosis and Management. Life (Basel). 2023;13(10):2097. https://doi.org/10.3390/life13102097.

2. Akimkin VG, Tutelyan AV, Shulakova NI. Medical mycological iceberg: recent trends in the epidemiology of mycoses. Infectious Diseases. 2022;20(1):120–126. (In Russ.) https://doi.org/10.20953/1729-9225-2022-1-120-126.

3. Vorobyova NE, Shipitsyna EV, Savicheva AM. Skin microbiota in women of reproductive age in norm and androgen-dependent dermatoses. Journal of Obstetrics and Women’s Diseases. 2019;68(2):7–16. (In Russ.) https://doi.org/10.17816/JOWD6827-16.

4. Strokova SO, Nikitina IV, Donnikov AE. Malassesia-associated infections in newborns: prospects of molecular genetic diagnostic methods. Klinicheskaya Dermatologiya i Venerologiya. 2023;22(4):392–398. (In Russ.) https://doi.org/10.17116/klinderma202322041392.

5. Poh SE, Goh JPZ, Fan C, Chua W, Gan SQ, Lim PLK et al. Identification of Malassezia furfur Secreted Aspartyl Protease 1 (MfSAP1) and Its Role in Extracellular Matrix Degradation. Front Cell Infect Microbiol. 2020;10:148. https://doi.org/10.3389/fcimb.2020.00148.

6. Goh JPZ, Ruchti F, Poh SE, Koh WLC, Tan KY, Lim YT et al. The human pathobiont Malassezia furfur secreted protease Mfsap1 regulates cell dispersal and exacerbates skin inflammation. Proc Natl Acad Sci U S A. 2022;119(49):e2212533119. https://doi.org/10.1073/pnas.2212533119.

7. Ianiri G, Heitman J, Scheynius A. The Skin Commensal Yeast Malassezia globosa Thwarts Bacterial Biofilms to Benefit the Host. J Invest Dermatol. 2018;138(5):1026–1029. https://doi.org/10.1016/j.jid.2018.01.008.

8. Matushevskaya EV, Ivanova MA, Shevchenko AG, Svirshchevskaya EV. Clinical and epidemiological aspects and modern approaches to the treatment of pityriasis versicolor. Meditsinskiy Sovet. 2024;18(13):57–66. (In Russ.) https://doi.org/10.21518/ms2024-328.

9. Georgescu SR, Mitran CI, Mitran MI, Amuzescu A, Matei C, Tampa M. A MetaAnalysis on the Effectiveness of Sertaconazole 2% Cream Compared with Other Topical Therapies for Seborrheic Dermatitis. J Pers Med. 2022;12(9):1540. https://doi.org/10.3390/jpm12091540.

10. Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Tinea versicolor: an updated review. Drugs Context. 2022;11:2022-9-2. https://doi.org/10.7573/dic.2022-9-2.

11. Goriachkina MV, Belousova TA, Potekaev NN. Sertaconazole in the topical treatment of superficial skin mycoses. Klinicheskaya Dermatologiya i Venerologiya. 2012;10(5):46–51. (In Russ.) Available at: https://www.mediasphera.ru/issues/klinicheskaya-dermatologiyai-venerologiya/2012/5/031997-2849201259.

12. Fadeev IE, Poletova TN, Mass EE. Local antifungal drug sertaconazole: a reserve antimycotic or a first-line medication of empirical therapy for vulvovaginitis? Consilium Medicum. 2019;21(6):73–76. (In Russ.) https://doi.org/10.26442/20751753.2019.6.190558.

13. Liebel F, Lyte P, Garay M, Babad J, Southall MD. Anti-inflammatory and antiitch activity of sertaconazole nitrate. Arch Dermatol Res. 2006;298(4):191–199. https://doi.org/10.1007/s00403-006-0679-8.

14. Sur R, Babad JM, Garay M, Liebel FT, Southall MD. Anti-inflammatory activity of sertaconazole nitrate is mediated via activation of a p38-COX-2-PGE2 pathway. J Invest Dermatol. 2008;128(2):336–344. https://doi.org/10.1038/sj.jid.5700972.

15. Kruglova LS, Mayorov RYu. Mycoses of the skin: Issues of effective therapy. Medical Alphabet. 2022;1(27):24–28. (In Russ.) https://doi.org/10.33667/2078-5631-2022-27-24-28.