Elsevier

The Lancet

Volume 364, Issue 9440, 25 September–1 October 2004, Pages 1173-1182
The Lancet

Seminar
Superficial fungal infections

https://doi.org/10.1016/S0140-6736(04)17107-9Get rights and content

Summary

Superficial fungal infections arise from a pathogen that is restricted to the stratum corneum, with little or no tissue reaction. In this Seminar, three types of infection will be covered: tinea versicolor, piedra, and tinea nigra. Tinea versicolor is common worldwide and is caused by Malassezia spp, which are human saprophytes that sometimes switch from yeast to pathogenic mycelial form.Malassezia furfur, Malassezia globosa, and Malassezia sympodialis are most closely linked to tinea versicolor. White and black piedra are both common in tropical regions of the world; white piedra is also endemic in temperate climates. Black piedra is caused by Piedraia hortae; white piedra is due to pathogenic species of the Trichosporon genus. Tinea nigra is also common in tropical areas and has been confused with melanoma.

Section snippets

Epidemiology

Tinea versicolor, also known as pityriasis versicolor, is one of the most common pigmentary disorders worldwide.1, 2, 3 It is frequently seen in tropical regions, with prevalence as high as 40%; it is also common in temperate areas, representing up to 3% of patients seen by dermatologists during the summer months.2, 4 The infection can arise at any age, with most cases occurring during adolescence and young adulthood.2 Hormonal changes or increases in sebum secretion might be relevant. In one

Epidemiology

Piedra, which means stone in Spanish, is an asymptomatic fungal infection of the hair shaft;91, 92, 93, 94, 95, 96 it is also known as trichomycosis nodularis. Both sexes and people of all ages are equally affected.97 Under-reporting of cases could happen because nodules of piedra can be inconspicuous.98

In 1911, Horta99 classified piedra into two types: black piedra and white piedra (trichosporosis).97, 98, 100, 101, 102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115 The two

Epidemiology

Tinea nigra is common in tropical regions of Central America, South America, Africa, and Asia, and is infrequent in the USA and Europe.116, 117, 118 In the USA, it typically affects coastal states such as Florida, Texas, Alabama, Louisiana, Virginia, Georgia, and North Carolina. Although cases of tinea nigra are also seen in patients from northern and inland regions of the USA, including New York City, Chicago, and Boston, such patients typically have a history of foreign travel, frequently to

Search strategy and selection criteria

I searched The Cochrane Library (from 1991 to October, 2002) and MEDLINE (from 1966 to present) with the terms “Malassezia”, “tinea versicolor”, “piedra”, and “tinea nigra”. I translated or had translated all relevant non-English articles from this search. I largely selected articles from the past decade, showing a preference for the most recent ones, but did not exclude older contributions of significant value. I also searched the journals Mikologia Lekarska (Wroclaw), Cesko-Slovenská

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