Translational medical mycology guides clinical and laboratory practice on fungal diseases

Patients with fungal infection having skin lesions may consult a dermatologist, which is a diagnostic and therapeutic challenge. Dermatologists take samples from the lesion to check the fungal elements under a microscope by KOH preparation and then treat the patient. This model has advanced from bedside to bench and from bench to bedside(B to B to B), which is defined as Translational Medical Mycology. Dermatologists have an advantageous position in finding, isolating and identifying the pathogenic fungi and treating the patient with antifungal drugs. Samples should be cultured in different media with or without chloramphenicol and cycloheximide and incubated at room temperature or 37 ℃. Non-culture techniques such as polymerase chain reaction based molecular identification, transmission electron microscopy, scanning electron microscopy, biochemistry tests and histopathology are also necessary to confirm the identification of the species, especially when the routine culture is negative. We start treatment upon obtaining evidence of fungal infection,i.e., positive KOH examination. Antifungal drugs such as itraconazole, fluconazole, terbinafine and amphotericin B can be used alone or in combination based on the fungal species and the location of the lesion. Practice on fungal infection includes screening of the patient, merging all of the laboratory techniques and methods from the microbiologists, pathologists, molecular researchers, identification of the pathogen and determination of the optimum antifungal drug.

Efficacy and safety of itraconazole use in infants

Background:Itraconazole has been used to treat fungal infections,in particular invasive fungal infections in infants or neonates in many countries.Data sources:Literature search was conducted through Ovid EMBASE,PubMed,ISI Web of Science,CNKI and Google scholarship using the following key words:“pediatric”or“infant”or“neonate”and“fungal infection”in combination with“itraconazole”.Based on the literature and our clinical experience,we outline the administration of itraconazole in infants in order to develop evidence-based pharmacotherapy.Results:Of 45 articles on the use of itraconazole in infancy,13 are related to superficial fungal infections including tinea capitis,sporotrichosis,mucosal fungal infections and opportunistic infections.The other 32 articles are related to systemic fungal infections including candidiasis,aspergillosis,histoplasmosis,zygomycosis,trichosporonosis and opportunistic infections as caused by Myceliophthora thermophila.Conclusion:Itraconazole is safe and effective at a dose of 5 mg/kg per day in a short duration of therapy for superficial fungal infections and 10 mg/kg per day for systemic fungal infections in infants.With a good compliance,it is cost-effective in treating infantile fungal infections.The profiles of adverse events induced by itraconazole in infants are similar to those in adults and children.

Dermoscopic clues for sebaceous carcinoma arising in nevus sebaceous

To the Editor:Sebaceous carcinoma(SC)is a rare cutaneous malignant tumor differentiated from the epithelium lining and arising from the sebaceous gland.[1]Consequently,nevus sebaceous(NS)tends to develop into a benign or malignant neoplasm.[2]Herein,we report dermoscopic findings in a rare case of SC arising in NS with protruding nodule in erosive erythematous surface rapidly arising from yellow pigment plaque resulting in no recurrence.Dermoscopy is a powerful diagnostic tool to generate a preoperative diagnosis.

Nail Psoriasis in a Child Observed Under Ultraviolet Dermoscopy Treated by a Topical Biological Agent Cream:A Case Report

Introduction:Nail psoriasis is a type of psoriasis involving nail lesions characterized by pitting,onycholysis,longitudinal ridges,and subungual hyperkeratosis.We herein describe a 9-year-old girl with nail psoriasis who presented with nail crumbling and was treated with topical cream containing 45μg/g mouse monoclonal antibody to human interleukin-8.Case presentation:A 9-year-old Chinese girl presented with a 6-month history of a rough,thickened fingernail and toenails.Nail plate crumbling,onycholysis,and fissured periungual folds were observed under dermoscopy and ultraviolet dermoscopy.The nails were soaked in warm water,then topical wrapped with Abcream cream overnight.After about 4 months of treatment,the nails significantly improved by both dermoscopy and ultraviolet-dermoscopy evaluattion.Discussion:Due to the different wavelengths of light emitted by polarized light dermatoscope and ultraviolet-dermatoscope,the characteristics of observation will be different.Abcream acts by antagonizing human interleukin-8,inhibiting leukocyte chemotaxis and neovascularization,and regulating the abnormal proliferation and differentiation of keratinocytes.Conclusion:Ultraviolet-dermoscopy is pivotal in evaluating the severity and potency of nail psoriasis.And Abcream can be regarded as a new drug for the treatment of nail psoriasis in children.

Indicators for Differentiating Atypical Discoid Lupus Erythematosus from Epifolliculitis with Dermoscopy

To the Editor： Dennoscopy is a noninvasive and widely used tool to diagnose skin lesions. It enables the observation of morphological patterns that are not otherwise visible to the naked eyes. Given the wide variety of clinical features and uncommon clinical manifestations of dermatoses, sometimes incorrect diagnoses and subsequent improper treatments may be applied to patientsdilated follicular openings filled with cornified material, follicular plugging, a necrosed part of the stratum basale,

Gene expression profiles of peripheral blood mononuclear cells from patients with atopic dermatitis stimulated with Malassezia globosa

To the Editor:Malassezia located in the skin of patients with atopic dermatitis(AD)might be related to its pathogenesis,consisting of Malassezia globosa and Malassezia restricta as the dominant species.[1]However,the specific molecular mechanisms of Malassezia on host immune cells from AD patients are still unclear.In our study,the Affymetrix Human Prime View array was used to detect the effect of M.globosa on the gene expression of peripheral blood mononuclear cells(PBMCs)from AD patients,which was favorable to further understand the role of Malassezia colonization in the pathogenesis of AD.

Infant eczema or insect dermatitis?Dermoscopy solved the mystery

A 4-month-old male infant presented with relapsing papules and pustules on his feet(especially on the sole of left foot)for one month(Fig.1a).He was in good health with no fever or obvious pruritus.Prior treatments of topical corticosteroid and antibiotics in a local hospital were ineffective.In our clinic,we went over those papules with dermoscopy one by one.A white tunnel with a small dark brown triangular structure(the head and the two pairs of front legs)and a transparent oval structure(the body of the mite)at its end,were observed on one of the papules(Fig.1b)[1,2].