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Pityriasis versicolor

Aktuelles zu einer alten Erkrankung

Pityriasis versicolor

New aspects of an old disease

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Zusammenfassung

Pityriasis versicolor (PV) ist eine der häufigsten erregerbedingten Hauterkrankungen. Unter den bisher bekannten Malassezia spp. wird M. globosa derzeit die pathogenetisch wichtigste Rolle zugeschrieben, da diese Spezies vorrangig in den PV-Läsionen nachgewiesen werden kann. Zudem scheinen ihre großen runden Sprosszellen Teilaspekte des nativmikroskopisch charakteristischen Bildes der Erkrankung (‚‚Spaghetti und Fleischklößchen’‘) erklären zu können. Die klinischen Besonderheiten dieser Erkrankungen wie Hyperpigmentierung, Depigmentierung, Fluoreszenz der Läsionen sowie fehlendes entzündliches Infiltrat bei hoher Erregerlast lassen sich aber allein mit dem Nachweis der auch zur residenten Flora gehörenden Hefe nicht hinreichend begründen. Ein von der Aminosäure Tryptophan abhängiger Stoffwechselweg in M.  furfur führt zu einer Reihe von Indolderivaten, die im Zusammenhang mit den oben genannten klinischen Phänomenen stehen könnten. Im Modellorganismus Ustilago maydis konnte gezeigt werden, dass diese Verbindungen sich spontan in Abhängigkeit von einem einzigen Enzym, der Aminotransferase Tam1, bilden. Der Beitrag gibt eine Übersicht über den aktuellen Kenntnisstand der PV und beleuchtet bislang nicht zufriedenstellend erklärte Phänomene unter dem Konzept der Aminotransferase Tam1. Erste vielversprechende therapeutische Ansätze mit dem Einsatz topischer Tam1-Inhibitoren bei der PV könnten diesen neuen Ansatz stützen.

Abstract

Pityriasis versicolor (PV) is one of the most common infectious skin diseases, as well as the most common dermatosis associated with pigmentation alterations of the skin. PV is prevalent in 1% of the population living in temperate climate zones and more common during the summer. In tropical areas, PV is found in up to 50% of all patients consulting a dermatologist. Of the known Malassezia species, M. globosa is currently felt to play a key role in the pathogenesis of PV, as it is most commonly found in PV lesions. In addition, its round-shaped cells may contribute to the characteristic histology of the disease (“spaghetti and meatballs”). However, the clinical appearance of PV including hyper- and hypopigmentation, fluorescence of the lesions, as well as a lack of inflammation despite high fungal load cannot fully be explained by the presence of M. globosa, which is also found on healthy skin. In M. furfur a tryptophan-dependent metabolic pathway generates a number of indole pigments, which may be associated with the clinical appearance of PV. In the model organism Ustilago maydis it was shown that the formation of the indole compounds occurs spontaneously after initial conversion of tryptophan into indole pyruvate controlled by the key enzyme aminotransferase Tam 1. We review the present knowledge of PV and highlight the potential role of Tam1 in explaining the poorly understood aspects of the disease. Promising therapeutic results using the application of Tam1 inhibitors to treat PV support the enzyme’s important role in the disease pathogenesis.

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Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht. Für die Anwendung von topischen Transaminasehemmern in der Therapie der PV besteht eine Patentanmeldung der Justus-Liebig-Universität Gießen (Deutsche Patentanmeldung 102009004959.2).

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  1. Klinik für Dermatologie, Venerologie und Allergologie – Standort Gießen, Universitätsklinikum Gießen und Marburg, Gaffkystr. 14, 35385, Gießen, Deutschland

    P.A. Mayser & J. Preuss

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Mayser, P., Preuss, J. Pityriasis versicolor. Hautarzt 63, 859–867 (2012). https://doi.org/10.1007/s00105-012-2380-5

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