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Levels of zinc and vitamin D3 in patients with pityriasis versicolor:A study in Southern Iran, Shiraz

Dear Editor, Pityriasis versicolor (PV) is a superficial fungal infection caused by the lipophilic yeasts of the genus Malassezia. Despite the presence of confirmatory evidence on the positive role of zinc and vitamin D3 in the improvement of the immune system function, there are contradictory findings regarding the role of these supplements in the growth and pathogenicity of microorganisms. Regarding this, the present study was conducted to further explore the possible relationship of zinc and vitamin D3 levels with PV. This case-control study was conducted on 85 patients with PV referring to the Dermatology Clinic of Shahid Faghihi Hospital, Shiraz, Southern Iran, from April 2017 to September 2018. The infection was confirmed by the observation of the yeasts and filamentous forms of Malassezia species (spaghetti and meatball model) using the direct microscopy of skin scales clarified by KOH 10% or stained with methylene blue. A control group, consisting of 85 age-, genderand sun exposure-matched clinically healthy individuals, was also considered in the study. The exclusion criteria were: (a) diagnosis of any skin diseases, autoimmune diseases, or cancers; (b) consumption of antimicrobials, corticosteroids, immunosuppressant, or anticonvulsants; and (c) pregnancy and lactation. Moreover, the participants of both groups had not taken any supplementations, containing zinc and vitamin D3, in the last 3 months. The history of each person was taken using a questionnaire. In addition, the concentrations of zinc and vitamin D3 were measured using atomic absorption spectroscopy (PerkinElmer) and direct enzyme-linked immunosorbent assay (Monobind ELISA kit), respectively. The two groups were compared in terms of serum zinc and vitamin D3 levels by analysis of covariance test using SPSS software, version 16.0 (SPSS, Inc). The mean age of the participants was 30 ± 14 years (age range: 2-67 years). Table 1 presents the mean serum levels of zinc and vitamin D3 in the study participants. The results revealed a significant difference between the case and control groups in terms of zinc levels after adjusting for the effect of gender. In this regard, the patients with PV had a higher serum zinc level compared to the control group (P < .001). Nevertheless, there was no significant difference between the two groups considering the vitamin D3 level (P = .38; Table 2). With regard to the reference range, 64.1% (n = 109) and 78.2% (n = 133) of participants had inadequate levels of zinc and vitamin D3, respectively. Several studies have shown the importance of zinc in the pathogenicity and morphogenesis of fungal pathogens. Because of the proliferation and morphogenesis of Malassezia species in the stratum corneum layer of the skin in PV, the serum zinc levels might be raised in patients compared to healthy individuals as a stimulating factor for the proliferation of Malassezia species. Therefore, further studies are required to investigate the reason behind high zinc deficiency in patients with PV. Vitamin D level is associated with many infectious and skin diseases; accordingly, it is used as a safe and efficient agent for therapeutic purpose. Recent studies have shown the role of this vitamin in fungal infections, such as candidiasis. However, our results indicated