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Epidemiological characteristics of Malassezia folliculitis and use of the May-Grünwald-Giemsa stain to diagnose the infection

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... The age predomination of MF are varied in different studies. A turkish study with 49 patients revealed that MF mostly eventuated around the age of 26 (Durdu et al, 2013), while 5year-american study with 110 patients argued that MF commonly occured at around 15 years old (Prindaville et al, 2017). The MF prevalention in Indonesian general population has not been well-documented. ...
... Patients would oftentimes scratch the affected areas to reduce the itchiness. The stinging sensation is commonly endured during increased activities and direct sun exposures which stimulates perspiration (Durdu et al, 2013). ...
... The KOH grading were predominated with 4+ grade patients, 99 patients (64.28%), and no patients resulted in KOH grade 1. These findings are in accordance with Durdu (2013) study which resulted in 81.6% of the patients were KOHpositive. ...
... 6 Microscopic examination, especially potassium hydroxide (KOH) staining, is routinely performed to diagnose MF in a dermatology practice, but further analysis using histopathological examination or culture is sometimes needed in cases with unclear results. 2,3 Study in China by Liu et al. revealed that the sensitivity and specificity of KOH stain were 60.6% and 89.4%, respectively. Due to insufficient color contrast and observer's skills, false-negative results could occur on KOH examination. ...
... Malassezia folliculitis, formerly known as Pityrosporum folliculitis, is a fungal acneiform condition caused by the genus Malassezia. 2,9 It was first described by Weary et al. in 1969 and recognized by Potter in 1973 as a specific disease that is not rare. However, it easily unrecognized and is not uncommonly misdiagnosed as acne, folliculitis, or eczema. ...
... Therefore, it may be treated with topical and/or systemic antibiotics for months or even years. 2 Exceptionally, in infants, it is typically described as 1-2 mm pruritic, monomorphic, pink papules, and pustules ( Figure 2). The occurrence of Malassezia folliculitis at the age of two months confirms the colonization of the human skin by Malassezia yeasts in a few weeks after the birth. ...
Article
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Background: Malassezia folliculitis (MF) is the most common fungal folliculitis, and it is caused by yeast of the genus Malassezia. MF may be difficult to be distinguished clinically from acne and other types of folliculitis, causing misdiagnosis and improper treatment. Dermoscopy has been very useful to support the diagnosis of several types of folliculitis, including MF. Purpose: To know the role of dermoscopic examination in MF. Review: The diagnosis of MF can be identified by usual clinical presentation with direct microscopy and culture of the specimen, Wood's light examination, histopathological examination, and rapid efficacy of oral antifungal treatments. Several studies reported that dermoscopy provides a deeper level of the image that links the clinical morphology and the underlying histopathology. Some dermoscopic patterns are observed consistently with certain diseases, including MF, so these could be used for establishing their diagnosis. The dermoscopic features of MF seem to correlate with the current understanding of its etiopathogenesis. Conclusion: Dermoscopic examination in MF will reveal dermoscopic patterns including folliculocentric papule and pustules with surrounding erythema, dirty white perilesional scales, coiled/looped hairs with perifollicular erythema and scaling, hypopigmentation of involved hair follicles, and dotted vessels.
... Malassezia folliculitis is another common worldwide disease with a prevalence of 1 to 17%. It occurs more commonly in young to middle-aged adult males [222][223][224]. Follicular occlusion or a disturbance of the normal cutaneous flora leads to an abnormal proliferation of Malassezia species and the development of disease. ...
... Follicular occlusion or a disturbance of the normal cutaneous flora leads to an abnormal proliferation of Malassezia species and the development of disease. Common associated species include M. globosa, M. restricta and M. sympodialis [6,202,[224][225][226][227][228]. Predisposing factors include hot and humid climate, excessive sweating, non-breathable clothing, application of make-up or sunscreens, certain drugs (antibiotics, glucocorticoids) and immunosuppression [6,224,229,230]. ...
... Common associated species include M. globosa, M. restricta and M. sympodialis [6,202,[224][225][226][227][228]. Predisposing factors include hot and humid climate, excessive sweating, non-breathable clothing, application of make-up or sunscreens, certain drugs (antibiotics, glucocorticoids) and immunosuppression [6,224,229,230]. The disease typically involves the face, upper back, extensor surfaces of the arms, chest and neck (Figure 3). ...
Article
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Malassezia spp. are commensals of the skin, oral/sinonasal cavity, lower respiratory and gastrointestinal tract. Eighteen species have been recovered from humans, other mammals and birds. They can also be isolated from diverse environments, suggesting an evolutionary trajectory of adaption from an ecological niche in plants and soil to the mucocutaneous ecosystem of warm-blooded vertebrates. In humans, dogs and cats, Malassezia-associated dermatological conditions share some commonalities. Otomycosis is common in companion animals but is rare in humans. Systemic infections, which are increasingly reported in humans, have yet to be recognized in animals. Malassezia species have also been identified as pathogenetic contributors to some chronic human diseases. While Malassezia species are host-adapted, some species are zoophilic and can cause fungemia, with outbreaks in neonatal intensive care wards associated with temporary colonization of healthcare worker’s hands from contact with their pets. Although standardization is lacking, susceptibility testing is usually performed using a modified broth microdilution method. Antifungal susceptibility can vary depending on Malassezia species, body location, infection type, disease duration, presence of co-morbidities and immunosuppression. Antifungal resistance mechanisms include biofilm formation, mutations or overexpression of ERG11, overexpression of efflux pumps and gene rearrangements or overexpression in chromosome 4.
... Malassezia yeast can also activate complement cascades by both the classical and alternative pathways (27) . Although there are many species that cause MF, all species have the same clinical presentation (28) . The most common species identified from lesional skin were M. globosa, M. restricta, and M. sympodialis (15,20) . ...
... These species were not only identified as most common on lesional skin, but also as non-lesional skin of the same patient as well as healthy controls (26) . This knowledge was confirmed by a study based on recombinant deoxyribonucleic acid (rDNA) analysis that identified the most common species from MF samples to be M. globosa, M. sympodialis, M. restricta, and M. furfur in order of most to least common (28) . It was also found that the same species were identified from both lesional and non-lesional samples of the same patient. ...
... It is also more common in men than women and in people living in hot, humid climates, which may be due to excessive sweating. Other predisposing factors include topical or oral antibiotic use, corticosteroid use, and other immunosuppressants (28,37) . MF presents as small, uniform, itchy papules, and pustules particularly on the upper chest and back. ...
Article
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Malassezia folliculitis (MF) results from overgrowth of Malassezia yeasts, which are normal skin flora. This condition is caused by a loss of balance between Malassezia yeasts, microenvironment, and human immunity. MF presented as small, monomorphic, itchy papules, and pustules particularly on hair line, face, and upper trunk. Because the appearance and location of MF are similar to acne, this makes it difficult to distinguish between the two conditions. MF is an under-recognized disease that is often misdiagnosed as acne vulgaris, recalcitrant acne, neonatal cephalic pustulosis or neonatal acne, and steroid acne. In addition, MF can occur simultaneously with acne vulgaris. The definite diagnosis is based on clinical presentations, direct microscopy, histopathological examination, and good response to antifungal treatments. MF may persist for years without complete resolution with standard acne treatment. Dermatologists should be aware of this disease when encountering patients with acne problems to provide proper management. Keywords: Malassezia folliculitis; Acne vulgaris; Recalcitrant acne; Neonatal acne; Steroid acne DOI: 10.35755/jmedassocthai.2022.02.13268
... There was no difference in incidence in terms of race or sex. 3 Study of 49 patients in Turkey by Durdu et al (2012) showed that the most common age group affected by MF was 26 years. 4 patients showed that MF mostly affects patients with the mean age group of 15 years old. 5 The prevalence of MF in Indonesia in the general population is still unknown. ...
... The high humidity resulting in increased sebum production, which promotes the growth of Malassezia sp. on the skin, and may disturb the skin barrier system. 4 The most age groups affected by MF in the Mycology Division Outpatient Clinic of Dermatology Venerology Department Dr. Soetomo General Academic Hospital Surabaya was 15-24 years, which equals to 129 (65.8 % ) patients, followed by age group of 25-44 years, which equals to 47 (24%) patients. Similar to the study conducted by Brea et al in the United States involving 110 MF patients from 2010 to 2015, the result showed that MF cases were mostly reported on persons aged 15-24 years old. ...
... This is similar to the previous study, showing that MF can be accompanied by itch and red erythematous nodules. 1,3,4,9 The degree of itch caused by MF was mostly moderate reported by 184 patients (93%). This is similar to a case report by Poitr (2010) which stated that MF is always accompanied by persistent itching, and according to Rubenstein, the intensity of pruritus or itching was 79.6% or 49 patients. ...
Article
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Background: Malassezia folliculitis (MF) is a chronic infectious disease of pilosebaceous follicles caused by Malassezia sp. Clinical features of MF include erythematous papules and itchy perifollicular pustules, especially on the upper body, neck, upper arms, and face. The disease is usually reported on adolescents. Objective: To evaluate the profile of MF patients in four years (2014-2017) period in the Mycology Division of Dermatovenerology Outpatient Clinic of Dr. Soetomo General Academic Hospital Surabaya. Methods: This study was a retrospective study to examine the medical records of MF patients in the Mycology Division of Dermatovenerology Outpatient Clinic General Academic Hospital Dr. Soetomo Surabaya from January 2014 to December 2017. Results: The number of new MF patient visits during 2014-2017 was 196 patients, and the average annual visit was 55 patients in 2014, 49 patients in 2015, 65 patients in 2016, and 27 patients in 2017. The majority of patients were males, were aged 15-24 years old. The chief complaint was reddish papules accompanied by moderate itching in the predilection area and most often found in the upper body. The Wood's lamp examination revealed greenish-yellow color, and 20% KOH examination showed spores. Most systemic therapies was ketoconazole and tretinoin 0.05% cream for topical therapy. Conclusions: There was a decrease in the number of MF patients. The diagnoses of MF were based on history taking, physical examination, 20% KOH, and Wood's lamp.
... Malassezia furfur includes both Pityrosporum ovale and Pityrosporum orbiculare. Malassezia has been associated several skin conditions, such as atopic dermatitis, folliculitis, pityriasis (tinea) versicolor and seborrheic dermatitis [1,4,5]. ...
... Predisposing factors for Malassezia folliculitis include excessive sweating, hot and humid climates, immunosuppression, systemic corticosteroid use and topical or oral antibiotic use; however, it can also occur in immunocompetent individuals [1,8]. Nearly 80% of the patients with the condition experience pruritus [4]. ...
... Malassezia folliculitis appears as monomorphous papules and pustules [1,4,5]. The most frequent lesion locations include the upper back, chest and extensor arms; lesions are also commonly found on the chin and the malar regions of the face [4]. ...
Article
Malassezia (Pityrosporum) folliculitis usually appears as pruritic monomorphous papules and pustules on the upper back, chest, extensor arms and face. Acne vulgaris, bacterial folliculitis, eosinophilic folliculitis and systemic corticosteroid-induced acne can clinically mimic the fungal-caused acneiform condition. The designation incognito is used to describe tinea or scabies when the characteristic presentation is masqueraded by the application of topical corticosteroid treatment. Application of corticosteroid cream altered the morphology of the skin lesions in a man with Malassezia folliculitis. His cutaneous findings-localized areas of post-inflammatory hyperpigmentation with flattened or completely resolved follicular papules-raised the possibility of partially treated follicular eczema or follicular contact dermatitis. Pathognomonic findings from biopsies of the skin lesions established the diagnosis of Malassezia folliculitis; the condition completely resolved after treatment with topical antifungal shampoo and cream. Similar to tinea incognito and scabies incognito, folliculitis caused by Malassezia yeast in which the cutaneous morphology has been concealed by management with topical corticosteroids should be referred to as Malassezia (Pityrosporum) folliculitis incognito.
... The sampling method is quite important for the detection of parasites. Appropriate sampling 11 Leishmania parasites in the granuloma (MGG x1000) method may vary depending on lesion type. The crusted lesions should be carefully handled, and crusts should be gently removed with a sterile forceps. ...
... This opportunistic fungal infection leads to excessive inflammation and necrosis and therefore may be missed during cytological examination with Diff-Quick and MGG stains (Fig. 8.36). In this respect, these fungal elements are detected by using Papanicolaou and hematoxylin-eosin stains [11]. ...
... If spores are deeply invasive, granulomas and foreign bodytype giant cells develop (Figs. 8.32, 8.33, and 8.34)[11]. ...
Chapter
The characteristic cytological findings for granulomatous dermatitis are granuloma formation and multinuclear giant histiocytes, which may be observed in three multinucleated giant cells, i.e., Langhans, foreign body, and Touton type. If granuloma structure and giant cell are positive, bacterial, fungal, and parasitic causes of granulomatous dermatitis should be checked. If there are no infectious agents, foreign body, mucin structure, necrobiotic material, and foamy histiocytes should be examined for noninfectious granulomatous diseases.
... In a direct immunofluorescence examination, if the positivity is detected with anti-herpes simplex virus monoclonal antibody, it supports the herpes folliculitis; however, if the positivity is detected with the anti-herpes zoster monoclonal antibody, herpes zoster folliculitis should be considered (6). Finally, if there is resistance to antibiotics in acne vulgaris patients, cytologic examination is quite important to exclude Gram-negative folliculitis and Malassezia folliculitis ( Figures 6-8) (11). ...
... Last, tufted hair is a sign of folliculitis decalvans. However, tinea capitis mimicking folliculitis decalvans has been reported with videodermatoscopy so that the cytological examination should be the first method for the diagnosis of folliculitis (11,23). ...
... The patients of Malassezia folliculitis may unnecessarily take antibiotic therapies for years if this discrimination is not made. In the Wood's light examination of papulopustular lesions, the yellow-green reflection indicates the Malassezia folliculitis, while the red reflection indicates acne lesions infected with Propionibacterium acnes (11). ...
Article
Full-text available
The diagnosis of dermatological diseases requires cytological, dermatoscopic, histopathological examinations, some laboratory tests, and radiology imaging in addition to clinical examination. However, these tests are quite important, not only in time of diagnosis, but also in patient follow ups and determining the therapeutic approach. In this article, the diagnostic tests are reviewed that may help to dermatologists in detecting the treatment of dermatological diseases.
... Malassezia folliculitis (MalF), a prevalent inflammatory skin disease in tropics and subtropics, [1][2][3][4][5] associates with colonization and overgrowth of Malassezia in hair follicles. 6,7 The typical clinical presentation is numerous erythematous, pruritic papules and pustules on the trunk and proximal extremities. ...
... 6,7 The typical clinical presentation is numerous erythematous, pruritic papules and pustules on the trunk and proximal extremities. [1][2][3][4][5]8 MalF sometimes mimics or coexists with acne vulgaris and bacterial folliculitis. 3,8,9 However, MalF does not present with comedones, and it responds to antifungal agents instead of traditional acne treatments or antibiotics. ...
... [6][7][8]10 Multiple stains, including blue/black Parker ink, May-Grunwald-Giemsa (MGG) stain, methylene blue, lactophenol blue and calcofluor white have all been used to visualize Malassezia. [1][2][3][4] Gram staining is widely used to visualize bacteria and has been used to identify Malassezia in one very early study, 12 in which demonstration of Malassezia was presumed to be diagnostic of MalF. However, the study design was simple and crude, focusing mainly on the clinical characteristics and epidemiology of MalF, rather than the diagnostic accuracy of Gram staining. ...
Article
Full-text available
Malassezia folliculitis (MalF) mimics acne vulgaris and bacterial folliculitis in clinical presentations. The role of Gram staining in rapid diagnosis of MalF has not been well studied. In our study, 32 patients were included to investigate the utility of Gram staining for MalF diagnosis. The final diagnoses of MalF were determined according to clinical presentation, pathological result and treatment response to antifungal agents. Our results show that the sensitivity and specificity of Gram staining are 84.6% and 100%, respectively. In conclusion, Gram staining is a rapid, non-invasive, sensitive and specific method for MalF diagnosis.
... Some molecular studies have investigated the epidemiological characteristics of MF [6][7][8]. Recently, we identified Malassezia globosa as the most common agent of MF, followed by M. sympodialis, M. restricta, and M. furfur, in Adana, Turkey [8]. Little is known regarding the clinical features and laboratory characteristics of folliculitis caused by fungal pathogens other than those in the genus Malassezia. ...
... Some molecular studies have investigated the epidemiological characteristics of MF [6][7][8]. Recently, we identified Malassezia globosa as the most common agent of MF, followed by M. sympodialis, M. restricta, and M. furfur, in Adana, Turkey [8]. Little is known regarding the clinical features and laboratory characteristics of folliculitis caused by fungal pathogens other than those in the genus Malassezia. ...
... To our knowledge, this study is the first report of the recovery of A. vanbreuseghemii from a patient with DF. Recently, we observed id reactions in 2 of 49 patients with MF [8]. However, in this study, we did not detect any id reactions in the CF or DF patients; this finding might result from the fact that only 6 CF and DF cases being included. ...
Article
Although some studies have investigated the epidemiological characteristics of Malassezia folliculitis (MF), little is known about the clinical features and laboratory characteristics of folliculitis caused by other fungi. In this prospective study, 158 patients with folliculitis were identified, and cytological and mycological examinations were performed. The positive fungal cultures were confirmed using conventional methods, ITS sequencing and HWP1 analysis. Additionally, an in vitro antifungal susceptibility test was performed. Of 158 patients with folliculitis, 65 (41.1 %) were found to have fungal folliculitis. The most common (90.8 %) fungal folliculitis was MF. Non-MF fungal folliculitis was detected in 6 (9.2 %) patients. Four patients were diagnosed with dermatophytic folliculitis (Trichophyton rubrum in three patients and Arthroderma vanbreuseghemii in one patient), and two patients were diagnosed with Candida albicans folliculitis. Although only 5 of the 6 samples were found to be positive via a potassium hydroxide test, all May–Grünwald–Giemsa-stained samples were positive. Both of the C. albicans isolates demonstrated a susceptibility profile to itraconazole, and all four dermatophytes were susceptible to terbinafine. All six patients completely recovered with systemic and topical treatment. This study revealed that dermatophytes and C. albicans are the primary causative agents of non-Malassezia fungal folliculitis. We compared our findings with published reports on fungal folliculitis.
... It is commonly found in people living in hot, humid climates, particularly those affected by excessive sweating, and is reported to be more common in males. [9][10]13 Other predisposing factors include topical or oral antibiotic use, particularly tetracyclines, oral corticosteroid use, and immunosuppression. 10,14 Malassezia furfur, made up of Pityrosporum orbiculare and ovale, have been detected in follicular contents of steroid acne. ...
... [9][10]13 Other predisposing factors include topical or oral antibiotic use, particularly tetracyclines, oral corticosteroid use, and immunosuppression. 10,14 Malassezia furfur, made up of Pityrosporum orbiculare and ovale, have been detected in follicular contents of steroid acne. 15 A study of 49 patients in Turkey, performed by Durdu et al, 10 found the incidence of MF to be four percent of patients attending their dermatology clinic, with an average age of 26 (range 12-62) years. ...
... 10,14 Malassezia furfur, made up of Pityrosporum orbiculare and ovale, have been detected in follicular contents of steroid acne. 15 A study of 49 patients in Turkey, performed by Durdu et al, 10 found the incidence of MF to be four percent of patients attending their dermatology clinic, with an average age of 26 (range 12-62) years. ...
Article
Malassezia (Pityrosporum) folliculitis is a fungal acneiform condition commonly misdiagnosed as acne vulgaris. Although often associated with common acne, this condition may persist for years without complete resolution with typical acne medications. Malassezia folliculitis results from overgrowth of yeast present in the normal cutaneous flora. Eruptions may be associated with conditions altering this flora, such as immunosuppression and antibiotic use. The most common presentation is monomorphic papules and pustules, often on the chest, back, posterior arms, and face. Oral antifungals are the most effective treatment and result in rapid improvement. The association with acne vulgaris may require combinations of both antifungal and acne medications. This article reviews and updates readers on this not uncommon, but easily missed, condition.
... Malassezia folliculitis presents as monomorphic papulopustular skin lesions commonly on the trunk, upper arms, and face. Itching is associated with the lesions in around 80% of cases [2]. The condition clinically resembles, commonly misdiagnosed, and can co-exist with acne vulgaris. ...
... The skin infection is common in adolescents and adults aged 11-30, with an average age of infection as 26 years. According to a study conducted on 49 patients by Durdu et al., the face and trunk were the most common sites of involvement in more than 50% of cases, with extremities being the other most commonly affected sites [2,6]. The predominant distinguishing features are involvement of the trunk, extremities, and face, as well as the presence of intense itching, and monomorphic papular and pustular skin lesions with a lack of comedones. ...
Article
Full-text available
Malassezia (Pityrosporum) folliculitis is a relatively common skin infection that affects the hair follicles. The condition is characterized by monomorphic perifollicular skin lesions and itching without comedones. Malassezia folliculitis significantly resembles acne vulgaris and steroid acne but is subtly distinct and managed differently. Oral antifungals are preferred for the treatment and result in a dramatic improvement in the disease condition. Early recognition of the disease is important for satisfactory clinical outcomes. This case reports about a female in the reproductive age group, who took multiple treatments for erythematous papular lesions on her face with a provisional diagnosis of acne vulgaris. After observing no improvement over the last three months, she visited the Dermatology clinic at a tertiary care hospital. A diagnosis of Malassezia folliculitis was considered and confirmed on microscopic examination and oral and topical antifungals were prescribed. She reported significant improvement in her skin lesions after two weeks of treatment.
... The most prevalent species associated with Malassezia folliculitis are M. globosa, M. restricta and M. sympodialis (Akaza et al., 2009;Ko et al., 2011;Durdu et al., 2013;Prohic et al., 2016). ...
... Systemic itraconazole 100-200 mg daily has been used for 1-4 weeks with a clinical treatment effect of 69-100% (Parsad et al., 1998;Durdu et al., 2013;Suzuki et al., 2016;Tsai et al., 2019) and fluconazole 100−200 mg daily for 1-4 weeks with a clinical effect of 80% (Rhie et al., 2000). Combination of systemic antifungals and topical antifungals (Abdel-Razek et al., 1995;Prindaville et al., 2018) or tretinoin/bensylperoxide (Ayers et al., 2005) is also useful. ...
Article
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Yeasts of the genus, Malassezia, formerly known as Pityrosporum, are lipophilic yeasts, which are a part of the normal skin flora (microbiome). Malassezia colonize the human skin after birth and must therefore, as commensals, be normally tolerated by the human immune system. The Malassezia yeasts also have a pathogenic potential where they can, under appropriate conditions, invade the stratum corneum and interact with the host immune system, both directly but also through chemical mediators. The species distribution on the skin and the pathogenetic potential of the yeast varies between different Malassezia related diseases such as head and neck dermatitis, seborrheic dermatitis, pityriasis versicolor, and Malassezia folliculitis. The diagnostic methods used to confirm the presence of Malassezia yeasts include direct microcopy, culture based methods (often a combination of morphological features of the isolate combined with biochemical test), molecular based methods such as Polymerase Chain Reaction techniques, and Matrix Assisted Laser Desorption/Ionization—Time Of Flight mass spectrometry and the chemical imprint method Raman spectroscopy. Skin diseases caused by Malassezia are usually treated with antifungal therapy and if there are associated inflammatory skin mechanisms this is often supplemented by anti-inflammatory therapy. The aim of this paper is to provide an overview of Malassezia related skin disease, diagnostic methods and treatment options.
... MF is often misdiagnosed as AV and can coexist with AV in the same patient. [11][12][13] This study reveals that the prevalence of MF in Thai patients clinically diagnosed with AV was 28.8%, which was higher than a previous study in Turkey and Korea, where the prevalence of MF among patients with AV was reported to be 25.3% and 25%, respectively. 7,14 The prevalence of MF in AV patients is significantly higher than the prevalence of MF in the population worldwide, which has been reported to be only 1-16.5%. ...
Article
Full-text available
Background: The clinical presentation of Malassezia folliculitis (MF) can imitate acne vulgaris (AV), making it difficult to distinguish between the two conditions. Moreover, MF can coexist with AV in the same patient. The incidence of MF in patients clinically diagnosed with AV may be underestimated. This study aimed to determine the prevalence, associated factors, and clinical characterization of MF patients diagnosed with AV. Materials and methods: Three hundred twenty new acne patients were questioned regarding general information, including age, sex, itchy symptoms, and past treatment history with antibiotics and steroids within four weeks. Clinical presentations of AV (location and severity), dandruff, and seborrheic dermatitis were examined by a dermatologist. Cytologic studies to determine the abnormal proliferation of Malassezia yeasts were performed from pustules or, in the absence of pustules, comedo-like papules, and comedones. The smears were stained with methylene blue and evaluated under a light microscope by the researcher. Results: The prevalence of MF in patients clinically diagnosed with AV was 28.8% (95% Confidence interval: CI = 23.8% - 33.7%), which can be classified as 24.7% were AV with MF and the remaining 4.1% were MF only. This study revealed that patients diagnosed with MF were 7.38 times more likely to have itchy symptoms than patients diagnosed with AV. MF patients had 8.89 times and 9.17 times higher risk of acneiform lesions on the scalp/ hairline and upper back than those who did not have MF, respectively. Conclusion: This present study revealed a high prevalence of MF in patients clinically diagnosed with AV. Dermatologists should be aware of MF when encountering AV patients with acneiform lesions on the scalp/ hairline and upper back with pruritus. Diagnosis based on clinical presentations alone may lead to misdiagnosis. Methylene blue staining is easy to perform and beneficial to diagnose MF.
... A direct microscopy examination of the smear was performed as part of the initial analysis to detect Malassezia and parasites such as mange. To determine the number of typical Malassezia cells per microscopy field, slides were stained with giemsa stain (40× magnification) [12]. In addition, gram staining was performed by the protocol to identify gram-positive and gram-negative bacteria [13]. ...
... When MF colonizes the sebaceous glands of the skin, which are glands that produce oil located in the dermal layer, it yields several skin-related complications such as irritation and inflammation, yeast-related breakouts, itching and burning. The yeast typically colonizes the face, back, extensor surfaces of the arms, chest, and neck [2]. Unlike typical complications of the acne vulgaris strain, MF does not respond to most antiacne treatments because of its lipid-based pathogenesis and proliferation that make it vehemently stubborn and unique to treat. ...
Article
Full-text available
Malassezia folliculitis is a condition in which the naturally occurring yeasts on the skin proliferate within the sebaceous glands and cause inflammation. The lipophilic Malassezia yeasts colonize the sebaceous glands of the skin and havoc on the skin, leaving patients and dermatologists alike, unhappy. The issue is further exacerbated by a lack of research on the comparative efficacies of treatment types alternative to those heavily implemented in the public sphere, such as allopathic and homeopathic medicines. This paper seeks to narrow this knowledge gap and identify potentially more efficacious treatments to eradicate MF than those already recognized by the public domain. Thus, such will be executed through a two-part, quantitative correlational study that investigates response to both conventional and alternative treatment types to determine the most efficacious type of treatment for eradicating or reducing MF. To encompass a personal and professional perspective, a questionnaire was distributed to patients who have suffered or are currently suffering from MF (the Patient Survey) and dermatologists who have treated or are currently treating patients with MF (the Dermatologist Survey). The data produced from both surveys (though more heavily supported by the Patient Survey as there were more responses) ultimately suggested that a combination treatment may be most ideal- a routine that incorporates both allopathic and homeopathic treatments taken both orally and topically.
... Some of the factors contributing the malassezia are age and hormonal therapy [9][10][11][12].It is mainly found in adolescence who are more prone to the oily skin and are more commonly seen in men and adolescence [3,13]. They are mainly found in face ,head , trunk and mainly occurs to the oily skin [5,14].It is commonly found in the peoples who live in the areas of hot and humid climates [14][15][16] and some times it is caused due to decreased immunity. Due to hormonal changes also those are seen and also by the use of corticosteroids ,malnutrition and increased cortisol levels [17]. ...
Article
Full-text available
Malassezia folliculitis is most commonly underdiagnosed by acne and malassezia folliculitis is caused by yeast of Malassezia, which is the cause of tinea versicolor.Malassezia folliculitis [MF] is also called pityrosporum folliculitis. It is a condition that shows breakouts on your skin, people who are mostly oily. People mostly think that it as a normal acne and try to treat them which is been misdiagnosed. It is mostly treated by the anti-fungals like itraconazole, fluconazole ,ketoconazole. It can be resolved within few weeks. Drug must be maintained; otherwise it may lead to reoccurrence of the infection.
... It is often misdiagnosed with antibiotics and corticosteroid preparations during treatment, resulting in lingering and even aggravating diseases. This study and many other domestic studies show that the incidence rate of Malassezia folliculitis has increased each year recently (35)(36)(37). It mostly invades young people, who are at an immature stage of psychology and physiology, and pay more attention to their appearance and image. ...
Article
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This study analyzed the infection of superficial mycosis and the relationship between the distribution characteristics of pathogenic fungi and age, time and sex in Northeast China in the past 10 years. We would like to provide a theoretical basis for the diagnosis and treatment of related diseases. From December 2008 to December 2018, 5,374 superficial mycoses from Northeast China were selected. The fungal species were identified by fungal microscopy, fungal culture, and species identification. Besides, the relationship between sex, age, time and the distribution of superficial mycosis and pathogenic fungi was analyzed. Among the 5,374 patients, the top three infections were tinea pedis (n=1,538, 28.62%), tinea cruris (n=1,018, 18.94%) and tinea corporis (n=938, 17.45%). The top three pathogens were Trichophyton rubrum (n=2,849, 48.65%), Trichophyton mentagrophytes (n=947, 16.14%) and Candida spp. (n=804, 13.70%). The main pathogenic fungi were dermatophytes. The age group with the highest incidence of tinea capitis was children (n=372, 6.92%). The highest incidence rate of tinea pedis was in 31-69-year adults (n=905, 16.84%); Malassezia mainly affects young people aged 15-30. Yeast and mold mostly invade the elderly patients >60 years old. The incidence of tinea cruris, tinea pedis and tinea corporis in male patients was higher than that in female patients. The incidence of onychomycosis in female patients was higher than that in male patients (P<0.05). The isolation rate of Candida, Mold, Microsporum canis, Malassezia and Sporothrix increased year by year, while that of Trichophyton rubrum, Trichophyton mentagrophyte, Trichophyton schoenleinii and Epidermophyton floccosum decreased. From December 2008 to December 2018, dermatophytes were the main pathogens of superficial mycosis in Northeast China. The distribution of disease species and pathogenic fungi varied in different gender, age and time.
... 7 Durdu et al. also found that 66.7% of Wood's lamp results illuminated bright yellowish-green color. 14 Research on staining comparison between MGG and KOH 10% + CSB in MF patients is still limited. The agreement between the three stainings, namely 20% KOH + Parker TM Blue-Black Ink, MGG, and 10% KOH + CSB, were processed using crosstabulation to determine the suitability on spore readings and to calculate the required sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of patients with MF clinical features. ...
Article
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Background: Malassezia folliculitis is a pilosebaceous follicular infection disease caused by Malassezia species. There are many misdiagnosed Malassezia folliculitis cases, causing the maladministration of therapy. A routine diagnostic test performed for Malassezia folliculitis cases is the identification of fungal elements (spore) with a microscope using potassium hydroxide, but it has several weaknesses. Purpose: To evaluate the suitability of Malassezia folliculitis diagnostic test using Potassium Hydroxide 20% + Blue-Black Parker Ink, May Grunwald Giemsa, and Potassium Hydroxide 10% + Chicago Sky Blue. Methods: Analytic observational study conducted in the Dermatomycology Division of Dermatology and Venereology outpatient clinic, Dr. Soetomo General Hospital Surabaya. The samples were thirty patients with clinical features of Malassezia folliculitis. The research material was obtained from the body as many as three pieces of papulomoluscoid lesion extracted. The material obtained was then divided into three glass objects for Potassium Hydroxide 20% + Blue-Black Parker Ink, May Grunwald Giemsa, and Potassium Hydroxide 10% + Chicago Sky Blue staining. Result: The identification of spores using Potassium Hydroxide 20% + Blue-Black Parker Ink was 90%, May Grunwald Giemsa was 90%, and Potassium Hydroxide 10% + Chicago Sky Blue was 93% with a value of κ=0.348 and p=0.051. The diagnostic values of May Grunwald Giemsa and Potassium Hydroxide 10% + Chicago Sky Blue were 96.6% sensitivity, 33.3% specificity, 92.9% Positive Predictive Value, and 50 % Negative Predictive Value. Conclusions: There was no significant concordance between May Grunwald Giemsa and Potassium Hydroxide 10% + Chicago Sky Blue with Potassium Hydroxide 20% + Blue-Black Parker Ink in establishing the diagnosis of Malassezia folliculitis. Potassium Hydroxide 20% + Blue-Black Parker Ink is still needed as a routine examination in cases with clinical features of Malassezia folliculitis.
... In Asia, M. globosa and M. furfur are respectively predominant in Iran [34,35] and Indonesia [36], while M. globosa and M. sympodialis are predominant in India [37,38] and M. globosa and M. restricta are predominant in southwest China [6]. Among MF patients, M. globosa is predominant in Tunisia and Turkey [4,39], M. restricta is predominant in Korea [40] and M. globosa or M. restricta are predominant in Japan [41]. Among HS, M. furfur and M. globosa are predominant in Africa [42,43]. ...
Article
Introduction. Malassezia folliculitis (MF) and pityriasis versicolor (PV) are common dermatoses caused by Malassezia species. Their molecular epidemiology, drug susceptibility and exoenzymes are rarely reported in China. Aim. To investigate the molecular epidemiology, drug susceptibility and enzymatic profile of Malassezia clinical isolates. Methodology. Malassezia strains were recovered from MF and PV patients and healthy subjects (HS) and identified by sequencing analysis. The minimum inhibitory concentrations (MICs) of nine antifungals (posaconazole, voriconazole, itraconazole, fluconazole, ketoconazole, miconazole, bifonazole, terbinafine and caspofungin) and tacrolimus, the interactions between three antifungals (itraconazole, ketoconazole and terbinafine) and tacrolimus, and the extracellular enzyme profile were evaluated using broth and checkerboard microdilution and the Api-Zym system, respectively. Results. Among 392 Malassezia isolates from 729 subjects (289 MF, 218 PV and 222 HS), Malassezia furfur and Malassezia globosa accounted for 67.86 and 18.88 %, respectively. M. furfur was the major species in MF and PV patients and HS. Among 60 M . furfur and 50 M . globosa strains, the MICs for itraconazole, posaconazole, voriconazole and ketoconazole were <1 μg ml ⁻¹ . M. furfur was more susceptible to itraconazole, terbinafine and bifonazole but tolerant to miconazole compared with M. globosa ( P <0.05). Synergistic effects between terbinafine and itraconazole or between tacrolimus and itraconazole, ketoconazole or terbinafine occurred in 6, 7, 6 and 9 out of 37 strains, respectively. Phosphatases, lipases and proteases were mainly secreted in 51 isolates. Conclusions. Itraconazole, posaconazole, voriconazole and ketoconazole are theagents against which there is greatest susceptibility. Synergistic effects between terbinafine and itraconazole or tacrolimas and antifungals may be irrelevant to clinical application. Overproduction of lipases could enhance the skin inhabitation of M. furfur .
... For the diagnosis of Malassezia folliculitis, Wood's lamp examination, cytologic examination, and histopathologic examination may be used. 19 Because the diagnostic accuracy of cytologic examination is higher than histopathologic examination, performing cytologic examination before taking a biopsy is recommended. 20,21 Recently, some dermatologic manifestations of Malassezia folliculi have been described. ...
Article
Background: Clinical differentiation of folliculitis types is challenging. Dermoscopy supports the recognition of folliculitis etiology, but its diagnostic accuracy is not known.
... La patogenia de esta entidad se explica por el sobre crecimiento de la levadura favorecido por la oclusión del folículo piloso y/o la alteración de la microbiota cutánea normal, (Crespo-Erchiga y Delgado-Florencio, 2002), por lo que el aumento de la temperatura y la sudoración como ocurre en NOTA CORTA regiones subtropicales y con gran humedad (Durdu et al., 2013) como lo es el estado de Yucatán, favorecen su desarrollo. ...
Article
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Antecedentes: La foliculitis por Malassezia spp. (fm) es una infección del folículo piloso causada principalmente por M. furfur. Afecta a adolescentes y adultos y se caracteriza por la presencia de pápulas y pústulas foliculares pruriginosas localizadas en el tronco.Objetivo: Describir las características epidemiológicas y clínicas de los pacientes con fm diagnosticados por examen directo (emd) en el Centro Dermatológico de Yucatán (cdy).Métodos: Se realizó un estudio transversal, descriptivo y retrospectivo en el que se revisaron los registros de los Emds realizados en el Laboratorio de Micología del cdy durante enero 2009 - diciembre 2015.Resultados y conclusiones: Se documentaron 56 casos, el 78.6% fueron hombres. La edad promedio fue de 21.4 años. La topografía más frecuente fue el tronco (94.6%), seguido de cara (16.1%), cuello (12.5%), extremidades superiores (10.7%) e inferiores (3.6%). Durante el 2015 se documentaron 22 casos (39.3%) de los cuales el 86.3% se presentaron en junio-septiembre. Seis casos (27.7%) utilizaron previamente esteroides tópicos y 3 casos (13.6%) antibióticos sistémicos. Todos los casos fueron diagnosticados mediante EMD con azul de metileno, el cual es una técnica rápida y no invasiva que permite iniciar un tratamiento temprano.
... La patogenia de esta entidad se explica por el sobre crecimiento de la levadura favorecido por la oclusión del folículo piloso y/o la alteración de la microbiota cutánea normal, (Crespo-Erchiga y Delgado-Florencio, 2002), por lo que el aumento de la temperatura y la sudoración como ocurre en NOTA CORTA regiones subtropicales y con gran humedad (Durdu et al., 2013) como lo es el estado de Yucatán, favorecen su desarrollo. ...
Article
Antecedentes La foliculitis por Malassezia spp. (FM) es una infección del folículo piloso causada principalmente por M. furfur. Afecta a adolescentes y adultos y se caracteriza por la presencia de pápulas y pústulas foliculares pruriginosas localizadas en el tronco. Objetivo Describir las características epidemiológicas y clínicas de los pacientes con FM diagnosticados por examen directo (EMD) en el Centro Dermatológico de Yucatán (CDY). Métodos Se realizó un estudio transversal, descriptivo y retrospectivo en el que se revisaron los registros de los EMDs realizados en el Laboratorio de Micología del CDY durante enero 2009 - diciembre 2015. Resultados y conclusiones Se documentaron 56 casos, el 78.6% fueron hombres. La edad promedio fue de 21.4 años. La topografía más frecuente fue el tronco (94.6%), seguido de cara (16.1%), cuello (12.5%), extremidades superiores (10.7%) e inferiores (3.6%). Durante el 2015 se documentaron 22 casos (39.3%) de los cuales el 86.3% se presentaron en junio-septiembre. Seis casos (27.7%) utilizaron previamente esteroides tópicos y 3 casos (13.6%) antibióticos sistémicos. Todos los casos fueron diagnosticados mediante EMD con azul de metileno, el cual es una técnica rápida y no invasiva que permite iniciar un tratamiento temprano.
... It can be classified as infectious and noninfectious [36]. Infectious folliculitis may arise as a result of infection with bacteria, viruses, fungi, or parasites [37]. Folliculitis may be present in a superficial or deep region of the hair follicle. ...
Chapter
Nanotechnology principles represent one of the most promising technologies and have been identified as a new industrial revolution. It provides therapeutic, diagnostic, and preventive applications in dermatology. Nanomaterials are being applied in sunscreens and cosmetics products to improve the properties attained by the particles at the nano level such as solubility, transparency, and color. However, prolonged use of nanotechnology in cosmeceuticals has initiated public health concern about the possible penetration and absorption of nanoparticles through the skin. Therefore, this review was performed to highlight the emerging role of this nanotechnology in the treatment of skin diseases and cancer as well as the safety aspects of nanotechnologybased cosmeceuticals. Taken together, this review could pave the way for the potential use of nanotechnology in the treatment of skin diseases. The potential implication of the nanotechnology-based cosmeceuticals could be significant and is warranted to be evaluated in long-term in vivo and clinical studies.
... The finding of a high prevalence of M. globosa from folliculitis has been reported by few authors such as Durdu et al. who had determined that M. globosa was involved in 68.6% of the cases followed by M. sympodialis (14.3%), M. restricta (11.4%) and M. furfur (5.7%) [19,21]. However, in a Korean study M. restricta was the predominant specie (20.6%) followed by M. sympodialis (18.3%), ...
Article
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Aim: Malassezia folliculitis is caused by the invasion of hair follicles by large numbers of Malassezia cells. Several Malassezia researches still use cultures, morphology and biochemical techniques. The aim of this study was to identify Malassezia species isolated from patients diagnosed with folliculitis, at the Parasitology and Mycology Laboratory of Sfax University Hospital, and to explore the genetic diversity of Malassezia by using PCR-RFLP and PCR-sequencing targeting the rDNA region of the Malassezia genome. Patients and methods: Specimens were taken from 27 patients with Malassezia folliculitis. For the molecular identification, PCR amplification of the 26S rDNAD1/D2 region was carried out using the Malup and Maldown primers and three restriction enzymes (BanI, MspI and HeaII) for RFLP analysis. The nucleotide sequences of each isolate were compared to those in the NCBI GenBank by using BLASTIN algorithm. Results: Three species of Malassezia yeasts were identified among the 31 Malassezia strains isolated: M. globosa (83.9%), M. sympodialis (12. 9%) and M. furfur (3.2%). The sequence analysis of M. globosa showed six genotypes. Conclusion: There is a high genotypic variability of M. globosa colonizing patients with folliculitis.
... Therefore, the aspect of the cutaneous lesions can cause misdiagnosis of these two diseases or favor a diminished report on the real frequency of Malassezia folliculitis. The incidence of the association of acne and MF is variable; some authors report 12.2 % [13] to 27 % [7]. ...
Article
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Malassezia spp. folliculitis is a variant quite frequent at the tropics. The clinical aspect of perifollicular pustules on an erythematous base with a central hair is the clue for the diagnosis, especially on hairy surfaces. We describe this clinical form caused by Malassezia sp., with background, direct examination findings, and histopathology.
... 2) M. restricta and other Malassezia spp. can form pseudohyphae both in culture and in clinical specimens, which may aid morphologic diagnosis (2,(11)(12)(13). More recently, molecular techniques that detect DNA and RNA have aided with species identification.(14-16) ...
Article
Malassezia species are commonly found on human skin as commensals but can cause invasive infections in premature infants and immunocompromised hosts. Due to their fastidious growth, diagnosis of Malassezia infections can prove challenging. Molecular techniques can aid in diagnosis and treatment of invasive infections. We describe the case of a pediatric oncology patient with splenic lesions secondary to Malassezia restricta.
Article
Acne vulgaris is one of the most common skin disorders worldwide. It typically affects skin areas with a high density of sebaceous glands such as the face, upper arms, chest, and/or back. Historically, the majority of research efforts have focused on facial acne vulgaris, even though approximately half of patients with facial lesions demonstrate truncal involvement. Truncal acne vulgaris is challenging to treat and poses a significant psychosocial burden on patients. Despite these characteristics, studies specifically examining truncal acne vulgaris are limited, with treatment guidelines largely derived from facial protocols. Therefore, truncal acne remains an understudied clinical problem. Here, we provide a clinically focused review on the epidemiology, evaluation, and available treatment options for truncal acne vulgaris. In doing so, we highlight knowledge gaps with the goal of spurring further investigation into the management of truncal acne vulgaris.
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Background: Lipophilic basidiomycetous yeasts of the Malassezia genus can cause various skin diseases, such as seborrheic dermatitis, pityriasis versicolor, folliculitis and atopic dermatitis, and even life-threatening fungemia in newborns and immunocompromised individuals. Routine mycological media used in clinical practice do not contain sufficient lipid ingredients required for the growth of Malassezia species. A recently developed medium, FastFung agar, is promising for culturing fastidious fungal species. Methods: In this study, we compared FastFung agar and mDixon agar for culturing Malassezia species from nasolabial fold and retroauricular specimens of 83 healthy individuals and 187 and 57 patients with acne vulgaris and seborrheic dermatitis, respectively. Results: Malassezia species were identified using conventional tests and matrix-assisted laser desorption/ionization mass spectrometry. In total, 96 of 654 samples (14.6%) contained Malassezia species. The total isolation rate was significantly higher in patients with seborrheic dermatitis (40.4%) than in healthy volunteers (21.7%; p < 0.05), and the rate of M. furfur isolation was significantly higher for patients with acne vulgaris (13.9%) and seborrheic dermatitis (24.6%) than for healthy individuals (1.5%; p < 0.05). FastFung agar was superior to mDixon agar in M. furfur isolation (p = 0.004) but showed similar performance in the case of non-M. furfur species (p > 0.05). Among cultured Malassezia species, perfect agreement between mDixon agar and FastFung agar was found only for M. globosa (κ = 0.90). Conclusion: Our results indicate that FastFung agar favors the growth of Malassezia species and should be useful in clinical mycology laboratories.
Article
During the Coronavirus disease 2019 (COVID‐19) pandemic, dermatologists are dealing with challenging clinical scenarios in their clinical practice. A wide range of cutaneous manifestations have been described, either directly associated with the COVID‐19, or as a consequence of management procedures, as well as an exacerbation of previous cutaneous conditions.
Article
Folliculitis is an inflammatory process involving the hair follicle, frequently attributed to infectious causes. Malassezia, an established symbiotic yeast that can evolve to a skin pathogen with opportunistic attributes, is a common source of folliculitis, especially when intrinsic (e.g. immunosuppression) or extrinsic (high ambient temperature and humidity, clothing) impact on the hair follicle and the overlying skin microenvironment. Our aim was to critically review the pathophysiology and clinical characteristics of Malassezia folliculitis, to describe laboratory methods that facilitate diagnosis and to systematically review treatment options. Malassezia folliculitis manifests as a pruritic, follicular papulopustular eruption distributed on the upper trunk. It commonly affects young to middle-aged adults and immunosuppressed individuals. Inclusion into the differential diagnosis of folliculitis is regularly oversighted and the prerequisite targeted diagnostic procedures are not always performed. Sampling by tape stripping or comedo extractor and microscopic examination of the sample usually identifies the monopolar budding yeast cells of Malassezia without presence of hyphae. However confirmation of the diagnosis with anatomical association with the hair follicle is performed by biopsy. For systematic review of therapies, Pubmed was searched using the search string "(malassezia"[MeSH Terms] OR "malassezia"[All Fields] OR pityrosporum [All Fields]) AND "folliculitis"[MeSH Terms]' and Embase was searched using the search string: 'malassezia folliculitis.mp OR pityrosporum folliculitis.mp'. In total 28 full-length studies were assessed for eligibility and 21 were selected for nclusion in therapy evaluation. Conclusively Malassezia folliculitis should be considered in the assessment of truncal, follicular skin lesions. Patient's history, comorbidities and clinical presentation are usually indicative, but microscopically and histological examination are needed to confirm the diagnosis. Adequate samples obtained with comedo extractor and serial sections in the histological material are critical for proper diagnosis. Therapy should include systemic or topical measures for the control of the inflammation, as well as the prevention of recurrences.
Chapter
Superficial fungal infections (SFIs) affect millions of people worldwide. The major causes of these infections include dermatophytes, non-dermatophyte molds (NDM), and yeasts. The etiological agents are restricted to stratum corneum. SFIs of importance include dermatophytosis, Malassezia associated infection, keratitis, and rare superficial fungal infection (tinea nigra and piedra). All the etiological agents have varied geographical distribution occurring in tropics where high humidity and hot climatic condition predominate. SFIs are also reported as epidemic infections in area of overcrowding and poor hygienic conditions. From the past two decades, the cases are increasingly being reported in patients undergoing transplants, chemotherapy and in immunocompromised patients. The epidemiology of SFIs in Asia is interesting as most of these regions have the climatic condition that supports the fungi to survive and proliferate.
Article
BACKGROUND: Clinical differentiation of folliculitis types is challenging. Dermoscopy supports the recognition of folliculitis etiology but its diagnostic accuracy is not known. OBJECTIVE: To assess the diagnostic accuracy of dermoscopy for folliculitis. METHODS: This observational study included patients (n=240) with folliculitis determined based on clinical and dermoscopic assessments. Dermoscopic image of the most representative lesion was acquired for each patient. Etiology was determined based on cytology, culture, histology, or manual hair removal (when ingrowing hair was detected) by Dermatologist A. Dermoscopic images were evaluated according to predefined diagnostic criteria by Dermatologist B blinded to the clinical findings. Dermoscopic and definitive diagnoses were compared by Dermatologist C. RESULTS: From 240 folliculitis lesions examined, 90% were infections and 10% were noninfectious. Infectious folliculitis was caused by parasites (n=71), fungi (n=81), bacteria (n=57), or 7 viruses (n=7). Noninfectious folliculitis included pseudofolliculitis (n=14), folliculitis decalvans (n=7), and eosinophilic folliculitis (n=3). The overall accuracy of dermoscopy was 73.7%. Dermoscopy showed good diagnostic accuracy for Demodex (88.1%), scabietic (89.7%), dermatophytic folliculitis (100%), and pseudofolliculitis (92.8%). LIMITATIONS: The diagnostic value of dermoscopy was calculated only for common folliculitis. Diagnostic reliability could not be calculated. CONCLUSION: Dermoscopy is a useful tool assisting the diagnosis of some forms of folliculitis.
Chapter
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Infectious folliculitis is not only caused by bacteria but also by viruses and parasites. If four different samples (KOH, May-Grünwald Giemsa, acid-fast staining, and Gram staining) are taken, all bacterial, fungal, and parasitic causes and viral cytopathic changes (intranuclear or intracytoplasmic inclusion bodies) can be detected. Numerous eosinophils without infectious agents are indicative of eosinophilic folliculitis. If the cytological examination is negative, biopsy, culture, and other molecular methods should be performed.
Article
The genus Malassezia comprises lipophilic species, the natural habitat of which is the skin of humans and other warm-blooded animals. However, these species have been associated with a diversity of dermatological disorders and even systemic infections. Pityriasis versicolor is the only cutaneous disease etiologically connected to Malassezia yeasts. In the other dermatoses, such as Malassezia folliculitis, seborrheic dermatitis, atopic dermatitis, and psoriasis, these yeasts have been suggested to play pathogenic roles either as direct agents of infection or as trigger factors because there is no evidence that the organisms invade the skin. Malassezia yeasts have been classified into at least 14 species, of which eight have been isolated from human skin, including Malassezia furfur, Malassezia pachydermatis, Malassezia sympodialis, Malassezia slooffiae, Malassezia globosa, Malassezia obtusa, Malassezia restricta, Malassezia dermatis, Malassezia japonica, and Malassezia yamatoensis. Distributions of Malassezia species in the healthy body and in skin diseases have been investigated using culture-based and molecular techniques, and variable results have been reported from different geographical regions. This article reviews and discusses the latest available data on the pathogenicity of Malassezia spp., their distributions in dermatological conditions and in healthy skin, discrepancies in the two methods of identification, and the susceptibility of Malassezia spp. to antifungals.
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Objective: It has been known that Malassezia spp. can play role in different dermatologic diseases. The aim of this study is to detect identification of Malassezia spp. species in folliculitis patients.
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Id reactions are a type of secondary inflammatory reaction that develops from a remote localized immunological insult. To date, id reactions caused by various fungal, bacterial, viral, and parasitic infections have been reported. Superficial fungal infections, especially tinea pedis, are the most common cause of id reactions. Id reactions exhibit multiple clinical presentations, including localized or widespread vesicular lesions, maculopapular or scarlatiniform eruptions, erythema nodosum, erythema multiforme, erythema annulare centrifugum, Sweet's syndrome, guttate psoriasis, and autoimmune bullous disease. The mechanisms underlying id reactions vary depending on the type of clinical presentation. The most important aspect of therapy involves the identification and adequate treatment of the underlying infection or dermatitis. This review comprehensively discusses the current state of the field concerning cutaneous id reactions, including diagnostic criteria, clinical presentations, underlying infectious conditions, etiologic agents, immunologic characteristics, histopathologic findings, and management strategies.
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So far, studies on the inter-relationship between Malassezia and Malassezia folliculitis have been rather scarce. We sought to analyze the differences in body sites, gender and age groups, and to determine whether there is a relationship between certain types of Malassezia species and Malassezia folliculitis. Specimens were taken from the forehead, cheek and chest of 60 patients with Malassezia folliculitis and from the normal skin of 60 age- and gender-matched healthy controls by 26S rDNA PCR-RFLP. M. restricta was dominant in the patients with Malassezia folliculitis (20.6%), while M. globosa was the most common species (26.7%) in the controls. The rate of identification was the highest in the teens for the patient group, whereas it was the highest in the thirties for the control group. M. globosa was the most predominant species on the chest with 13 cases (21.7%), and M. restricta was the most commonly identified species, with 17 (28.3%) and 12 (20%) cases on the forehead and cheek, respectively, for the patient group. Statistically significant differences were observed between the patient and control groups for the people in their teens and twenties, and in terms of the body site, on the forehead only.
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Comparative analysis of molecular sequence data is essential for reconstructing the evolutionary histories of species and inferring the nature and extent of selective forces shaping the evolution of genes and species. Here, we announce the release of Molecular Evolutionary Genetics Analysis version 5 (MEGA5), which is a user-friendly software for mining online databases, building sequence alignments and phylogenetic trees, and using methods of evolutionary bioinformatics in basic biology, biomedicine, and evolution. The newest addition in MEGA5 is a collection of maximum likelihood (ML) analyses for inferring evolutionary trees, selecting best-fit substitution models (nucleotide or amino acid), inferring ancestral states and sequences (along with probabilities), and estimating evolutionary rates site-by-site. In computer simulation analyses, ML tree inference algorithms in MEGA5 compared favorably with other software packages in terms of computational efficiency and the accuracy of the estimates of phylogenetic trees, substitution parameters, and rate variation among sites. The MEGA user interface has now been enhanced to be activity driven to make it easier for the use of both beginners and experienced scientists. This version of MEGA is intended for the Windows platform, and it has been configured for effective use on Mac OS X and Linux desktops. It is available free of charge from http://www.megasoftware.net.
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The Tzanck smear test is a simple, rapid, valuable, and cost-effective diagnostic method based on the investigation of characteristics of individual cells. In this method, materials are obtained by various techniques and then transferred to a glass slide. Slides can be stained with various dyes and then are examined under a light microscope. To date, cytology has mostly been used in the diagnosis of various erosive-vesiculobullous and nodular lesions, including many tumors. The sampling methods for Tzanck smears and the cytologic findings of a broad range of skin diseases that could provide a rapid diagnosis are described.
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Malassezia furfur was the first species described within the cosmopolitan yeast genus Malassezia, which now comprises 13 species. Reported isolation rates of these species from healthy and diseased human skin show geographic variations. PCR-fingerprinting with the wild-type phage M13 primer (5'-GAGGGTGGCGGTTCT-3') was applied to investigate phylogeographic associations of M. furfur strains isolated from Scandinavians residing permanently in Greece, in comparison to clinical isolates from Greek, Bulgarian and Chinese native residents. Seven M. furfur strains from Scandinavians were compared with the Neotype strain (CBS1878), CBS global collection strains (n=10) and clinical isolates from Greece (n=4), Bulgaria (n=15) and China (n=6). Scandinavian, Greek and Bulgarian M. furfur strains mostly formed distinct group clusters, providing initial evidence for an association with the host's geographical origin and with the underlying skin condition. These initial data address the hypothesis that M. furfur could be a eukaryotic candidate eligible for phylogeographic studies.
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A medium for the isolation and enumeration of Malassezia furfur is described. Incubation at 34 degrees C yielded geometric mean counts (in CFU per square centimeter) of 2.6 X 10(3) on the forehead, 8.5 X 10(2) on the cheek, and 9.6 X 10(3) on the back. These counts compared favorably with microscopic counts and greatly exceeded those obtained with previously described media.
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The genus Malassezia has been revised using morphology, ultrastructure, physiology and molecular biology. As a result the genus has been enlarged to include seven species comprising the three former taxa M. furfur, M. pachydermatis and M. sympodialis, and four new taxa M. globosa, M. obtusa, M. restricta and M. slooffiae. The descriptions of all the species include morphology of the colonies and of the cells, together with ultrastructural details. The physiological properties studied were the presence of catalase, the tolerance of 37 degrees C and the ability to utilize certain concentrations of Tween 20, 40, 60 and 80 as a source of lipid in a simple medium. Information is given for each of the taxa on mole% GC and also the rRNA sequence from the comparison previously described for the genus.
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This study demonstrated the application of internal transcribed spacer 1 (ITS1) ribosomal DNA sequences to the species identification and strain typing of 28 standard strains and 46 clinical isolates of the genus Malassezia. The size of ITS1 regions ranged from 162 to 266 bp. Members of the genus Malassezia (M. pachydermatis, M. furfur, M. sympodialis, M. globosa, M. obtusa, M. restricta and M. slooffiae) were classified into seven ITS1-homologous groups and 22 ITS1-identical, individual groups. The 46 clinical isolates of lipophilic Malassezia spp. were identified as belonging to just three ITS1-homologous groups, i.e., M. furfur (19 strains: 11 from pityriasis versicolor, 4 from seborrhoeic dermatitis and 4 from atopic dermatitis). M. sympodialis (22 strains: 7 from pityriasis versicolor, 3 from seborrhoeic dermatitis, 1 from atopic dermatitis and 11 from healthy controls) and M. slooffiae (five strains: three from chronic otitis media and two from healthy controls).
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The lipophilic yeast Malassezia globosa is one of the major constituents of the mycoflora of the skin of patients with atopic dermatitis (AD). We compared the genotypes of M. globosa colonizing the skin surface of 32 AD patients and 20 healthy individuals for polymorphism of the intergenic spacer (IGS) 1 region of the rRNA gene. Sequence analysis demonstrated that M. globosa was divided into four major groups, which corresponded to the sources of the samples, on the phylogenetic tree. Of the four groups, two were from AD patients and one was from healthy subjects. The remaining group included samples from both AD patients and healthy subjects. In addition, the IGS 1 region of M. globosa contained short sequence repeats: (CT)n, and (GT)n. The number of sequence repeats also differed between the IGS 1 of M. globosa from AD patients and that from healthy subjects. These findings suggest that a specific genotype of M. globosa may play a significant role in AD, although M. globosa commonly colonizes both AD patients and healthy subjects.
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Malassezia yeasts are associated with several dermatological disorders. The conventional identification of Malassezia species by phenotypic methods is complicated and time-consuming, and the results based on culture methods are difficult to interpret. A comparative molecular approach based on the use of three molecular techniques, namely, amplified fragment length polymorphism (AFLP) analysis, sequencing of the internal transcribed spacer, and sequencing of the D1 and D2 domains of the large-subunit ribosomal DNA region, was applied for the identification of Malassezia species. All species could be correctly identified by means of these methods. The results of AFLP analysis and sequencing were in complete agreement with each other. However, some discrepancies were noted when the molecular methods were compared with the phenotypic method of identification. Specific genotypes were distinguished within a collection of Malassezia furfur isolates from Canadian sources. AFLP analysis revealed significant geographical differences between the North American and European M. furfur strains.
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The expansion of the genus Malassezia has generated interest in the epidemiological investigation of the distribution of new species in a range of dermatoses, on which variable results have been reported from different geographical regions. No data are thus far available from South-east Europe (Greece). To study the distribution of Malassezia species in pityriasis versicolor (PV) and seborrhoeic dermatitis (SD) and to investigate whether polymorphisms in the internal transcribed spacer (ITS) 1 region facilitate detection of M. globosa and M. sympodialis subtypes. In total, 109 patients with PV and SD and positive Malassezia cultures were included in the study. Age, gender, primary/recurrent episode, disease extent and clinical form of PV were recorded. ITS 1 polymorphisms of M. globosa and M. sympodialis type and clinical strains were investigated by polymerase chain reaction (PCR)-single-strand conformational polymorphism (SSCP) analysis. Malassezia globosa was the prevalent species isolated from PV and SD either alone (77% and 39%, respectively) or in combination (13% and 18%, respectively) with other Malassezia species. The pigmented form of PV was strongly correlated with the female gender. PCR-SSCP differentiated five subgroups of M. globosa with one being associated with extensive clinical disease. All M. sympodialis isolates displayed a homogeneous ITS 1 PCR-SSCP profile. Malassezia species isolation rates were in agreement with those reported from South-west Europe. PCR-SSCP of the ITS 1 is useful for highlighting prospective clinical implications of M. globosa subtypes.
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The genus Malassezia has been revised using morphology, ultrastructure, physiology and molecular biology. As a result the genus has been enlarged to include seven species comprising the three former taxa M. furfur, M. pachydermatis and M. sympodialis, and four new taxa M. globosa, M. obtusa, M. restricta and M. slooffiae. The descriptions of all the species include morphology of the colonies and of the cells, together with ultrastructural details. The physiological properties studied were the presence of catalase, the tolerance of 37 degrees C and the ability to utilize certain concentrations of Tween 20, 40, 60 and 80 as a source of lipid in a simple medium. Information is given for each of the taxa on mole% GC and also the rRNA sequence from the comparison previously described for the genus.
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Folliculitis is a superficial inflammation of the hair follicles, and can be observed in individuals of any age or race. The incidence of folliculitis is unknown because most patients only consult a doctor in cases of increasing lesions. There are various infectious and non-infectious causes of folliculitis, and the most common causative agent is Staphylococcus aureus. In addition, several Gram-negative bacterial, fungal, parasitic, and viral pathogens can cause follicular papules and pustules. In routine practice, however, these lesions are usually thought to be bacterial. Therefore, topical and/or systemic antibacterial treatment is recommended, but this involves the risk of being misused for months or even years. Cytology, a simple, rapid, inexpensive, and repeatable diagnostic method, can reveal various bacterial, fungal, viral, and parasitic pathogens. This review discusses the use of clinical sampling and staining of cytologic samples for the differential diagnosis of folliculitis, cytologic findings, and the frequency with which dermatologists use cytology to diagnose folliculitis, particularly in the age of molecular biology and more expensive, sophisticated investigations.
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Members of the genus Malassezia have rarely been associated with lagomorphs. During the course of an investigation of the lipophilic mycobiota of rabbit skin, two lipid-dependent isolates which could not be identified were recovered on Leeming and Notman agar medium from different animals. No growth of Malassezia yeasts was obtained either on Sabouraud's glucose agar or modified Dixon agar media. In this study, we describe a new taxon, Malassezia cuniculi sp. nov., including its morphological and physiological characteristics. The validation of this new species was supported by analysis of the D1/D2 regions of the 26S rRNA gene and the ITS-5.8S rRNA gene sequences. The results of these studies confirm the separation of this new species from the other species of the genus Malassezia, as well as the presence of Malassezia yeasts on lagomorphs.
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Reported isolation rates of Malassezia yeast from human skin show geographic variations. In China, the populations of the Han (1,182.95 million) and Tibetan (5.41 million) ethnic groups are distributed over 9.6 and 3.27 million square kilometers respectively, making biodiversity research feasible and convenient. Malassezia furfur clinical strains (n = 29) isolated from different individuals, with or without associated dermatoses, of these two ethnic groups (15 Han and 12 Tibetan) were identified and analyzed with DNA fingerprinting using single primers specific to minisatellites. Using the Bionumerics software, we found that almost all M. furfur clinical isolates and type strains formed five distinct group clusters according to their associated skin diseases and the ethnic groups of the patients. These findings are the first to focus on the genetic diversity and relatedness of M. furfur in the Tibetan and Han ethnic groups in China and reveal genetic variation associated with related diseases, host ethnicity and geographic origin.
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Although the lipophilic yeasts of the genus Malassezia are part of the cutaneous microbiota in healthy individuals, they are also associated with several skin diseases, such as seborrheic dermatitis. However, the effects of age and gender on the Malassezia microbiota have not been completely elucidated. We analyzed the cutaneous Malassezia microbiota of 770 healthy Japanese using the highly accurate real-time PCR with a TaqMan probe to investigate the effects of age and gender on the Malassezia population. The numbers of Malassezia cells increased in males up to 16-18 years of age and in females to 10-12 years old, and subsequently decreased gradually in both genders until senescence. Malassezia restricta overwhelmingly predominated at ages over 16-18 years in males and 23-29 years in females. M. globosa and M. restricta together accounted for more than 70% of Malassezia spp. recovered regardless of gender. The total colonization of Malassezia and the ratio of the two major species change with age and gender in humans.
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The recent sequencing of the whole genome of Malassezia globosa and M. restricta forms the basis for molecular epidemiology studies and instigates investigations into their respective virulence factors. Thus, reviewing current knowledge on Malassezia molecular typing methods would reveal the pros and cons of each method and would highlight potential scarcity of epidemiological data regarding this ubiquitous fungal commensal and pathogen. Methods employed for Malassezia molecular typing can be categorized into those detecting sequence variations of strains and those that selectively amplify polymorphic DNA markers for discriminating Malassezia species subtypes. The former exploit rRNA gene sequence variations in order to trace M. globosa, M. restricta and M.pachydermatis subtypes associated with specific skin diseases, or detect M. furfur geographical variations. Polymorphic DNA amplification methods, such as amplified fragment length polymorphism analysis, demonstrated association of M. furfur subtypes with the origin of the strain (skin or systemic isolate), whereas PCR-fingerprinting of the mini-satellite DNA clustered M. furfur strains according to their geographic origin and disease origin. Moreover, much typing work has already been performed regarding the zoophilic species M. pachydermatis and the relevant methods can be adapted for studying the anthropophilic Malassezia species. In the near future, molecular typing will be a powerful tool in epidemiological studies that could be employed for the elucidation of the pathobiology of Malassezia species in associated skin diseases
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Malassezia folliculitis [MF] is caused by the invasion of hair follicles by large numbers of Malassezia cells, but it remains unclear which Malassezia species are involved in the disease. To clarify this situation, Malassezia species isolated from lesions of MF patients were analyzed by both culture and non-culture methods. In addition, Malassezia species recovered from the non-lesion areas of the skin of MF patients and skin samples of healthy subjects were included in this study. The test population consisted of 32 MF patients and 40 healthy individuals. The lesions were obtained using a comedone extractor, while swabs were employed to obtain skin samples from non-lesion areas of the patients and healthy subjects. Malassezia DNA was analyzed using a real-time PCR technique. The detection limit of the culture method was 5 CFU/cm(2) as opposes 50 cells/cm(2) with non-culture procedures. The predominant species recovered from MF lesions were M. globosa and M. sympodialis by culture method analysis, and M. restricta, M. globosa, and M. sympodialis with non-culture methods. These results were in agreement with those found with samples from non-lesion skin areas of MF patients and healthy subjects. This study clarified that MF is caused by Malassezia species that are part of the cutaneous microflora and not by exogenous species.
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Sixty-eight typical cases were studied to define the course of Pityrosporum folliculitis in a tropical setting. Contrary to reports in the literature, we found Pityrosporum folliculitis to be polymorphic. The "molluscoid" comedopapule was the most characteristic and common lesion, and it yielded consistently high spore counts. The face was commonly involved. To establish the diagnosis, we used direct microscopy of potassium hydroxide/Parker blue-black ink mounts of the lower poles of comedonal plugs. Pityrosporum folliculitis is common in the Philippines, although our adult controls had a low incidence of skin carriage of Pityrosporum orbiculare on the face compared with those reported in the West. Pityrosporum folliculitis coexisted with acne vulgaris in 56% of patients, and the addition of antimycotics to the acne regimen produced dramatic clearing of lesions.
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The MICs of ketoconazole and itraconazole against Pityrosporum orbiculare were 0.02 to 0.05 and 0.1 to 0.2 micrograms ml-1, respectively. In a rabbit model, orally administered ketoconazole (1 mg kg-1) afforded protection against experimental pityriasis (tinea) versicolor in all animals. Itraconazole (5 mg kg-1) was effective in four of five rabbits.
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Twenty-two male and 20 female adults with Down's syndrome were examined. Ten of the men and two of the women had a follicular rash consistent with Malassezia folliculitis. Oral itraconazole treatment produced a significant improvement in the rash, accompanied by a decrease in the skin Malassezia count. Clinical relapse occurred when therapy was discontinued, and was accompanied by return of the Malassezia yeasts.
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Pityrosporum folliculitis (PF) is frequently misdiagnosed as acne vulgaris, resulting in unnecessary and prolonged treatment. Sixty-two patients with PF seen in the Dermatology Clinic, King Gahad Hofuf Hospital, Saudi Arabia were evaluated clinically. The diagnosis was confirmed by routine histology with haemotoxylineosin staining and Periodic acid-Schiff staining. Scrapings of the lesions, especially the molluscum-like papules, were mounted in KOH/Parker blue ink and examined under the microscope. Patients, divided into three groups as follows, were given treatment for 4 weeks: (1) 20 were treated with ketoconazole, 200 mg orally in addition to ketoconazole shampoo 2% daily; (2) 20 were given only ketoconazole, 200 mg daily, orally; (3) 12 used econazole nitrate 1% solution applied twice daily; and (4) 10 used miconazole nitrate 2% cream twice daily. Cases in groups 3 and 4, who did not respond, were given the same treatment as for group 1. All who responded were kept on ketoconazole shampoo 2% twice weekly. PF was commoner in young adult females as the female to male ratio was 2:1 while the mean age was 21.5 years. The most common site involved was the trunk (95%) in the form of papules, pustules and molluscoid lesions. The latter type of lesion yielded the highest number of spores using KOH/Parker blue ink. Biopsy was positive in 87% of the patients but is usually not necessary. Combined topical and systemic ketoconazole produced clearance of the lesions in 20 patients (100%), while systemic therapy only resulted in 75% clearance (15 of 20). Topical econazole and miconazole failed in 20 of 22 (90%) and improved only two patients. There were no significant side-effects from the drugs.
Article
The predominant itchy folliculitis associated with human immunodeficiency virus (HIV) infection appears to be an eosinophilic folliculitis (EF). This is characterized by lytic degeneration of sebaceous glands and an inflammatory infiltrate in which eosinophils and CD8+ T lymphocytes predominate. All patients have low CD4 counts and present late on in their HIV disease. Lesional distribution is mainly truncal, with a significant proportion also having facial involvement. Our prospective survey has shown that it is impossible to differentiate clinically between infective folliculitis and EF, and we recommend therefore that all cases are biopsied. We review the clinicopathological and immunological aspects of HIV-associated itchy folliculitis, in particular HIV-associated EF as well as current theories on pathogenesis and treatment. We suggest that HIV-associated EF is an autoimmune disease with the sebocyte or some constituent of sebum acting as the autoantigen.
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Orthotopic heart transplant recipients need immunosuppressive treatment and are at an increased risk for opportunistic infections such as Malassezia folliculitis. During a 4-month period (July to October 1990), 11 such cases were identified and treated; all were male with mean age of 43+/-9 years and on standard triple immunosuppressive therapy. Skin scrapings in potassium hydroxide (KOH) preparation with microscopy and/or culture identified either Malassezia furfur or Malassezia pachydermatis as the etiologic agent. A treatment with topical preparation (clotrimazole 1% and selenium sulfide lotion) was effective in 6 patients, whereas the rest received systemic fluconazole treatment with satisfactory outcome; all lesions were resolved within 3 weeks. Fluconazole appears to be an effective agent with excellent therapeutic outcome when administered for 3 weeks.
Article
Early detection of fungal infection is essential for beginning of prompt and specific therapy. In this study we describe a rapid and sensitive procedure to detect, by polymerase chain reaction (PCR) assays, a wide range of medically important opportunistic and pathogenic fungi in dermal specimens from dermatomycoses-affected patients. Three primer pairs, amplifying fragments of the highly conserved gene coding for small ribosomal RNA (18S rDNA) and the adjacent internal transcribed spacer (ITS) rDNA, previously published by others, were probed on DNA from pure cultures of medically relevant human and animal fungal species. In order to evaluate the specificity of the assay, amplifications of control DNAs from other eukaryotes and prokaryotes were also carried out, and they gave negative results. These primer sets, in single amplification or double-rounded PCR assays, allowed specific amplification when applied to a wide number of fungal DNA from human and animal tissue specimens, including dermatophytes (genera Trichophyton, Microsporum), several yeast species (Candida, Saccharomyces, Cryptococcus, Malassezia) and moulds (Aspergillus, Penicillium). The PCR assay was able to detect as little as 10 pg of fungal DNA, corresponding to approximately 25 fungal genomes per sample specimen. A small-scale DNA extraction method was also developed. This simple, time-saving and sensitive procedure was successfully applied to 40 human and veterinary specimens, and the diagnosis was confirmed with cultural techniques, being shown to work even in the presence of other lesions or contaminating organisms. This method allows early recognition of fungal pathogen cells in clinical samples as an alternative tool to conventional detection techniques.
Article
Quantitative cultures were obtained using contact plates to determine whether the quantity and composition of Malassezia species at a given anatomic site in normal individuals differs from that of patients with various cutaneous dermatoses. The sample included 20 clinically healthy individuals (without any dermatosis) and 110 patients with dermatoses (including 31 with atopic dermatitis [AD], 28 with psoriasis [PS], 28 with seborrheic dermatitis [SD] and 23 with pityriasis versicolor [PV]). Contact plates filled with special culture medium were used to obtain a quantitative culture from five body sites (scalp, forehead, arm, trunk and leg) of every individual. The number of cfu were recorded for every plate that grew Malassezia yeasts, and 3-5 colonies were isolated for identification to species level using microscopic, physiological and molecular characteristics. The mean cfu counts observed among patients with AD, PS and SD was significantly lower than normal control subjects (P < 0.05). The mean cfu counts from PV patients was not different from that of healthy control subjects. Overall, for all conditions considered together, the mean cfu counts in lesional sites were significantly lower than in non-lesional sites (P <0.05). Furthermore, the mean cfu counts from lesional sites in patients with AD and PS were significantly lower than the corresponding value in patients with PV (P <0.05). Six Malassezia species were recovered from the different dermatoses. Malassezia sympodialis was the most common species associated with AD and PV patients and healthy control subjects, while M. globosa was most frequently isolated from PS and SD patients. More than one Malassezia species was recovered at any given anatomic site from both controls as well as individuals with dermatoses. M. globosa was equally likely to be recovered from scalp, forehead and trunk, but less likely to derive from arms and legs. M. restricta and M. slooffiae were recovered more frequently from the upper body (scalp and forehead) than from the lower body. Among normal individuals and for patients with AD and PV, M. sympodialis was significantly more likely to affect the forehead than the legs.
Article
The yeasts of the genus Malassezia have been associated with a number of diseases affecting the human skin, such as pityriasis versicolor, Malassezia (Pityrosporum) folliculitis, seborrheic dermatitis and dandruff, atopic dermatitis, psoriasis, and--less commonly--with other dermatologic disorders such as confluent and reticulated papillomatosis, onychomycosis, and transient acantholytic dermatosis. Although Malassezia yeasts are a part of the normal microflora, under certain conditions they can cause superficial skin infection. The study of the clinical role of Malassezia species has been surrounded by controversy because of their fastidious nature in vitro, and relative difficulty in isolation, cultivation, and identification. Many studies have been published in the past few years after the taxonomic revision carried out in 1996 in which 7 species were recognized. Two new species have been recently described, one of which has been isolated from patients with atopic dermatitis. This review focuses on the clinical, mycologic, and immunologic aspects of the various skin diseases associated with Malassezia. It also highlights the importance of individual Malassezia species in the different dermatologic disorders related to these yeasts.
Pityrosporum folliculitis is a common inflammatory skin disorder that may mimic acne vulgaris. Some adolescents with recalcitrant follicular pustules or papules may have acne and Pityrosporum folliculitis simultaneously. Clinical response is dependent on treating both conditions. To demonstrate the similarity in clinical manifestation between acne vulgaris and Pityrosporum folliculitis, the benefit of potassium hydroxide preparation, and the benefit of appropriate antifungal therapy. We describe 6 female adolescents with concurrent Pityrosporum folliculitis infection and acne vulgaris. A potassium hydroxide examination was performed on all 6 patients from the exudate of follicular pustules exhibiting spores consistent with yeast. All patients were treated with oral antifungals, and 5 of the 6 patients were also treated with topical antifungals. Six of 6 patients improved with antifungal treatment. All patients also required some ongoing therapy for their acne. These patients demonstrate that follicular papulopustular inflammation of the face, back, and chest may be due to a combination of acne vulgaris and Pityrosporum folliculitis, a common yet less frequently identified disorder. Symptoms often wax and wane depending on the patient's activities, time of the year, current treatment regimens, and other factors. Pityrosporum folliculitis will often worsen with traditional acne therapy and dramatically respond to antifungal therapy.
Article
The human and animal pathogenic yeast genus Malassezia has received considerable attention in recent years from dermatologists, other clinicians, veterinarians and mycologists. Some points highlighted in this review include recent advances in the technological developments related to detection, identification, and classification of Malassezia species. The clinical association of Malassezia species with a number of mammalian dermatological diseases including dandruff, seborrhoeic dermatitis, pityriasis versicolor, psoriasis, folliculitis and otitis is also discussed.
Article
We quantified the cutaneous Malassezia in patients with atopic dermatitis using a real-time PCR assay. Seven to 12 times more Malassezia colonized the head and neck compared to the trunk or limbs, and the species M. globosa and M. restricta accounted for approximately 80% of all Malassezia colonization at any body site.
Article
Malassezia species colonize the skin of normal and various pathological conditions including pityriasis versicolor (PV), seborrhoeic dermatitis (SD) and atopic dermatitis (AD). To elucidate the pathogenic role of Malassezia species in SD, Malassezia microflora of 31 Japanese SD patients was analyzed using a PCR-based, culture-independent method. Nested PCR assay using the primers in the rRNA gene indicated that the major Malassezia species in SD were M. globosa and M. restricta, found in 93 and 74% of the patients, respectively. The detection rate and number of each species varied similarly in SD, PV and healthy subjects (HSs), whereas AD showed higher values. Real-time PCR assay showed that the lesional skin harbored approximately three times the population of genus Malassezia found in nonlesional skin (P<0.05), and that M. restricta is a significantly more common species than M. globosa in SD (P<0.005). Genotypic analysis of the rRNA gene showed that the M. globosa and M. restricta from SD patients fell into specific clusters, and could be distinguished from those collected from HSs, but not from those colleted from AD patients. Our results indicate that certain strains of M. restricta occur in the lesional skin of SD patients.
Article
Superficial Malassezia folliculitis was diagnosed in 1-1.5% of all dermatology patients seen in a Dermatology Out-Patient clinic in Urumqi City, Xinjiang province, west China. It was most prevalent in healthy, middle-aged males in the warm seasons. This disease, first reported in 1969, is usually diagnosed as a systemic disease of immuno-compromised patients. Our findings indicate it is a relatively common superficial skin disease that can be managed with ketoconazole or itraconazole.
Article
This is a case of seborrheic dermatitis (SD) barbae from which Malassezia furfur (M. furfur) was isolated. The patient was a 57-year-old Dutch male, who was hospitalized for fever and weakness of extremities. He presented with symmetrical erythema with an abundance of greasy chaffy scales on his beard area. No reasons were detected for his fever following a routine search. M. furfur was identified through mycological examination, including direct microscopic examination, culture, Tween test, esculine splitting test and DNA sequencing, of samples from the skin lesions. The patient was treated with oral itraconazole capsules (200 mg, b.i.d. for 8 days, then 200 mg o.d. for 13 days), washing his scalp and face with 2% ketoconazole shampoo (once a day) and topical application of a cream containing 1% naftifine hydrochloride and 0.25% ketoconazole (b.i.d.). After treatment the fever subsided and the SD lesion gradually healed. M. furfur was not isolated again from skin scrapings and 7 days later therapy was terminated and no recurrence was noted after one week follow-up since the cessation of treatment.
and parasitic causes of folliculitis (Durdu and Ilkit, 2013) Our study revealed that the positivity of MGG-stained smears was higher (100%) than that of KOH-stained smears (81.6%). Moreover, the MGG-stained smears revealed several different features compared with the KOH smears (Fig
  • Additionally
Additionally, cytology can also reveal other bacterial, fungal, viral, and parasitic causes of folliculitis (Durdu and Ilkit, 2013). Our study revealed that the positivity of MGG-stained smears was higher (100%) than that of KOH-stained smears (81.6%). Moreover, the MGG-stained smears revealed several different features compared with the KOH smears (Fig. 3A–F;
6%) of our MF patients had been previously misdiagnosed and treated with antibiotics or oral isotretinoin. Another 3 patients had been misdiagnosed with pruritus and eczema and treated unnecessarily with steroid creams
  • Clinically
  • Mf
Clinically, MF can mimic bacterial folliculitis and acne vulgaris. Thus, 15 (30.6%) of our MF patients had been previously misdiagnosed and treated with antibiotics or oral isotretinoin. Another 3 patients had been misdiagnosed with pruritus and eczema and treated unnecessarily with steroid creams (Fig. 1E).
To diagnose MF routinely in a dermatology practice, a sample is usually taken for KOH staining (Durdu and Ilkit, 2013) A cytological examination can also be undertaken with MGG-, Papanicolaou-, Giemsa-, or methylene blue– stained smears. MGG is a simple, reliable, rapid
  • Fearfield
Similar cases of pruritic folliculitis have been reported (Fearfield et al., 1999; Helm and Lookingbill, 1993). To diagnose MF routinely in a dermatology practice, a sample is usually taken for KOH staining (Durdu and Ilkit, 2013). A cytological examination can also be undertaken with MGG-, Papanicolaou-, Giemsa-, or methylene blue– stained smears. MGG is a simple, reliable, rapid (20–25 seconds), and inexpensive ($1 per test) method (Durdu et al., 2011).
Seborrheic dermatitidis flare in a Dutch male due to commensal Malassezia furfur overgrowth
  • Y Ran
  • X He
  • H Zhang
Ran Y, He X, Zhang H, et al. Seborrheic dermatitidis flare in a Dutch male due to commensal Malassezia furfur overgrowth. Med Mycol 2008;46:611–4.