Molecular Analysis of Malassezia Microflora on the Skin of the Patients with Atopic Dermatitis

BACKGROUND: The yeasts of the genus Malassezia are members of the normal flora on human skin and they are found in 75~80% of healthy adults. Since its association with various skin disorders have been known, there have been a growing number of reports that have implicated Malassezia yeast in atopic dermatitis (AD). OBJECTIVE: The aim of the present study is to isolate the various Malassezia species from AD patients by using 26S rDNA (ribosomal Deoxyribonucleic acid) PCR-RFLP and to investigate the relationship between a positive Malassezia culture and the severity of AD. METHODS: Cultures for Malassezia yeasts were taken from the scalp, cheek, chest, arm and thigh of 60 patients with atopic dermatitis. We used a rapid and accurate molecular biological method 26S rDNA PCR-RFLP, and this method can overcome the limits of the morphological and biochemical methods. RESULTS: Positive Malassezia growth was noted on 51.7% of the patients with atopic dermatitis by 26S rDNA PCR-RFLP analysis. The overall dominant species was M. sympodialis (16.3%). M. restricta was the most common species on the scalp (30.0%) and cheek (16.7%). M. sympodialis (28.3%) was the most common species on the chest. The positive culture rate was the highest for the 11~20 age group (59.0%) and the scalp showed the highest rate at 66.7%. There was no significant relationship between the Malassezia species and SCORing for Atopic Dermatitis (SCORAD). CONCLUSION: The fact that the cultured species was different for the atopic dermatitis lesion skin from that of the normal skin may be due to the disrupted skin barrier function and sensitization of the organism induced by scratching in the AD lesion-skin. But there was no relationship between the Malassezia type and the severity score. The severity score is thought to depend not on the type, but also on the quantity of the yeast.

The Investigation on the Distribution of Malassezia Yeasts on the Normal Korean Skin by 26S rDNA PCR-RFLP

BACKGROUND: Malassezia yeasts are normal flora of the skin that are discovered in 75~98% of health subjects, but since its association with various skin disorders have been known, many studies have been conducted in the distribution of the yeasts. OBJECTIVE: To isolate, identify, and classify Malassezia yeasts from the normal human skin of Koreans by using the rapid and accurate molecular biology method (26S rDNA PCR-RFLP) which overcome the limits of morphological and biochemical methods, and to gather a basic database that will show its relation to various skin diseases. METHODS: Malassezia yeasts were cultured from clinically healthy human skin using scrub-wash technique at five sites (forehead, cheek, chest, upper arm, and thigh) and swabbing technique at scalp in 160 participants comprised of 80 males and 80 females aged from 0 to 80. Identification of obtained strains were placed into the one of the 11 species by 26S rDNA PCR-RFLP. RESULTS: An overall positive culture rate was 62.4% (599/960). As shown in the experiment groups by their age, the positive culture rate was the highest (74.2%) in the age 21~30 and 31~40 (89/120). In the experiment groups by different body areas, the scalp showed the highest positive culture rate of 90% (144/160). On analysis of 26S rDNA PCR-RFLP, M. globosa was the most predominant species in the age 0~10 (32.8%), 11~20 (28.9%), 21~30 (32.3%). M. restricta was identified as predominant species in the age 41~50 (27.9%), 61~70 (31.5%) and 71~80 (24.0%). In the age 31~40 years, M. sympodialis was found to be the most common species (24.6%). According to body site, M. restricta was more frequently recovered in the scalp (56.8%), forehead (39.8%) and cheek (24.0%) and while M. globosa was more frequently recovered in the chest (36.8%). Higher positive culture rates of Malassezia yeasts were shown in male subjects than female counterparts in all body areas except scalp (p<0.05). Especially in this study, M. dermatis, newly isolated Malassezia species from atopic dermatitis patient in Japan, was isolated and identified in 19 cases (1.9%) in healthy subjects. CONCLUSION: The key is to recognize the existence of a difference in the type of Malassezia species in different ages as well as body areas, which reflects differing skin lipid levels in various ages and different body areas. Moreover, 26S rDNA PCR-RFLP analysis which was opted in this study could provide a sensitive and rapid identification system for Malassezia species, which may be applied to epidemiological surveys and clinical practice.

A Case of Generalized Syringoma Misdiagnosed as Verruca Plana / 대한피부과학회지

Generalized syringoma is a rare variant of syringoma, whose incidence peaks during childhood and adolescence, with no difference seen in either sex. It frequently affects the chest, neck, abdomen and axilla, and occasionally shows spontaneous regression. A 34-year-old woman presented with pruritic, multiple, 1~3 mm sized, lightbrownish papules on the chest, abdomen, and back. One year before, she had been diagnosed as having verruca plana at a private dermatologic clinic and had received immunotherapy, but experienced disappointing results. Histologically, the disorder showed numerous dilated eccrine ducts lined by two rows of epithelial cells. We herein report a case of generalized syringoma misdiagnosed as verruca plana, plus a review of the literature.

A Case of Localized Scleroderma Treated with Low-dose UVA1 Phototherapy / 대한피부과학회지

Localized scleroderma is a form of connective tissue disease in which the normally soft-textured surface of the skin hardens due to deposition of collagen within the dermis. Recently, UVA1 phototherapy with shorter wavelength in the UVA2 region has been shown to have excellent effect in the treatment of scleroderma, including systemic sclerosis. Here, we report a case of a 57 year-old female with linear scleroderma and manifestation of Raynaud's phenomenon who showed marked improvement after 13 sessions of whole body therapy with low dose UVA1. Ultrasound scanning and skin elasticity measurement were taken to evaluate therapeutic effectiveness of UVA1 phototherapy.

A Case of the Autoimmune Progesterone Dermatitis / 대한피부과학회지

Autoimmune progesterone dermatitis is a rare cyclic premenstrual reaction to a variety of progesterone produced during the luteal phase of a woman's menstrual cycle, including urticaria, urticarial papule, papulovesicle, eczematous lesion, erythema multiforme, and progesterone-induced anaphylaxis. A 23-year-old woman presented with brown colored hyperpigmented reticular patches on the chest and abdomen. Since the age of 20, she had been recurrently suffering from pruritic eruption that appeared regularly 5 to 10 days prior to menstruation and persisted for several days. Intradermal skin test reaction to progesterone was positive. These features were consistent with the diagnosis of autoimmune progesterone dermatitis.

The Effect of Intense Pulsed Light Treatment on the Vascular lesions / 대한피부과학회지

BACKGROUND: The intense pulsed light (IPL) system is a high-intensity pulsed light source which emits noncoherent, defocused, polychromatic light is a broad wavelength spectrum of 400-1200 nm. The mechanism of action of the light system corresponds to selective photothermolysis. Nowaday, the IPL system is widely used in the dermatologic field for the removal of unwanted hairs, epidermal melanocytic lesions, vascular lesions, and for photorejuvenation. OBJECTIVE: The purpose of this study was to evaluate the clinical results of diverse vascular lesions after treatment with an IPL source. METHOD: Forty Asian patients with vascular lesions were enlisted. The IPL treatment was administered to patients in 4-week sessions. Irradiation wavelength was controlled using cutoff filters ranging from 555 to 950 nm, with a fluence of 15-16J/cm2 (except forehead and zygomatic arch area), with single pulse illumination and a pulse width of 7 msec. RESULTS: At the end of the study, three physicians assessed the results and concluded that 72.5 % of the patients showed excellent or good results from the treatment. However, no difference was observed in 62.5 % of the patients after treatments. Furthermore, no specific adverse effects, except two cases of purpura and crust, were observed after the treatment. CONCLUSION: The treatment of vascular lesions on Asian skin using IPL is an effective, safe, and rapid treatment, with relatively few side effects and high patient satisfaction.

The Distribution of Malassezia Yeasts on the Earwax of Young Adults / 대한피부과학회지

No abstract available.

A Clinical and Mycological Study of Dermatophytosis Associated with Animal Contact / 대한의진균학회지

BACKGROUND: Dematophytes are classified into geophilic, zoophilic and anthrophilic fungi, based on their ecological traits. Zoophilic dermatophytosis primarily is responsible for infection in animals, and the inflammatory reaction often tends to be more severe than skin lesions inflicted by anthrophilic species. For the clinical manifestation of superficial dermatophytosis caused by these zoophilic dermatophyte are highly variable, a through review of history about the contact with these animals is often solicited. OBJECTIVE: The purpose of this study is to evaluate clinical and epidemiological zoophilic dermatophytosis associated with animal contact, in an effort to elucidate the link between the causative organism and the route of infection. METHOD: We performed clinical and mycological study on 63 cases of dermatophytosis associated with prior animal contact at the department of dermatology, Konkuk University Hospital from September 2004 to August 2005. RESULT: The ratio of male to female patient was 1: 1.17 and showed more prevalence in female. The age distribution of patients was highest in the age group of 10 years (22.2%). The exposed area (71.4%) was more frequently affected than unexposed area (28.6%) and the most common site was face and forearm. Single lesions were 41 cases (65.1%). Dogs, cats, and rabbits were the most common culprits in animal contact-associated dermatophytosis, each comprising 19, 15, and 10 respectively, of total cases. Hamsters, Guinea pigs, miniature pigs, and miscellaneous (cattles and birds) were among other causative animals. Twenty nine patients with dermatophytosis had accompanying diseases. In the age group of under 10 years old, 6 patients were being treated with atopic dermatitis; in the age group of under 40 yrs, 15 were being treated with diabetes, and 3 with pulmonary tuberculosis, and 1 with rheumatoid arthritis. These evidences support the fact that underlying conditions renders patients susceptible to opportunistic infections. In all age groups, M. canis and T. mentagraphytes var. mentagraphytes were the most predominant species, with most of them in the age groups of teens and twenties. In patients who had contact with dogs, M. canis was recovered in 8 cases, T. mentagraphytes var. mentagraphytes in 7 and M. gypseum in 3. In those patients who had contact with cats, M. canis was found in 6, and T. mentagraphytes var. mentagraphytes in 3, M. gypseum in 2, and T. verrucosum in 1 case. In those who had contact with hamsters, 2 cases each of M. canis, T. mentagraphytes var. mentagraphytes, and M. gypseum were recovered. CONCLUSION: As evidenced above, contact with specific animals play an important role in the pathogenesis of dermatomycosis. As the leisure and recreational activities of people become more diverse and more extensive, and as the influx of exotic domestic animals increases, and frequent contact with people from abroad makes the manifestation of this disease more complex, it would be wise for us to strive to come up with an effective strategy for prevention and epidemiological studies.

A Case of Panniculitis Following Mesotherapy / 대한피부과학회지

Mesotherapy was first introduced in France by Pistor in 1952. This is a widely used technique of intradermal or subcutaneous microinjections of a highly diluted drug, or cocktail of drugs. The use of mesotherapy is commonplace in medicine, especially in painful disorders of the locomotory apparatus. The technique has also been employed in cutaneous affections and esthetical conditions such as keloids and hypertrophic scars, acne, psoriasis, vitiligo, wrinkles, alopecia areata and hair loss, cellulitis, lipodystrophy, obesity, telangiectasias, lymphedemas, peripheral vascular diseases, and leg ulcers. A 24-year-old woman presented with painful eczematous subcutaneous nodules located at the points where mesotherapy had been applied. Histologically, it showed panniculitis with acute inflammation, aggregation of neutrophils, and fat necrosis. We report an unusual case of panniculitis after mesotherapy.

A Clinical and Mycological Study of Tinea Faciale / 대한의진균학회지

BACKGROUND: Tinea faciale is a dermatophyte infection of glabrous skin of the face except bearded areas of the adult male. Tinea faciale usually has been classified as tinea corporis but recently recognized as a separate disease entity. OBJECTIVE: The purpose of this study is to evaluate the correlation of clinical and mycological features of tinea faciale. METHODS: We performed clinical and mycological study on 46 cases of tinea faciale at the department of dermatology, Konkuk University Hospital from September 2001 to August 2004. RESULTS & CONCLUSIONS: 1. The age distribution of patients was highest in the age group of 10 years or under (34.8%). The ratio of male to female patient was 1: 1.4. The seasonal distribution of patients was highest in autumn. 2. Among 46 cases, dermatophytes were isolated in 37 cases. They were Trichophyton (T.) rubrum (19 cases), Microsporum (M.) canis (9 cases), T. mentagrophytes (6 cases), M. gypseum (2 cases), and Epidermophyton (E.) floccosum (1 case). 3. Although there was no notable discrepancies among the age groups, in both T. rubrum and T. mentagrophytes. M. canis was found to be more frequent as the main causative organism in the age group of 10 years or under. According to seasonal variation, there were no significant differences among T. rubrum species. M. canis was seen more frequently during winter season, and T. mentagrophytes in spring. 4. There were no significant difference in clinical variations of tinea faciale according to the type of dermatophytes. Coexisting fungal infections were found in 10 patients and tinia corporis was most frequently.

The Quantitative Study on the Distribution of Malassezia Yeasts on the Normal Skin of the Young Adults / 대한의진균학회지

BACKGROUND: The yeasts of genus Malassezia are dimorphic and lipophilic and are numbers of the normal flora in humans. Malassezia yeasts are implicated in various diseases, including pityriasis versicolor, Malassezia folliculitis, seborrheic dermatitis and the systemic fungal infections. OBJECTIVE: The study was done to perform a comprehensive survey of the distribution of Malassezia yeasts on the normal human skin to provide a baseline for a companion study of Malassezia yeasts in patients with various dermatoses. METHODS: Malassezia yeasts were cultured from the clinically normal skin using the scrub-wash technique at four sites in sixty subjects, age range, 11~40 years. Malassezia yeasts were also cultured from the scalp of the same groups using the swabbing technique. The obtained strains were placed into the one of the seven species by their colony morphologies, microscopic morphologies and physiological characteristics. We also examined the relationship between the Malassezia species, age groups and the body sites. RESULTS: An overall positive culture rate was 75% (225/300). A positive culture rate was highest (88%) in the age groups 21~25 and 26~30 and lowest (50%) in the age group 11~15. M. restricta was recovered more frequently from the age groups 21~25 (62%), 26~30 (66%), and 31~35 (54%) and interestingly lowest in the age group 11~15 (40%). In the age group 16~20, M. globosa was the predominant species (42%). For the various age groups, body sites were more related with the kind of Malassezia yeasts and the recovery rate. A positive culture rate was highest from the chest (91%) and lowest from the thigh (60%). From the chest, M. globosa (44%) and M. restricta (35%) was recovered more frequently; from the forehead, M. restricta (75%). CONCLUSION: This study shows that Malassezia yeasts are a major component of the microbial flora of the clinically normal skin of the young adults. The kind of Malassezia species that can be recovered from the human skin varies with the age and the body site. The results of our study replicate and expand on the finding of some of the earliest studies and would be of value to investigate the role of Malassezia yeast in the related diseases.