In vitro sensitivity of Malassezia furfur isolates from HIV-positive and negative patients to antifungal agents / Sensibilidad in vitro a antifúngicos de aislamientos de Malassezia furfur de pacientes positivos y negativos para HIV

Introduction. Malassezia is a lipophilic and lipid-dependent yeast genus belonging to the skin microbiota of humans and other animals. However, due to dysbiosis processes or other factors in the host, this yeast can cause different pathologies, ranging from skin diseases, such as seborrheic dermatitis, to fungemia. Isolation of Malassezia furfur has been reported in HIV-positive patients with or without skin lesions. Due to its opportunistic nature and its variable resistance to antifungal compounds, it is relevant to know the Malassezia sensitivity profiles. Objective. To determine the sensitivity to different antifungal agents, of clinical isolates of M. furfur obtained from HIV-positive or negative patients, with or without seborrheic dermatitis. Materials and methods. Assessment of isolates sensitivity to itraconazole, voriconazole, fluconazole, and amphotericin B was performed by two techniques: (1) Broth microdilution using Clinical and Laboratory Standards Institute (CLSI) protocol M27-A3 with modifications; and (2) agar tests using Etest®. Results. Isolates obtained from HIV patients showed an increase in the minimum inhibitory concentration of fluconazole, voriconazole, and amphotericin B, compared with those of non-HIV patients. Itraconazole was the antifungal with the lowest minimum inhibitory concentration (MIC) in most isolates. Conclusion. We observed differences in the sensitivity profiles of M. furfur isolates according to the context of the patient. High MIC of antifungals like fluconazole, commonly used for treating pathologies caused by Malassezia, were identified.

Introducción. Malassezia es un género de levaduras lipofílicas que dependen de los lípidos y hacen parte de la microbiota de la piel de humanos y otros animales. No obstante, debido a procesos de disbiosis u otros factores en el huésped, esta levadura puede llegar a causar diferentes enfermedades: desde cutáneas (como dermatitis seborreica) hasta fungemias. Se han reportado aislamientos de Malassezia furfur en pacientes positivos para HIV, con lesiones cutáneas o sin ellas. Por su carácter oportunista y sensibilidad variable a los compuestos antifúngicos, es relevante conocer los perfiles de sensibilidad. Objetivo. Determinar la sensibilidad a diferentes antifúngicos de aislamientos clínicos de M. furfur obtenidos de pacientes positivos o negativos para HIV, con dermatitis seborreica o sin ella. Materiales y métodos. La sensibilidad de los aislamientos a itraconazol, voriconazol, fluconazol y anfotericina B, se determinó mediante dos técnicas: microdilución en caldo según el protocolo M27-A3 del Clinical & Laboratory Standards Institute (CLSI), con modificaciones, y pruebas en agar mediante Etest®. Resultados. Los aislamientos obtenidos de pacientes con HIV mostraron aumento de la concentración inhibitoria mínima a fluconazol, voriconazol y anfotericina B, en comparación con los de pacientes sin HIV. Por otro lado, al evaluar la mayoría de los aislamientos, el itraconazol fue el antifúngico con la menor concentración inhibitoria mínima. Conclusión. Se evidencian diferencias en los perfiles de sensibilidad de los aislamientos de M. furfur, según el contexto del paciente, y elevadas concentraciones inhibitorias mínimas de antifúngicos como el fluconazol, usados comúnmente para el tratamiento de las enfermedades causadas por Malassezia spp.

Imunoterapia de dessensibilização para Malassezia spp. - Relato de caso experimental / Desensitization immunotherapy for Malassezia spp: experimental case report

A pitiríase versicolor (PV) consiste em uma infecção fúngica ocasionada por leveduras de Malassezia spp., que apesar de manejo simples, é uma doença com elevadas chances de recidiva e cronificação, além da pouca variedade de terapias efetivas para tratar cepas resistentes. Existem relatos na literatura sobre utilização de dessensibilização para Malassezia spp., mas para o tratamento de dermatite atópica e não PV, conferindo caráter inovador ao relato em questão. O caso apresentado consiste em um paciente de 28 anos, do sexo masculino, com manifestações típicas de PV em região de face, cervical, dorsal e axilar, há 4 anos, com resistência aos esquemas terapêuticos tópicos e sistêmicos. Uma vez identificada a ineficácia das terapias tradicionais, foi iniciado o tratamento com dessensiblização para Malassezia spp., em aplicações semanais, com aumento progressivo da dosagem e posterior aumento no intervalo das aplicações. Após onze meses de realização do novo tratamento, o paciente evoluiu com melhora completa das lesões. Conclui-se que a utilização de técnicas imunoterápicas para o tratamento de PV foi considerado eficaz no caso relatado, apesar de ainda não haver evidências que amparem sua utilização em maior escala.

Pityriasis versicolor is a infection caused by Malassezia yeast species, which, despite simple management, involves a high risk of recurrence and chronicity, and there are few effective therapies for resistant strains. Desensitization for Malassezia spp. has been reported in the literature, but for atopic dermatitis, rather than pityriasis versicolor, making this an innovative report. The case presented herein is of a 28-year-old man who had typical manifestations of pityriasis versicolor in the face, cervical, dorsal, and axillary region for 4 years that were resistant to topical and systemic therapies. Once the ineffectiveness of traditional therapies had been determined, weekly Malassezia desensitization sessions were begun, progressively increasing first in dosage and then in frequency. After 11 months, the lesions had improved completely. In this case, immunotherapeutic techniques effectively treated pityriasis versicolor, although the evidence is as yet insufficient to support large-scale use.

Homeopathy treatment of Malassezia Pachydermatis in vitro

A common clinical occurrence in dogs is otitis externa caused by excessive growth of yeasts Malassezia pachydermatis, which can become chronic after wrong treatments, in which microbial resistance can occur. Homeopathic remedies can be considered a successful alternative, selecting the medicine through the similitude principle. Herein, 50 µL of a 1:1000 dilution of Malassezia pachydermatis suspension at 0.5 McFarland scale was used to seed the yeast into Sabouraud dextrose agar plates using a Drigalski spreader to proceed with colony unit counting. Before being seeded, the yeast suspensions were treated with 1% of different homeopathic treatments previously selected from a pilot study, which means Sulphur 6cH, Dolichos pruriens 6cH, and Kali carbonicum 6cH, being water, and succussed water used as controls. For comparison, a set of Sabouraud dextrose agar plates containing 1% Tween 80 was seeded in parallel. The treatments were made blind and evaluated in triplicate. Contaminated cultures were withdrawn. The number of colonies per plate was assessed, and smears were made from the cultures to classify yeast growth according to cytomorphology on ImageJ®software. The preliminary results show no significant effect of all tested medicines compared to the controls. High data variability was also observed, mainly in those cultures whose medium was prepared with Twin 80. In conclusion, at this point of the study, no evidence of the effects of the studied medicines on Malassezia pachydermatis growth in vitro could be identified. The analysis of cytomorphology is still in course.

Prevalence of sensitization to Malassezia spp. in adults with atopic dermatitis and psoriasis and its correlation with disease severity / Prevalência da sensibilização a Malassezia spp. em pacientes adultos portadores de dermatite atópica e psoríase e sua correlação com a gravidade das doenças

Fundamentals: Atopic Dermatitis (AD) and Psoriasis (PS) share clinical and physiopathological similarities. Objective: Determine the prevalence of sensitization to Malassezia spp. in adults with AD and PS and its correlation with disease severity. Methods: A cross-sectional study was carried out from January 2016 to August 2017 with adults. Malassezia spp.-specific IgE dosages were measured, and skin scrapings for fungal culture performed. Parametric or nonparametric tests were used for analysis. Results: Median age of the 20 participants with AD was 29 years old, and the mean SCO-RAD was 45.35 ± 18.32. Malassezia spp.- specific IgE median dosage was 0.63 kU/l. M. furfur and M. sympodialis were isolated. Spearman's nonparametric correlation analysis showed no correlation between sensitization to Malassezia spp. and disease severity. The median age of the 36 participants with PS was 61 years old, the median body surface area affected was 22%, and Malassezia spp.-specific IgE median dosage was 0.00 kU/l. M. furfur and Malassezia spp. were identified. Study limitations: Assessing the sensitization to Malasseziaspp. was difficult due to the reduced number of participants in the study. Furthermore, there was no uniformity in the location to collect skin scrapings. The use of topical medication was not suspended before collecting skin specimens for mycological examination, therefore interfer-ing with fungal isolation. Conclusion: Sensitization to Malassezia spp. was only detected in the AD sample. Malassezia spp.-specific IgE test did not prove to be a marker for disease severity in our AD sample (AU)

Fundamentos: Dermatite atópica (DA) e psoríase apresentam similaridades clínicas e fisiopatológicas. Objetivos: Avaliar a frequência da sensibilização a Malasseziaspp. em adultos portadores de DA e psoríase e correlacionar à gra-vidade dos quadros clínicos. Métodos: De janeiro de 2016 a agosto de 2017, conduziu-se um estudo observacional em indivíduos adultos onde foram realizadas dosagem de IgE específica anti-Malassezia spp. e raspados das lesões para cultura micológica. Testes paramétricos ou não paramétricos foram utilizados para análise. Resultados: Nos 20 portadores de DA, a mediana da idade foi 29 anos. O valor médio do Scoring Atopic Dermatitis foi 45,35 ± 18,32. A mediana de IgE específica anti-Malasseziaspp. foi 0,63 kU/l. M. furfur e M. sympodialis foram isolados. A análise de correlação não-paramétrica de Spearman não mostrou correlação entre a sensibilização à Malassezia spp. e a gra-vidade. Nos 36 pacientes com psoríase, foram obtidas as seguintes medianas: idade 61 anos, comprometimento de superfície corpórea 22% e IgE específica anti-Malassezia spp. 0,00 kU/l. Houve identificação de M. furfur e Malasse-zia spp. Limitações do estudo: O número reduzido de participantes dificultou a avaliação da sensibilização por IgE a Malasseziaspp. Não houve uniformidade nos locais de coleta dos raspados cutâneos. Medicamentos tópicos não foram suspensos anteriormente ao exame micológico, prejudicando o isolamento dos fungos. Conclusões: Sensibili-zação a Malassezia spp. apenas ocorreu nos portadores de DA. O teste de IgE específica anti-Malassezia spp. não se mostrou um marcador de gravidade para a DA neste grupo (AU)

Effect of 1 064-nm Q-switched Nd:YAG laser on cell viability, protease activity and structures of Malassezia furfur / 中华皮肤科杂志

Objective:To investigate the effect of 1 064-nm Q-switched Nd:YAG laser at different energy settings on cell viability, protease activity and structures of Malassezia furfur. Methods:Cultured standard strains of Malassezia furfur were divided into several groups to be irradiated with 1 064-nm Q-switched Nd:YAG laser at different energies of 0 (control group) , 500, 600, 700, 800 and 900 mJ, respectively. Then, fungal suspensions in the above groups were inoculated onto the Leeming & Notman medium separately. After 7-day culture, the diameter and number of colonies were measured to evaluate the fungal cell viability, the protease activity was measured by using the whole-milk plate medium, and the ultrastructure of Malassezia furfur in each group was observed by transmission electron microscopy. One-way analysis of variance was used for comparisons among multiple groups, least significant difference- t test for multiple comparisons, and Pearson correlation analysis for analyzing correlations of laser energy with colony diameter, number and protease activity. Results:The colony diameter and number both significantly differed among the control group, 500-, 600-, 700-, 800- and 900-mJ groups (colony diameter: 4.05 ± 0.69, 3.76 ± 0.51, 3.28 ± 0.41, 3.09 ± 0.72, 2.54 ± 0.64 and 2.43 ± 0.41 mm, respectively; colony number: 4 787 ± 597, 4 287 ± 761, 1 879 ± 275, 1 082 ± 248 and 209 ± 42, 72 ± 31 colony-forming units, respectively; F = 14.83, 231.85, respectively, both P < 0.05) , and were significantly decreased in the 600-, 700-, 800- and 900-mJ groups compared with the control group (all P < 0.05) . The laser energy was negatively correlated with the colony diameter and number ( r = -0.67, -0.91, respectively, both P < 0.05) . The protease activity significantly differed among the control group, 500-, 700- and 900-mJ groups ( F = 346.60, P < 0.05) , and was significantly lower in the 700- and 900-mJ groups than in the control group (both P < 0.05) . There was a negative correlation between the laser energy and protease activity ( r = -0.94, P < 0.05) . Transmission electron microscopy showed intact fungal structures in the control group, relatively intact fungal structures in the 500-mJ group, and obviously damaged fungal structures in the 600- to 900-mJ groups, and the greater the laser energy, the more severely the fungal structures were damaged. Conclusion:The 1 064-nm Q-switched Nd:YAG laser could affect the cell viability of and protease activity in Malassezia furfur, and damage its structures.

The correct nomenclature of Zirelí sign in the propaedeutics of pityriasis versicolor (in memoriam)

Abstract Aiming at disclosing the semiotic method used in the diagnosis of pityriasis versicolor, the authors go through the history of the creation of Zirelí sign, describing the method, its usefulness and practicality in dermatological clinical practice, whether public or private, and to give credit to the author of this semiological maneuver, in memoriam.

Seborrheic dermatitis and its relationship with Malassezia spp / Dermatitis seborreica y su relación con Malassezia spp

Abstract Seborrheic dermatitis (SD) is a chronic inflammatory disease that that is difficult to manage and with a high impact on the individual's quality of life. Besides, it is a multifactorial entity that typically occurs as an inflammatory response to Malassezia species, along with specific triggers that contribute to its pathophysiology. Sin ce the primary underlying pathogenic mechanisms include Malassezia proliferation and skin inflammation, the most common treatment includes topical antifungal keratolytics and anti-inflammatory agents. However, the consequences of eliminating the yeast population from the skin, the resistance profiles of Malassezia spp. and the effectivity among different groups of medications are unknown. Thus, in this review, we summarize the current knowledge on the disease´s pathophysio logy and the role of Malassezia sp. on it, as well as, the different antifungal treatment alternatives, including topical and oral treatment in the management of SD.

Resumen La dermatitis seborreica (DS) es una enfermedad inflamatoria crónica, con un elevado impacto en la calidad de vida del individuo. Además, DS es una entidad multifactorial que ocurre como respuesta inflamatoria a las levaduras del género Malassezia spp., junto con factores desencadenantes que contribuyen a la fisio patología de la enfermedad. Dado que el mecanismo patogénico principal involucra la proliferación e inflamación generada por Malassezia spp., el tratamiento más usado son los agentes tópicos antifúngicos y antiinflamatorios. Sin embargo, se desconocen las consecuencias de eliminar la población de levaduras de la piel, los perfiles de resistencia de Malassezia spp. y la efectividad entre grupos diferentes de medicamentos. Por tanto, en esta revisión de la literatura, resumimos el conocimiento actual sobre la fisiopatología de la enfermedad y el papel de Malassezia sp., así como de las diferentes alternativas de tratamiento antifúngico tanto tópico como oral en el manejo de la DS.

Fungemia por Malassezia sympodialis en una Unidad de Cuidados Intensivos Neonatal de Colombia / Fungemia by malassezia sympodialis in a neonatal intensive care unit in Colombia

Resumen El género Malassezia comprende levaduras lipofílicas, comensales de la piel de humanos y animales, responsables de infecciones dermatológicas y sistémicas, particularmente en recién nacidos pretérmino hospitalizados en Unidades de Cuidados Intensivos Neonatal (UCIN) con catéteres venosos centrales, antibióticos de amplio espectro y nutrición parenteral rica en lípidos. La información acerca de las fungemias por este microorganismo es limitada, sin embargo, la mayoría de infecciones invasivas reportadas en la literatura han sido asociadas con M. furfur y M. pachydermatis. Se reporta un caso de fungemia por M. sympodialis en un recién nacido pretérmino hospitalizado en la UCIN de un hospital colombiano con sospecha clínica de sepsis neonatal, antibioticoterapia de amplio espectro y hemocultivos de rutina negativos. El aislamiento fue susceptible a fluconazol y voriconazol, y resistente a anfotericina B. Existen pocos reportes de fungemia producida por M. sympodialis, pero todos concuerdan en que es una levadura subestimada en individuos con factores predisponentes.

Abstract The genus Malassezia comprises lipophilic yeasts, commensals of the skin of humans and animals, responsible for dermatological and systemic infections, particu larly in preterm infants hospitalized in Neonatal Intensive Care Units (NICU) with central venous catheters, broad-spectrum antibiotics and parenteral nutrition rich in lipids. Information about fungemia by this microorganism is limited, however, the majority of invasive infections reported in the literature have been associated with M. furfur and M. pachydermatis. A case of M. sympodialis fungemia is reported in a preterm newborn hospitalized in the NICU of a Colombian hospital with clinical suspicion of neonatal sepsis, broad-spectrum antibiotic therapy and negative routine blood cultures. The isolation was susceptible to fluconazole and voriconazole, and resistant to amphotericin B. There are few reports of fungemia produced by M. sympodialis, but all agree that it is an underestimated yeast in individuals with predisposing factors.

Características clínico-epidemiológicas de los pacientes con pitiriasis versicolor en un centro de referencia de Colombia / Clinical-epidemiological characteristics of patients with tinea versicolor in a Colombian reference center

Resumen Objetivo: describir las características socio-demográficas, presentación clínica y condiciones extrínsecas que pueden favorecer el desarrollo de la pitiriasis versicolor. Material y métodos: estudio observacional descriptivo, de corte transversal y prospectivo, en el que se incluyeron pacientes con diagnóstico clínico y micológico de pitiriasis versicolor entre enero y diciembre de 2018, que asistieron al Hospital Universitario Centro Dermatológico Federico Lleras Acosta. Resultados: se incluyeron un total de 42 pacientes con diagnóstico de pitiriasis versicolor confirmado por examen directo, el 62% fueron hombres con una edad promedio de 33 años. La localización más común fue el tórax anterior (68%) y posterior (65%), en fototipos III y IV (78.5%), con una tonalidad hipocrómica. El 28% presentaron cuadros recurrentes, con síntomas hasta 7 años antes de la consulta. El signo de Besnier fue positivo en el 95% de los casos. El 64% refirió antecedente personal de hiperhidrosis y el 67% practicaba algún deporte como buceo, natación o gimnasia. Discusión: la identificación de las condiciones extrínsecas presentes esta población permite orientar medidas de prevención para evitar recurrencias de pitiriasis versicolor. Los viajes a lugares de clima cálido y la práctica de deportes son factores que favorecen el desarrollo de la micosis. En las formas clínicas atípicas se sugiere realizar siempre el examen micológico directo para confirmar el diagnóstico. El signo de Besnier es una maniobra útil para el diagnóstico clínico de la pitiriasis versicolor, particularmente cuando el acceso al examen directo es limitado.

Abstract Objective: to describe the sociodemographic aspects, clinical presentation and extrinsic conditions that may increase the risk of developing pityriasis versicolor. Materials and methods: a descriptive, cross-sectional and prospective observational study was conducted. Patients with clinical and mycological diagnosis of ptyriasis versicolor were included from january to december 2018 who attended to the Hospital Universitario Centro Dermatológico Federico Lleras Acosta. Results: a total of 42 patients were included in the study, all of them had confirmed mycological diagnosis of pityriasis versicolor. The most common location of the lesions was the anterior thorax (68%) and posterior thorax (65%), in III and IV phototypes (78.5%) with a hypochromic color. 28% had recurrent infection, with symptoms mean of 7 years before the consultation. The Besnier sign was positive in 95% of cases, 64% reported personal history of hyperhidrosis and 67% practiced some sports: diving, swimming and gymnastics. Discussion: recognizing extrinsic conditions that may increase the risk of developing pitiraisis versicolor in this population allows identifying control measures to prevent a relapse. The main factors involved in the development of pitiraisis versicolor were traveling to places with high temperatures and sport practice. In atypical clinical presentation it is mandatory to perform the mycological direct test to confirm the diagnosis. The Besnier sign is a useful method for the clinical diagnosis of pityriasis versicolor, particularly when access to direct examination is limited.

An update on pityrosporum folliculitis in Singapore from a single tertiary care dermatological centre

INTRODUCTION@#Pityrosporum folliculitis (PF) is a common skin condition that can be easily misdiagnosed, especially by non-dermatologists. While the initial diagnosis is often made clinically, skin microscopy may help to confirm the same. However, there is scant literature regarding the clinical epidemiology of PF. To our knowledge, in Singapore, only one prior epidemiological study was performed in 1987. Through the present study, we aimed to provide an update regarding the epidemiology, diagnosis and treatment of patients with PF in Singapore.@*METHODS@#We performed a retrospective review of patients with clinical presentations compatible with PF who presented to the dermatology clinic at the National University Hospital, Singapore, between 1 January 2011 and 31 December 2015. The medical records of patients identified as having clinical presentations that resembled PF were reviewed via written and electronic databases. Information regarding the demographics and clinical presentation of the patients was collected.@*RESULTS@#Of the 375 patients identified, 214 (57.1%) were confirmed as having PF based on Gram-stain microscopy. Most (35.0%) of these 214 patients were aged between 21 and 30 years, with a male-to-female ratio of 3:1. The lesions predominantly occurred on the trunk and the back. The majority of patients presented with symptoms that lasted more than one month. 128 (59.8%) patients received oral antifungal treatment, whereas 82 (38.3%) patients were treated with topical antifungal treatment alone.@*CONCLUSION@#A typical Singapore patient with PF is a young man aged 21-30 years, with erythematous follicular papules or pustules over the trunk and the back.

Dermatitis seborreica infantil extensa en un lactante / Extensive infantile seborrhoeic dermatitis in an infant

RESUMEN Introducción: la dermatitis seborreica es una enfermedad inflamatoria cutánea crónica que se caracteriza por la presencia de eritema y descamación de la piel en las zonas afectadas. Es el resultado de la combinación de tres factores: secreción sebácea, presencia de Malassezia y la respuesta inmune; se distinguen dos formas principales: la infantil y la del adulto. Presentación del caso: lactante de tres meses de edad, producto de parto distócico por cesárea a las 39 semanas, gemelar; que asistió a consulta de Dermatología traído por sus padres, quienes refirieron cuadro de 15 días de evolución de lesiones en cuero cabelludo y área del pañal eritematosas. Según la madre el paciente recibe alimentación complementaria y su hermano gemelar presentaba el mismo cuadro, pero de menor intensidad. Se diagnosticó dermatitis seborreica infantil, patrón Costra Láctea y patrón dermatitis seborreica de los pliegues. Se brindó Educación Sanitaria a los padres e indicó tratamiento local a ambos pacientes basado en el lavado frecuente del cuero cabelludo, loción capilar (ácido salicílico 2 % + aceite mineral 100 ml) y cremas esteroidea y antimicótica. Se logró mejoría clínica evidente. Conclusiones: esta enfermedad es una dermatosis frecuente en los lactantes, con un patrón clínico característico cuyo estudio resulta necesario, sobre todo por parte de los médicos de la Atención Primaria de Salud, para garantizar un tratamiento adecuado que evite complicaciones.

ABSTRACT Introduction: seborrhoeic dermatitis is a chronic inflammatory skin disease characterized by the presence of erythema and peeling of the skin in the affected areas. It results from the combination of three factors: sebaceous secretion, presence of Malassezia and the immune response; distinguishing two main forms: the infantile and the adult. Case report: a 3-month-old twin infant, born by dystocic caesarean delivery at 39 weeks. His parents brought him to the dermatology clinic; they reported a 15-day chart of evolution of scalp lesions and diaper erythematous area. The mother stated the patient receives complementary feeding and the twin brother has the same clinical picture, but in less extent. Infantile seborrhoeic dermatitis, milky crust pattern with seborrhoeic dermatitis pattern of the folds were examined and diagnosed. Hygienic education was provided to parents and local treatment is indicated to both patients based on frequent washing of the scalp, hair lotion (2% salicylic acid + 100 ml mineral oil), steroid and antifungal creams, achieving obvious clinical improvement. Conclusions: this entity is a frequent dermatosis in infants, with a clinical characteristic pattern which study is necessary, particularly for Primary Health Care Physicians, to ensure adequate treatment avoiding complications.

Eficácia de uma nova geração de xampus no controle da dermatite seborreica do couro cabeludo / Efficacy of a new generation of shampoos in controlling seborrheic dermatitis of the scalp

Introdução: A dermatite seborreica é uma doença inflamatória crônica sobre áreas com maior concentração de glândulas sebáceas, com participação de fungos do gênero Malassezia sp. Objetivo: Avaliar a eficácia do tratamento da dermatite seborreica moderada a intensa com o uso de duas formulações de xampu em monoterapia. Métodos: Pacientes portadores de dermatite seborreica de couro cabeludo moderada à intensa, com cabelos processados quimicamente ou não, foram agrupados de acordo com o grau da afecção e usaram uma das duas versões de xampus em monoterapia, por quatro semanas. Também foi avaliada a ocorrência de recidivas após a suspensão do tratamento. Resultados: Houve redução significativa (p<0,05) da oleosidade desde a primeira aplicação. Os demais sinais (eritema e descamação) apresentaram melhora significativa para ambos os tratamentos. Também foi relatada uma melhora significativa do prurido, eritema e descamação pelos participantes. O efeito sobre os fios foi considerado positivo com ambos os tratamentos. Após uma semana da suspensão, o índice de recidivas foi considerado não significativo (p<0,05). Conclusões: As duas versões de xampus foram capazes de promover um controle efetivo da dermatite seborreica moderada à intensa. Essas formulações demonstraram também não agredirem os fios, mesmo quando processados, fato considerado fundamental para a adesão ao tratamento.

Introduction: Seborrheic dermatitis is a chronic inflammatory disease in areas with a higher concentration of sebaceous glands and the participation of the fungi of the genus Malassezia sp. Objective: To assess the effectiveness of treating moderate to severe seborrheic dermatitis using two shampoo formulations in monotherapy. Methods: Patients with moderate to severe seborrheic dermatitis of the scalp, with or without chemically processed hair, were grouped according to the degree of affection and used one of two versions of shampoo monotherapy for four weeks. Relapse after treatment cessation was also evaluated. Results: There was a significant reduction (p <0.05) of oiliness since the first application. The other signs (erythema and peeling) showed significant improvement for both treatments. Participants also reported a considerable improvement in pruritus, erythema, and peeling. The effect on the hair strands was considered positive with both procedures. After one week of suspension, the relapse rate was considered non-significant (p <0.05). Conclusions: Both versions of shampoos were able to promote effective control of moderate to severe seborrheic dermatitis. These formulations also demonstrated not to harm the hair strands, even when chemically processed, a fundamental fact to treatment adherence.

Identification of Malassezia species as part of normal skin and ear canal microbiota in horses / Identificación de especies de Malassezia como microbiota normal en piel y canal auditivo externo de equinos / Identificação de espécies de Malassezia como microbiota normal em pele e canal auditivo externo de cavalos

Abstract Background: The yeasts of the genus Malassezia are considered part of the normal skin microbiota in humans and animals. In horses, several species of the genus Malassezia have been reported in different areas of the skin and ear canal. Objective: Isolate, characterize and identify the different species belonging to the genus Malassezia isolated from the ear canal and skin of equine patients with no dermatological lesions that were referred to the large animal clinic of veterinary teaching hospital at the National University of Colombia. Methods: 22 horses were evaluated and sampled. Eighty-two samples were obtained by swabbing either the ear canals (left and right), skin areas of prepuce, mammary gland and inguinal region. The samples were examined by cytological evaluation and were cultured on modified Dixon's agar and phenotypic and molecular identification were performed for yeast colonies. Results: Fourteen yeast isolates were obtained from the 82 samples. Biochemical identification determined that 50% (n=7) were Malassezia spp., 35.7% (n=5) were identified as Candida spp. and 14.3% (n=2) as Cryptococcus spp.. Using molecular tests, the Malassezia species were M. slooffiae (28.6%) and M.nana (57.1%); only one isolate was classified as Trichosporo asahii. Conclusion: M.nana and M. slooffiae were identified as part of the normal ear canal and skin microbiota in the evaluated horses. The observed prevalence of Malassezia spp. was 18.2% (n=4/22) in this study sample.

Resumen Antecedentes: Las levaduras del género Malassezia hacen parte de la microbiota normal cutánea de humanos y animales. En equinos se han reportado diferentes especies de Malassezia aisladas de varias regiones de piel y canal auditivo externo. Objetivo: Aislar, caracterizar e identificar las especies del género Malassezia spp. a partir de canal auditivo externo y piel de equinos sin lesiones dermatológicas, remitidos a la Clínica de Grandes Animales de la Facultad de Medicina Veterinaria y de Zootecnia de la Universidad Nacional de Colombia. Metodología: Se evaluaron 22 equinos, a partir de los cuales se obtuvieron 82 muestras entre hisopados de canal auditivo externo (izquierdo y derecho) y diferentes regiones de piel (prepucio, glándula mamaria e ingle). Las muestras fueron procesadas mediante examen directo y cultivo en agar Dixon modificado. A partir de los aislamientos en los que se observaron colonias morfológicamente compatibles con Malassezia spp. se realizó la identificación fenotípica y molecular. Resultados: De las 82 muestras procesadas se obtuvieron 14 aislamientos de levaduras, de las cuales mediante identificación bioquímica el 50% (n=7) correspondió a Malassezia spp., el 35,7% (n=5) a Candida spp., y el 14,3% (n=2) a Cryptococcus spp. Luego mediante pruebas moleculares se identificaron las especies del género Malassezia como: M. slooffiae (28,6%) y M . nana (57,1%); y un aislamiento correspondió a Trichosporon asahii. Conclusión: Se logró identificar las especies M.nana y M. slooffiae como microbiota normal de la piel y el canal auditivo en los equinos evaluados. La prevalencia de Malassezia spp. para la población evaluada fue de 18,2% (n=4/22).

Resumo Antecedentes: As leveduras do gênero Malassezia fazem parte da microbiota cutânea normal de humanos e animais. Em cavalos, diferentes espécies de Malassezia isoladas de várias regiões da pele e do canal auditivo externo foram reproduzidas. Objetivo: Isolar, caracterizar e identificar as espécies do gênero Malassezia spp. do canal auditivo externo e pele eqüinos sem lesões cutâneas, referiu-se à Clínica de Grandes Animais da Faculdade de Medicina Veterinária e Zootecnia da Universidade Nacional da Colômbia. Métodos: 22 equinos foram avaliadas a partir dos quais 82 amostras a partir de esfregaços do canal auditivo externo (esquerda e direita) e diferentes regiões da pele (prepúcio, glândula mamaria e virilha) foram obtidos. As amostras foram processadas por exame direto e cultura em ágar Dixon modificado. Dos isolados nos quais as colônias foram observadas morfologicamente compatíveis com Malassezia spp. identificação fenotípica e molecular foi realizada. Resultados: Das 82 amostras processadas 14 isolados de levedura, que foram obtidos por identificação bioquímica de 50% (n=7) correspondia a Malassezia spp., 35,7% (n=5) a Candida spp., e 14,3% (n=2) para Cryptococcus spp.. Em seguida, usando o teste molecular espécie Malassezia foram identificadas como M. slooffiae (28,6%) e M . nana (57,1%); e um isolamento correspondia a Trichosporon asahii. Conclusão: As espécies M.nana e M. slooffiae foram identificadas como microbiota de pele normal e do canal auditivo nos equídeos avaliados. A prevalência de Malassezia spp. para a população avaliada foi 18,2% (n=4/22).

Especies de Malassezia causantes de pitiriasis versicolor en Paraguay / Malassezia species causative of pityriasis versicolor in Paraguay

Resumen Introducción: La pitiriasis versicolor es una patología frecuente en Paraguay; sin embargo, su epidemiologia es desconocida. Objetivo: Determinar la frecuencia de especies de Malassezia causantes de pitiriasis versicolor y las características epidemiológicas de la población. Materiales y Métodos: Se recolectaron muestras de pacientes con diagnóstico presuntivo de pitiriasis versicolor. El diagnóstico de laboratorio se realizó mediante examen en fresco y cultivo en agar Dixon modificado y agar cromogénico Chromagar Malassezia®, incubados a 32°C; y la identificación por las características macro y micromorfológicas, pruebas bioquímicas y fisiológicas. Resultados: Se incluyeron 102 pacientes (51% femenino), de 1 mes a 63 años de edad, predominando el grupo de 11 a 20 años (35,3%). La localización más frecuente fue el dorso (60,8%). Predominaron las formas hipocrómicas (48%). La especie más frecuente fue M. globosa (52,9%), seguida de M. furfur (24,5%), M. sympodialis (18,6%) y M. slooffiae (6,9%). Conclusiones: La epidemiología observada es similar a otros estudios sudamericanos, no hace distinción de sexo, se presenta predominantemente en la forma clínica hipocrómica y M. globosa aparece como principal responsable. Este es el primer reporte sobre las especies causantes de pitiriasis versicolor en Paraguay y las características de la población con esta patología.

Background: Pityriasis versicolor is a frequent pathology in Paraguay; however, its epidemiology is unknown. Aim: To determine the frequency of Malassezia species causing pityriasis versicolor and the epidemiological characteristics of the population. Methods: Samples from patients with a presumptive diagnosis of pityriasis versicolor were collected. Laboratory diagnosis was carried out by fresh examination and culture in modified Dixon agar and chromogenic Chromagar Malassezia®, incubated at 32° C, and identification by macro and micromorphological features, biochemical and physiological tests. Results: 102 patients were included (51% female) from 1 month to 63 years of age, the predominant age group was 11-20 years (35.3%). The most frequent location was on the back (60.8%). Hipocromic clinical forms (48%) predominated. The most frequent species was M. globosa (52.9%), followed by M. furfur (24.5%), M. sympodialis (18.6%) and M. slooffiae (6.9%). Conclusions: The observed epidemiology is similar to other South American studies, with no sex distinction, predominantly hypochromic clinical form and as primary responsible species appears M. globosa. This is the first report on species causing pityriasis versicolor in Paraguay and the characteristics of the affected population.

Genotyping of Malassezia pachydermatis disclosed genetic variation in isolates from dogs in Colombia / Genotipagem de Malassezia pachydermatis revelou variação genética em isolados de cães na Colômbia

Malassezia pachydermatis is a lipophilic and lipid-dependent yeast mostly isolated from animals' skin; hence, it is regarded as a zoophilic species causing otitis externa in dogs. Aspects associated with its epidemiology and pathogenicity is a matter of interest. This study aimed to conduct a molecular characterization of 43 isolates of M. pachydermatis obtained from dogs with otitis externa. For this purpose, the 5.8S internal transcribed spacer 2 (ITS2) and D1/D2 26S rRNA regions were amplified, sequenced and analyzed using restriction fragment length polymorphism (RFLP) with AluI, CfoI, and BstF5I endonucleases. Phylogenetic analyses revealed that these isolates grouped with the sequence types I, IV and V, previously proposed for M. pachydermatis. Interestingly, we found a new polymorphic RFLP pattern using BstF5I, these isolates were associated with the sequence types IV and V, nevertheless an association between polymorphic RFLP patterns, and fosfolipase activity or canine population data was not observed. These findings underline the genetic diversity of M. pachydermatis and provide new insights about the epidemiology of this species in the analyzed population.(AU)

Malassezia pachydermatis é uma levedura lipofílica e dependente de lipídios, principalmente da pele de animais. Sendo, por essa razão, considerada uma espécie zoofílica e causadora de otite externa em cães. Neste sentido, aspectos associados à sua epidemiologia e patogenicidade constituem um tema de interesse científico. O objetivo deste estudo foi realizar a caracterização molecular de 43 isolados de M. pachydermatis obtidos a partir de cães com otite externa. Para esta propósito, foram amplificadas, sequenciadas e analisadas com enzimas de restrição as regiões do gene 5.8S, do espaçador interno transcrito 2 (ITS2) e D1/D2 do 26S do rRNA pelo método RFLP, com as endonucleases AluI, CfOI e BstF5I. Análises filogenéticas revelaram que os isolados se agruparam com as sequências tipo I, IV e V de M. pachydermatis como já descrito anteriormente. De maneira interessante, se observou um novo RFLP polimórfico utilizando BstF5I. Os isolados que mostraram esse padrão foram associados com os padrões IV e V. No entanto, não foi observada associação entre padrões polimórficos de RFLP e atividade de fosfolipase ou dados da população canina. Estes resultados demonstram a diversidade genética de M. pachydermatis e fornecem novas perspectivas sobre a epidemiologia destas espécies na população analisada.(AU)

Isolation of Malassezia spp. in HIV-positive patients with and without seborrheic dermatitis

Abstract Background Malassezia, a skin saprophyte, is frequently isolated from patients with seborrheic dermatitis, which is one of the most common dermatoses in HIV-infected patients. Its role in pathophysiology has not been defined. Objective To determine whether patients living with HIV and seborrheic dermatitis have more Malassezia than those without seborrheic dermatitis. Method This is an descriptive, observational, prospective cross-sectional study to which all adult patients living with HIV that attend the infectious disease outpatient clinic at the Dr. Manuel Gea González General Hospital were invited. Patients presenting with scale and erythema were included in Group 1, while patients without erythema were included in Group 2. Samples were taken from all patients for smear and culture. Results Thirty patients were included in each group. All patients with seborrheic dermatitis had a positive smear, with varying amounts of yeasts. In the control group, 36.7% of patients had a negative smear. The results are statistically significant, as well as the number of colonies in the cultures.Study limitations The study used a small sample size and the subspecies were not identified. Conclusions Patients with clinical manifestations of seborrheic dermatitis have larger amounts of Malassezia. Further studies need to be performed to analyze if the greater amount is related to imbalances in the microbiota of the skin.

A Study on Demographic Profile and Risk Factor Association in Pityriasis Versicolor Cases Attending at a Tertiary Care Hospital in Kolkata

Pityriasis versicolor (PV), also known as tinea versicolor, is a chronic, mild, superficial and recurrent infection of the stratum corneum, caused by different Malassezia spp and seen predominantly in young age group and primarily in hot and humid climates. The aim of this study was to analyze epidemiological parameters and risk factors association in clinically diagnosed PV cases and also the mycological evaluation of those PV cases. Methods: A total of 116 patients attending the OPD of Dermatology were included and analysed for detailed history, clinical examination, epidemiological parameters, risk factors and investigations. Skin scrapings collected were processed by direct microscopy with 10% KOH and culture in modified Dixon agar (mDA). Isolates were identified by colony morphology, gram staining, biochemical characteristics & tween assimilation test. Results: Females were more affected (56.03%) than the males (43.97%) with F: M ratio 1.27:1. PV affected most commonly (36.21%) in 11-20 years of age group. Students (32.29%) were affected in maximum. Majority of affected patients (65.52%) used oily body creams, whereas 34.48% cases shared their body towels with others. 10.34% cases were associated with seborrheic dermatitis. Seasonal occurrence mostly seen in May - August. Patients with type III (Medium) complexion (56.03%) with normal skin texture (49.14%) were mostly affected. Maximum patients (74.14%) were associated with excessive sweating. 18.96% patients were associated with Type II DM. Most of the cases presented with macular, scaly hypopigmented, bilaterally asymmetrically distributed and having well defined margin. Neck was the most affected site (28.45%) followed by back (20.69%). Conclusion: M.furfur was the most common isolate (47.06%) followed by M. globosa (24.71%) and M. sympodialis (15.29%).

Antifungal Mechanism of Action of Lauryl Betaine Against Skin-Associated Fungus Malassezia restricta

Betaine derivatives are considered major ingredients of shampoos and are commonly used as antistatic and viscosity-increasing agents. Several studies have also suggested that betaine derivatives can be used as antimicrobial agents. However, the antifungal activity and mechanism of action of betaine derivatives have not yet been fully understood. In this study, we investigated the antifungal activity of six betaine derivatives against Malassezia restricta, which is the most frequently isolated fungus from the human skin and is implicated in the development of dandruff. We found that, among the six betaine derivatives, lauryl betaine showed the most potent antifungal activity. The mechanism of action of lauryl betaine was studied mainly using another phylogenetically close model fungal organism, Cryptococcus neoformans, because of a lack of available genetic manipulation and functional genomics tools for M. restricta. Our genome-wide reverse genetic screening method using the C. neoformans gene deletion mutant library showed that the mutants with mutations in genes for cell membrane synthesis and integrity, particularly ergosterol synthesis, are highly sensitive to lauryl betaine. Furthermore, transcriptome changes in both C. neoformans and M. restricta cells grown in the presence of lauryl betaine were analyzed and the results indicated that the compound mainly affected cell membrane synthesis, particularly ergosterol synthesis. Overall, our data demonstrated that lauryl betaine influences ergosterol synthesis in C. neoformans and that the compound exerts a similar mechanism of action on M. restricta.

Important skin microbiota associated with the occurrence of acne / 中华皮肤科杂志

Skin microbiota begin to form shortly after birth,with a wide variety and huge quantity,and are closely related to skin health.Acne is a common skin disorder associated with microbial infections.Propionibacterium acnes,Staphylococcus,Malassezia,etc.,are three species of microorganisms currently known to be most closely associated with the occurrence of acne.This review summarizes the relationship between the above three species of microorganisms and the occurrence of acne,and mainly includes the pathogenicity of bacteria or fungi of different types,the relationship between these bacteria or fungi and the pathogenesis of acne,the difference in host immune responses induced by these bacteria or fungi,so as to provide evidence for developing new strategies for the treatment of acne.

Comparison of fluorescent staining versus KOH wet-mount microscopy for detection of superficial fungal infection / 中华皮肤科杂志

Objective To compare the diagnostic value of fluorescent staining versus KOH wet-mount microscopy in detecting superficial fungal infection.Methods Totally,600 specimens from cases of clinically diagnosed superficial fungal infections and 102 from cases of clinically diagnosed Malassezia infection (including 54 cases of pityriasis versicolor and 48 cases of Malassezia folliculitis) were collected from the dermatology clinic of Tenth People's Hospital of Tongji University between July 2017 and February 2018.These specimens were subjected to fluorescent staining and KOH wet mount separately followed by direct microscopy,and the positive rate and average time for slide reading were compared between the two methods.Culture served as the gold standard method,and the missed diagnosis rate was compared between the two methods.Statistical analysis was carried out using chi-square test or Fisher's exact test for comparing enumeration data,and paired t test for comparing emeasurement data.Results Of the 600 specimens from clinically diagnosed superficial fungal infection cases,fungi were detected in 546 (91.00％) and 489 (81.50％) by fluorescent staining and KOH wet-mount microscopy respectively (x2 =22.83,P ＜ 0.05).Fluorescent staining showed significantly shorter average reading time (73.67 ± 13.56 s)compared with KOH wet-mount microscopy (87.12 ± 15.83 s,t =14.60,P ＜ 0.05).Among the 54 specimens from pityriasis versicolor cases,fluorescent staining and KOH wet-mount microscopy positive results in 51 (94.44％) and 50 (92.59％) specimens respectively (adjusted x2 =0,P ＞ 0.05),with the average reading time being 38.36 ± 8.79 s and 41.25 ± 15.67 s respectively (t =1.14,P ＞ 0.05).Of the 48 specimens from Malassezia infection cases,43 (89.58％) and 11 (22.92％) specimens were detected to be positive for fungi by fluorescent staining and KOH wet-mount microscopy respectively (x2 =43.34,P ＜ 0.05),and fluorescent staining showed shorter average reading time (42.14 ± 12.61 s) compared with KOH wet-mount microscopy (103.56 ± 9.48 s,t =17.83,P ＜ 0.05).Among the 600 specimens from superficial fungal infection cases,culture yielded fungi in 479.Moreover,476 specimens were found positive by fluorescent staining,and 3 were found negative (0.63％),while KOH wet-mount microscopy showed 465 positive results and 14 negative results (2.92％).There was a significant difference in the missed diagnosis rate between the two methods (x2 =7.25,P ＜ 0.05).Conclusion Compared with KOH wet-mount microscopy,fluorescent staining can increase the detection rate,reduce missed diagnosis rate and shorten reading time.