Epidemiologic Study of Malassezia Yeasts in Acne Patients by Analysis of 26S rDNA PCR-RFLP

BACKGROUND: Although acne is a common follicular inflammatory dermatosis, studies of the relationship between Malassezia yeasts and acne have rarely been conducted. OBJECTIVE: We sought to identify Malassezia yeasts from acne patients and establish a relationship between specific types of species of Malassezia and acne. METHODS: Sixty acne patients were enrolled. Each strain obtained was identified as one of eleven species by 26S rDNA PCR-RFLP. We then compared these data with those of age- and sex-matched healthy subjects. RESULTS: Growth of Malassezia was evident in fewer patients with acne (50%) in comparison to controls (70.6%). M. restricta was dominant in patients with acne (23.9%), whereas M. globosa was most common (26.7%) in healthy controls. In the patients group, the rate was the highest (71.7%) in the twenties and, in terms of body site, the rate was the highest (60%) in the chest. In the control group, the rate was the highest (75.0%) in the thirties and in the forehead (85.0%). CONCLUSION: The detection rate of Malassezia yeasts was conspicuously low in the acne patients group. Statistically significant differences were observed between the patient and the control groups in the twenties and thirties, and in terms of body site, in the forehead and chest.

A Case of Fibroelastolytic Papulosis on the Neck of a Young Man

Fibroelastolytic papulosis of the neck (FEPN) encompasses a spectrum of two disorders that were previously reported as pseudoxanthoma elasticum-like papillary dermal elastolysis (PXE-PDE) and white fibrous papulosis of the neck (WFPN). The clinical presentation of FEPN is asymptomatic to mildly pruritic whitish-yellow papules that may coalesce into cobblestone patterned plaques that resemble pseudoxanthoma elasticum (PXE). The histology is characterized by a decrease or loss of elastic fibers in the papillary dermis and this is sometimes accompanied by a minimal or nodular increase of dermal collagen fibers. We report here on a 28-year-old Korean man with asymptomatic, multiple, skin-colored to slightly yellowish, match-head sized, cobblestone-patterned papules on the neck, and these were histologically consistent with FEPN and the papules showed slightly increased dermal collagen associated with decreased and fragmented elastic fibers, elastin and tropoelastin. The pathogenesis of FEPN in this case might have been related with mild dermal inflammation, followed by fragmentation, elastolysis and increased dermal collagen.

Comparison of Nested PCR and RFLP for Identification and Classification of Malassezia Yeasts from Healthy Human Skin

BACKGROUND: Malassezia yeasts are normal flora of the skin found in 75~98% of healthy subjects. The accurate identification of the Malassezia species is important for determining the pathogenesis of the Malassezia yeasts with regard to various skin diseases such as Malassezia folliculitis, seborrheic dermatitis, and atopic dermatitis. OBJECTIVE: This research was conducted to determine a more accurate and rapid molecular test for the identification and classification of Malassezia yeasts. METHODS: We compared the accuracy and efficacy of restriction fragment length polymorphism (RFLP) and the nested polymerase chain reaction (PCR) for the identification of Malassezia yeasts. RESULTS: Although both methods demonstrated rapid and reliable results with regard to identification, the nested PCR method was faster. However, 7 different Malassezia species (1.2%) were identified by the nested PCR compared to the RFLP method. CONCLUSION: Our results show that RFLP method was relatively more accurate and reliable for the detection of various Malassezia species compared to the nested PCR. But, in the aspect of simplicity and time saving, the latter method has its own advantages. In addition, the 26S rDNA, which was targeted in this study, contains highly conserved base sequences and enough sequence variation for inter-species identification of Malassezia yeasts.

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 Zosteriform Piloleiomyoma / 대한피부과학회지

Cutaneous leiomyoma is a rare benign tumor that originates from the smooth muscles derived from arrector pili muscles, the media of dermal blood vessels and the dartos muscle of the scrotum, vulva or nipples. Piloleiomyomas usually occur in the second to third decades of life with an equal incidence in men and women. They can be solitary, but multiple lesions are seen in 80% of these patients. Although multiple leiomyomas are often grouped, unilateral zosteriform pilar leiomyoma is rare. We report here on a rare case of grouped piloleiomyomas that presented as a zosteriform pattern on the right trunk of a 59-year-old woman.

A Case of Lichen Nitidus with the Koebner Phenomenon Mimicking Lichen Striatus / 대한피부과학회지

Lichen nitidus is an uncommon, asymptomatic cutaneous shiny papular eruption and it can rarely show Koebner's phenomenon, which may clinically resemble lichen striatus. It is known that for such cases, the clinicopathological correlation is the most important factor for making the diagnosis and immunohistochemical staining for CD4, CD8 and CD68 can be helpful to differentiate these two diseases. We experienced a case of Koebner phenomenon, which clinically mimicked lichen striatus, in a patient suffering with lichen nitidus.

A Case of Actinic Granuloma Limited on Both Hands in a Patient with Colon Cancer / 대한피부과학회지

Actinic granuloma develops in the chronically sun-damaged skin of the neck, face, upper chest or arms. Lesions present as skin colored to erythematous papules and plaques that coalesce to form centrifugally enlarging annular patterns. Histologically, elastolytic granuloma is formed by a dense infiltrate of giant cells and histiocytes with active phagocytosis of elastoclastic fibers on the background of solar elastosis in the upper dermis. We report a clinically rare presentation of actinic granuloma, limited to both hands of a 75-year-old female with colon cancer.

Paronychia during Iressa(R) Treatment in a Lung Cancer Patient / 대한피부과학회지

Iressa(R) (ZD 1839, gefitinib) is a new anti-cancer agent which selectively inhibits the epidermal growth factor receptor (EGFR) tyrosine kinase in the pathway of the signal transduction. This agent can induce adverse effects in the cutaneous which are related to the interruption of normal epidermal cell kinetics. We report a case of paronychia in a 65-year-old man, developed in both sides of his finger and toe nails during treatment of non-small cell lung cancer (Stage IV) with Iressa(R) for 7 days. The patient came to our clinic with painful periungal inflammation with granulation tissue formation. The lesion was improved after treatment with topical or systemic antibiotics, Burrow's solution (0.3% aluminum acetate) soaking and electrodessication.

The Application of Pyrosequencing Method in the Identification and Classification of Malassezia Yeasts / 대한의진균학회지

BACKGROUND: Malassezia yeasts are lipophilic fungi that are found in 75~80% of healthy adults. Recently, various molecular biological techniques are being preferred to identify and classify the Malassezia yeasts. Pyrosequencing is a real-time DNA sequencing technique. This technology has the potential advantage of accuracy, ease-of-use, high flexibility and is now emerging as a popular platform for microbial typing. OBJECTIVE: We sought to implement novel molecular biology technique, namely pyrosequencing method in identifying and classifying Malassezia yeasts, and assess its clinical applicability. METHODS: We obtained ribosomal RNA sequences of 11 Malassezia standard strains from NCBI database. Primers for the initial PCR amplification of the target region (ITS2) and sequencing primers within the regions amplified by the PCR primers were designed using Pyrosequencing Assay Design Software (Biotage AB, Uppsala, Sweden). We obtained PCR amplifying fragments of genomic DNA isolated from the Malassezia yeasts. And pyrosequence reactions were performed using reagents provided with the PSQ 96 Sample Preparation kit. RESULTS: In the PCR analysis, all of 11 standard strains are shown at the 130 bp levels. In the pyrosequencing analysis, M. obtusa and M. furfur sequences were corresponded among 11 Malassezia standard strains. But, in 4 cases, Malassezia strains mismatched with expected Malassezia strain and in rest of 5 Malassezia strains, pyrosequencing was failed. CONCLUSION: As evidenced above, pyrosequencing analysis could provide a sensitive and rapid identification system for Malassezia species. But it still has many limitation to be applied to epidemiological surveys and clinical practice.

The Studies on the Concomitant Diseases and Combined Medication in Patients with Onychomycosis / 대한의진균학회지

OBJECTIVE: We performed this survey to provide the information about how many patients with onychomycosis have concomitant diseases and combined medication and to gauge about the drug interaction risk of antifungal agent. METHOD: The findings presented in this report are based on total 569 onychomycosis patients, with KOH positive, who visited 6 university hospitals from February 2007 to March 2007. RESULT: The patients with onychomycosis had concomitant diseases (43.1%) and used combination medication (36.4%). The majority of the patient have concomitant diseases, such as hypertension (12.2%), diabetic melitus (9.5%) and hyperlipidemia (4.1%), more frequent in elderly patients. Main factor to choose antifungal agent for the cure of onychomycosis is the efficacy of the medication (55%), as well as, the safety and drug interaction risk of antifungal agent, more important in case of the patient taking a variety of concomitant drugs. CONCLUSION: It is concluded that physicians should be aware of the potential interaction of the medications in order to prevent or reduce the burden of adverse events. It is required to have more cautious choice of oral antifungal agent in those patients who are taking combined medications in patients with onycomycosis.

A Case of Majocchi's Granuloma / 대한의진균학회지

Majocchi's granuloma is a well recognized but uncommon infection of dermal and subcutaneous tissue by fungal organisms usually limited to the superficial epidermis. The organism usually associated with Majocchi's granuloma is Trichophyton(T.) rubrum, however, other dermatophytes may be the causative agent. We presented a 74-year-old female who had a well defined erythematous nodular plaque on her right cheek for 1 month. Histopathologic findings was consistent with the Majocchi's granuloma, showing perifolliculitis and granulomatous inflammation in dermis. Many fungal elements were noted in the follicular keratin plug and giant cells in the granulomatous inflammation of the perifollicular dermis in the H & E stain. But no fungal hyphae was noted in horny layer of the epidermis and a culture for the fungus was failed. The cutaneous lesion treated with terbinafine (Lamisil(R)) 250 mg and lanoconazole cream daily with cured one month later.

A Case of Desmoplastic Trichoepithelioma / 대한피부과학회지

Desmoplastic trichoepithelioma is a rare, benign, adnexal tumor of hair follicle origin and is most commonly found on the face of young females. Clinically it presents as a solitary, asymptomatic, firm and annular plaque with a raised border. The histopathological findings show narrow strands of basaloid tumor cells with variable nests in a trabecular pattern and horn cysts in the desmoplastic stroma. This closely resembles morphea type basal cell carcinoma and microcystic adnexal carcinoma. We herein report a case of desmoplastic trichoepithelioma on the cheek of a 22-year-old man, with discussion of the significance of the immunohistochemical stains in the differential diagnosis of similar skin tumors, using antibodies for CD10, CD34, CEA, CK14, CK7 and Bcl-2.

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.