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.

Progress in Malassezia Research in Korea

Yeasts of the genus Malassezia are part of the normal flora of human skin. However, they are also associated with various skin diseases. Since the introduction of Malassezia to the Korean Dermatologic Society two decades ago, remarkable progress has been made in our knowledge of this genus. In this paper, we review recent developments in Malassezia research, including taxonomy and methods for species identification, recent genome analyses, Malassezia species distribution in healthy conditions and in specific skin diseases, trials investigating the mechanisms underlying Malassezia-related diseases, as well as therapeutic options. This review will enhance our understanding of Malassezia yeasts and related skin diseases in Korea.

Comparison between Malassezia Folliculitis and Non-Malassezia Folliculitis

BACKGROUND: Among the various types of folliculitis, differentiation of Malassezia folliculitis (MF) from other forms of folliculitis is important because it is usually treated with antifungal agents. OBJECTIVE: We attempted to find a method to enhance the detection rate of MF, and examined the differences in the clinical manifestation between MF and non-MF (NMF). METHODS: We performed a retrospective study involving patients with folliculitis who were previously diagnosed with MF or NMF on the basis of serial tissue sectioning and diastase-Periodic acid-Schiff (d-PAS) staining findings. The clinical features of MF and NMF were compared. RESULTS: Among a total of 100 folliculitis patients, 20 were diagnosed with MF and 80 with NMF. Tissues from the 80 patients with NMF were sectioned serially into 10 slices and stained with hematoxylin and eosin stain; among these, 10 had many round-to-oval yeast organisms in the hair follicles that confirmed MF. Finally, d-PAS staining was used to detect the presence of yeast in the NMF slides. Notably, among the 70 d-PAS-stained samples, yeast organisms were found in 6 samples, confirming MF. As a result, the diagnosis of 16 patients changed from NMF to MF. Compared with NMF, MF showed major involvement of the trunk and low involvement of the face and legs as well as male predilection. CONCLUSION: Physicians should consider serial sectioning and/or d-PAS staining of folliculitis lesions, particularly of those on the trunk of male patients, even if no yeast organisms are detected initially.

Malassezia folliculitis Resembling Erythema Annulare Centrifugum / 대한피부과학회지

Malassezia yeasts are lipophilic fungi that are regarded as normal flora of the skin. They are associated with a number of diseases affecting human skin, such as pityriasis versicolor, Malassezia folliculitis, and seborrheic dermatitis, and less commonly with other dermatologic disorders, such as confluent and reticulated papillomatosis and transient acantholytic dermatosis. Clinically, Malassezia folliculitis shows erythematous papules, sometimes pustules. Here, mutiple erythematous papules and pustules over the trunk and upper arms developed in a 37-year-old man. The skin lesions became enlarged and confluent, resulting in the formation of an annular configuration. They spread gradually to form a large plaque with central hyperpigmentation, with the edge of the lesions showing multiple papules and pustules. Microspores were found in potassium hydroxide preparations of these lesions, and large-sized circular, cream colored, raised, smooth, and dentate colonies were found in culture media. Histologically, sectioning showed mild acanthosis of the epidermis and perivascularinflammation in the superficial dermis. PAS-stained sections showed spheric to oval yeast organisms in the follicularepithelium. In PCR analysis, Malassezia sympodialis was identified. The patient was treated with oral itraconazle, resulting in complete clearing of the lesions. Here, we report an interesting case of Malassezia follicultis that showed clinical configuration of erythema annulare centrifugum.

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

BACKGROUND: So far, studies on the inter-relationship between Malassezia and Malassezia folliculitis have been rather scarce. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Malassezia Species Cultured from the Lesions of Malassezia Folliculitis / 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 systemic fungal infections. OBJECT: The study was done to classify the Malassezia yeasts cultured from the lesions of Malassezia folliculitis into one of the revised species and to find out the relationship between certain species of Malassezia and Malassezia folliculitis. METHODs: The specimen obtained from the lesions of twenty cases of Malassezia folliculitis and twenty cases of healthy controls were cultured on Leeming & Notman's media. The obtained strains were placed into one of the seven species by their colony morphologies, microscopic morphologies and physiological characteristics. RESULTS: In the lesions of Malassezia folliculitis, M. globosa occupied most of the cultured colonies in 15 cases, M. restricta in 4 cases and M. furfur in 1 case respectively. In the control group, M. restricta was found to be predominant on the face and M. sympodialis, M. globosa, M. restricta and M. furfur were isolated on the trunk. CONCLUSION: M. restricta and M. globosa could be considered to be mostly implicated species in the seven revised Malassezia species in the lesions of Malassezia folliculitis of the face and trunk respectively.

A Case of Malassezia Folliculitis in an Infant with Liver Cirrhosis / 대한피부과학회지

Malassezia folliculitis is characterized by pruritic follicular papules and pustules by Malassezia which are inhabitants of normal skin. We report a case of Malassezia folliculitis in a 12-month-old female, with a history of liver cirrhosis due to congenital biliary atresia. She presented with erythematous papules and pustules on the face 4 months ago. The diagnosis of Malassezia folliculitis was established by Parker ink-KOH direct microscopy. The lesions were successfully treated with topical ketoconazole cream for 2 weeks.

A Comparative Study on Clinical and Therapeutic Features Between Malassezia Folliculitis and Steroid Acne / 대한의진균학회지

BACKGROUND: Steroid acne have similar clinical manifestations with Malassezia folliculitis, so it is not easy to distinguish between these disease entities clinically. And there have been few reports about them and the therapeutic efficacy of antifungal agent for steroid acne. OBJECTIVE: We aimed to find out different points clinically between steroid-using acneiform eruption group and the group without use, and describe the results of direct-microscopic examinations and establish the relationships between therapeutic responses to oral antifungal agent and some variables like use of corticosteroids, grade of direct-microscopically positive score. METHODS: With 91 patients according to the protocol prepared, we described characteristics of the lesions, sites, and distributions, use of corticosteroids, then examined Malassezia spores with 10% KOH/Parker blue black ink mount from patient's skin lesions. And finally we compared the reponses to antifungal agent. For objective evaluation we used direct microscopic grading method to count spores introduced by Jacinto-Jamora et al. RESULTS: In both groups with and without use of corticosteroids, most had characteristics of papules and pustules, symmetric distributions except the patients using topical corticosteroids. In all positive groups, there was no significant difference in therapeutic responses regardless of the previous use of corticosteroids. Interestingly therapeutic response rate of (1+) group to itraconazole are similar with that of higher scoring groups. CONCLUSION: We suggest that not in a tropical area like Korea, direct-microscopically low score ((1+) or (2+)) and even negatives with typical manifestations of Malassezia folliculitis has a clinical significance and both steroid acne and Malassezia folliculitis may be one spectrum of the same disease.