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.

Malassezia(Pityrosporum) Infections of the Skin / 대한의진균학회지

The lipophilic yeast Pityrosporum ovale (Malassezia sp.) is a member of the normal human cutaneous flora in adults but also associated with several skin diseases. Treatment of P. ovale related diseases include topical and systemic antifungal therapy In pityriasis versicolor, under the influence of predisposing factors, P. ovale changes from the round blastospore form to the mycelial form. Pityriasis versicolor may be treated with topical treatment. However, with more extensive lesions, in patients with recurrence of the disease or patients not responding to topical therapy short term treatment with oral antifungal drugs is very effective. Recurrence is a great problem in pityriasis versicolor with a recurrence rate of 60% within 1 year. To avoid this oral ketoconazole 400mg once monthly or 200mg on 3 consecutive days every months have a documented effect. Pityrosporum folliculitis is a chronic disease characterized by pruritic follicular papules and pustules located primarily on the upper trunk, neck and upper arms. In direct microscopy clusters of round budding yeast cells are found. The same treatments used for pityriasis versicolor are effective in the treatment of Pityrosporum folliculitis. However, the treatment period has to be prolonged. With topical therapy 3 to 4 weeks of daily treatment and then prophylactic therapy once or twice weekly is often necessary to first clear the disease and then to avoid recurrence. However, due to the presence of P. ovale deep down in the follicle several patients will not be completely cleared with topical therapy and systemic therapy may be necessary. There are now many studies indicating that J9 ovale plays an important role in seborrheic dermatitis. Many of these are treatment studies showing a good effect of antimycotics parallelled by a reduction in number of organisms. Severe seborrheic dermatitis often difficult to treat is associated with AIDS. In peripheral blood from a high number of patients with seborrheic dermatitis we found an increase in number of natural killer T-cells and decreased PHA and Con-A stimulation. Secondary we found low serum IgG antibody titres in patients compared to controls. Other studies have found a reduced lymphocyte stimulation reaction when lymphocytes from patients with seborrheic dermatitis were stimulated with a P. ovale extract. Additionally, IL-2 and IFN gamma pruduction by lymphocytes from patients was markedly depressed and IL-10 sythesis were increased after stimulation with p. ovale extract. Several studies have clearly documented that antifungal therapy is very effective in the treatment of seborrheic dermatitis.

A case of Malassezia (Pityrosporum) Folliculitis Associated with Pityriasis(Tinea) Versicolor / 대한의진균학회지

We report a case of Malassezia folliculitis associated with pityriasis versicolor in a 16-year-old man. He had asymptomatic multiple erythematous papulopustular eruptions and scaly confluent hypopigmented maculas on the anterior chest for 2 months. The diagnosis of Malassezia folliculitis was established with the mycological and histological examinations from the specimen of papulopustules on the chest. Pityriasis versicolor was confirmed by KOH examination with the scales of the hypopigmented macules on the chest. Although the association of these two dermatoses is not common, they are generally accepted as being caused by the same organism of the genus Afafaffgfio, which has different pathogenic stages. In our case, both types of skin lesions were improved after 3 weeks of antifungal therapy with systemic itraconazole (200 mg/day) and topical 1% isoconazole nitrate cream.

Pityrosporum Folliculitis

Thirty-nine patients with pityrosporum folliculitis were investigated clinically and histopathologically. On clinical observation there were numerous, chronic, moderately itchy (64.1%), dome-shaped papules (89.7%) and pustules (66.7%). The most frequent sites of the lesions were the upper portion of the chest (76.9%) and back (56.4%). In biopsy specimens, abundant round and budding yeast cells were seen in a dilated hair follicle. The reptured follicle was observed in 19 specimen (48.7%). The accumulation on inflammatory cells were observed in or around the upper part of the follicle in all specimens. The effect of antimycotic treatment was excellent. After 4 weeks of treatment, 36 patients (92%) were cured and 3 (8%) had improved significantly. KOH/Parker Ink direct smear was done in 20 patients. Blue-colored round and budding yeast cells were observed under a light mcroscope in all patients. We suggest that pityrosporum folliculitis is a common disease of young and middle-aged Koreans.