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Henning MAS, Hay R, Rodriguez-Cerdeira C, Szepietowski JC, Piraccini BM, Ferreirós MP, Arabatzis M, Sergeev A, Nenoff P, Kotrekhova L, Nowicki RJ, Faergemann J, Padovese V, Prohic A, Skerlev M, Schmid-Grendelmeier P, Sigurgeirsson B, Gaitanis G, Lecerf P, Saunte DML. Position statement: Recommendations on the diagnosis and treatment of Malassezia folliculitis. J Eur Acad Dermatol Venereol 2023. [PMID: 36912427 DOI: 10.1111/jdv.18982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/07/2023] [Indexed: 03/14/2023]
Abstract
Malassezia is a lipophilic yeast that is a part of the human mycobiome. Malassezia folliculitis appears when the benign colonization of the hair follicles, by the Malassezia yeasts, becomes symptomatic with pruritic papules and pustules. Although Malassezia folliculitis is common in hospital departments, diagnosing and treating it varies among dermatologists and countries. The European Academy of Dermatology and Venereology Mycology Task Force Malassezia folliculitis working group has, therefore, sought to develop these recommendations for the diagnosis and management of Malassezia folliculitis. Recommendations comprise methods for diagnosing Malassezia folliculitis, required positive findings before starting therapies and specific treatment algorithms for individuals who are immunocompetent, immunocompromised or who have compromised liver function. In conclusion, this study provides a clinical strategy for diagnosing and managing Malassezia folliculitis.
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Affiliation(s)
- M A S Henning
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - R Hay
- King's College London, London, UK
| | | | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - B M Piraccini
- Dermatology, IRCCS Policlinico di Sant'Orsola, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - M P Ferreirós
- Department of Dermatology, Faculty of Medicine, University of Santiago de Compostela, A Coruña, Spain
| | - M Arabatzis
- Dermatology Department, Medical School, University of Thessaloniki, Thessaloniki, Greece
| | - A Sergeev
- All-Russian National Academy of Mycology, Moscow, Russia
| | - P Nenoff
- Laboratory of Medical Microbiology, Mölbis, Germany
| | - L Kotrekhova
- Department of Dermatovenereology, North Western State Medical University, Saint Petersburg, Russia
| | - R J Nowicki
- Department of Dermatology, Venereology, and Allergology, Medical University of Gdansk, Gdańsk, Poland
| | - J Faergemann
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - V Padovese
- Department of Dermatology and Venereology, Genitourinary Clinic, Mater Dei Hospital, Msida, Malta.,International Foundation for Dermatology, Migrants Health Dermatology Working Group, London, UK
| | - A Prohic
- Department of Dermatovenereology, University Sarajevo School of Science and Technology, Sarajevo Medical School, Sarajevo, Bosnia and Herzegovina
| | - M Skerlev
- Department of Dermatology and Venereology, Zagreb University School of Medicine and Zagreb University Hospital, Zagreb, Croatia
| | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital Zurich and Medical Faculty, University of Zurich, Zurich, Switzerland
| | - B Sigurgeirsson
- Department of Dermatology, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - G Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - P Lecerf
- Department of Dermatology, University Hospital Brugmann & Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - D M L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
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Green M, Kashetsky N, Feschuk A, Maibach H. Pityrosporum folliculitis in immunocompromised populations: A systematic review. J Am Acad Dermatol 2023; 88:690-692. [PMID: 35868569 DOI: 10.1016/j.jaad.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Maxwell Green
- Tulane University School of Medicine, New Orleans, Louisiana.
| | - Nadia Kashetsky
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Aileen Feschuk
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Howard Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, California
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3
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Guo W, Zhang B. Itchy papules and pustules on the forehead. BMJ 2023; 380:e070988. [PMID: 36758994 DOI: 10.1136/bmj-2022-070988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Wu Guo
- Department of Dermatology, Children's Hospital affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital. Zhengzhou, China
| | - Bin Zhang
- Beijing Children's Hospital of Capital Medical University, Beijing, China
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Barrera-Godínez A, Figueroa-Ramos G. Malassezia Folliculitis in the Setting of COVID-19. CURRENT FUNGAL INFECTION REPORTS 2023; 17:71-76. [PMID: 36741270 PMCID: PMC9886535 DOI: 10.1007/s12281-023-00450-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 02/03/2023]
Abstract
Purpose of Review To review recent literature on Malassezia folliculitis and explore its association with COVID-19. Recent Findings Reports of Malassezia folliculitis in the setting of COVID-19 are scarce. Shared characteristics between affected individuals include male sex, obesity, intensive care, and administration of systemic antibiotics and systemic steroids. Dexamethasone can potentially stimulate sebum production and therefore lead to Malassezia proliferation. The clinical picture of Malassezia folliculitis accompanying COVID-19 is similar to classic descriptions but tends to spare the face and predominates in occlusion sites. Summary Malassezia folliculitis is under-recognized. Fever, sweating, occlusion, immobility, antibiotics, and dexamethasone contribute to COVID-19 patients developing Malassezia folliculitis. Antifungal therapy, together with correcting predisposing factors, is the mainstay of management. Future research should explore the relationship between systemic steroids and other acneiform reactions.
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Affiliation(s)
- Alejandro Barrera-Godínez
- Department of Dermatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15 Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080 Mexico City, Mexico
| | - Grecia Figueroa-Ramos
- Department of Dermatology, Instituto Nacional de Ciencias Médicas Y Nutrición Salvador Zubirán, Vasco de Quiroga 15 Colonia Belisario Domínguez Sección XVI, Tlalpan, 14080 Mexico City, Mexico
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Nenoff P, Klonowski E, Uhrlaß S, Verma SB, Mayser P. [Clinical picture, causative agents and diagnostics of dermatomycoses]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 74:974-993. [PMID: 37889305 DOI: 10.1007/s00105-023-05245-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023]
Abstract
Dermatomycoses affect free skin, hairy scalp, fingernails and toenails. In addition, oral mucosa and genital mucosa can also be affected by fungal infections. The most common pathogens causing skin fungal infections are dermatophytes. They are responsible for, among others, tinea corporis, tinea capitis and onychomycosis (tinea unguium). Mainly anthropophilic dermatophytes are found as pathogens. In the case of tinea capitis-at least in Europe and in German-speaking countries-zoophilic skin fungi must also be considered. Rarely, geophilic dermatophytes can also be isolated. Yeast infections of the skin, mostly caused by Candida albicans, primarily affect the intertriginous skin areas, for example, the groin region, but also the submammary area and the spaces between the fingers and toes. Elderly patients are often affected, but also infants and, in particular, immunocompromised patients. These patient groups are also more frequently affected by oral mucosal infections caused by Candida albicans and other Candida species. Pseudomembranous candidiasis of the oral mucosa and tongue typically affects patients with HIV/AIDS. Mold infections in dermatology are relevant in onychomycosis of the big toenail. The causative agent is usually Scopulariopsis brevicaulis. Cutaneous mold infections are rare and only occur in immunocompromised patients. The mycological diagnosis of dermatomycoses is based on the microscopic, if possible fluorescence-optical detection of fungal hyphae and spores from skin scales, nail shavings and hair roots. The culture detection of dermatophytes, yeasts and molds allows the identification of the causative fungal species, but often fails, especially in patients who have already been treated with antifungal agents. In view of the high sensitivity and specificity of the molecular methods for fungal detection compared to culture, polymerase chain reaction (PCR) must realistically be regarded as the gold standard for dermatophytosis diagnostics. However, it should not be neglected that the three pillars of diagnostics-preparation, culture, PCR-currently deliver the best results.
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Affiliation(s)
- Pietro Nenoff
- labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland.
| | - Esther Klonowski
- labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Silke Uhrlaß
- labopart - Medizinische Laboratorien, Mölbiser Hauptstr. 8, 04571, Rötha/OT Mölbis, Deutschland
| | - Shyam B Verma
- Nirvan & 'In Skin Clinic', Vadodara, Indien
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
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Kurniadi I, Hendra Wijaya W, Timotius KH. Malassezia virulence factors and their role in dermatological disorders. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2022. [DOI: 10.15570/actaapa.2022.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Melin A, Chosidow O, Foulet F, Ingen-Housz-Oro S, Limal N, Audard V, Le Bras F, Botterel F, Fardet L, Bernigaud C. Don't Judge a Book by its Cover. 'Steroid Acne': an unrecognized role of Malassezia and Demodex? J Eur Acad Dermatol Venereol 2021; 36:e229-e231. [PMID: 34657328 DOI: 10.1111/jdv.17759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- A Melin
- Department of Dermatology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - O Chosidow
- Department of Dermatology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.,EA 7380, DYNAMYC, Ecole nationale vétérinaire d'Alfort, Université Paris-Est Créteil, USC Anses, Maisons-Alfort, France
| | - F Foulet
- EA 7380, DYNAMYC, Ecole nationale vétérinaire d'Alfort, Université Paris-Est Créteil, USC Anses, Maisons-Alfort, France.,Department of Microbiology, Parasitology and Mycology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, UPEC, Créteil, France
| | - S Ingen-Housz-Oro
- Department of Dermatology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - N Limal
- Department of Internal Medicine, Faculté de Santé, AP-HP, Hôpital Henri Mondor, UPEC, Créteil, France
| | - V Audard
- Department of Nephrology and Transplantation, Faculté de Santé, AP-HP, Hôpitaux Universitaires Henri Mondor, UPEC, Créteil, France.,Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Univ Paris Est Créteil, Créteil, France
| | - F Le Bras
- Lymphoid Hemopathy Unit, Faculté de Santé, AP-HP, Hôpital Henri Mondor, UPEC, Créteil, France
| | - F Botterel
- EA 7380, DYNAMYC, Ecole nationale vétérinaire d'Alfort, Université Paris-Est Créteil, USC Anses, Maisons-Alfort, France.,Department of Microbiology, Parasitology and Mycology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, UPEC, Créteil, France
| | - L Fardet
- Department of Dermatology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
| | - C Bernigaud
- Department of Dermatology, Faculté de Santé, AP-HP, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.,EA 7380, DYNAMYC, Ecole nationale vétérinaire d'Alfort, Université Paris-Est Créteil, USC Anses, Maisons-Alfort, France
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Saunte DML, Gaitanis G, Hay RJ. Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment. Front Cell Infect Microbiol 2020; 10:112. [PMID: 32266163 PMCID: PMC7098993 DOI: 10.3389/fcimb.2020.00112] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/28/2020] [Indexed: 11/13/2022] Open
Abstract
Yeasts of the genus, Malassezia, formerly known as Pityrosporum, are lipophilic yeasts, which are a part of the normal skin flora (microbiome). Malassezia colonize the human skin after birth and must therefore, as commensals, be normally tolerated by the human immune system. The Malassezia yeasts also have a pathogenic potential where they can, under appropriate conditions, invade the stratum corneum and interact with the host immune system, both directly but also through chemical mediators. The species distribution on the skin and the pathogenetic potential of the yeast varies between different Malassezia related diseases such as head and neck dermatitis, seborrheic dermatitis, pityriasis versicolor, and Malassezia folliculitis. The diagnostic methods used to confirm the presence of Malassezia yeasts include direct microcopy, culture based methods (often a combination of morphological features of the isolate combined with biochemical test), molecular based methods such as Polymerase Chain Reaction techniques, and Matrix Assisted Laser Desorption/Ionization—Time Of Flight mass spectrometry and the chemical imprint method Raman spectroscopy. Skin diseases caused by Malassezia are usually treated with antifungal therapy and if there are associated inflammatory skin mechanisms this is often supplemented by anti-inflammatory therapy. The aim of this paper is to provide an overview of Malassezia related skin disease, diagnostic methods and treatment options.
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Affiliation(s)
- Ditte M L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - George Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.,DELC Clinic, Biel/Bienne, Switzerland
| | - Roderick James Hay
- St. Johns Institute of Dermatology, Kings College London, London, United Kingdom
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