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Green M, Feschuk AM, Kashetsky N, Maibach HI. Clinical characteristics and treatment outcomes of Pityrosporum folliculitis in immunocompetent patients. Arch Dermatol Res 2023; 315:1497-1509. [PMID: 36517586 PMCID: PMC9750048 DOI: 10.1007/s00403-022-02506-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/10/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
Pityrosporum folliculitis (PF) is a fungal acneiform disease of the hair follicles that often presents with pruritic papules and pustules on the upper body and face. This condition is commonly mistaken for acne vulgaris and can be distinguished from bacterial acne by the presence of fungal spores in the follicular lumen. Although studies have been performed to describe PF in cohorts, little work has been done to aggregate these data. Thus, the goal of this review is to describe the clinical characteristics and treatment outcomes of PF in immunocompetent patients. PubMed, Web of Science, and Embase were searched using the terms "Pityrosporum folliculitis" or "Malassezia folliculitis." All cohorts reporting PF characteristics in patients classified as immunocompetent were reviewed. A total of 15 studies were included. Majority of patients were male (64%) with the average age of presentation of 24.26 years. The most common locations of lesions were the chest (70%) and back/shoulders (69.2%). Pruritus was reported by the majority of patients (71.7%). Additionally, 40.5% of patients reported a history of unsuccessful treatment regimens. Treatment was most successful with an oral antifungal (92%), followed by a topical antifungal (81.6%). In conclusion, majority of patients with PF were younger males. Many patients were primarily treated incorrectly, suggesting the importance of proper diagnosis. PF may be distinguishable from acne vulgaris by the presence of pruritus or suggested when a new acneiform eruption develops following antibiotic therapy or immunosuppression. When properly diagnosed, majority of cases of PF achieve complete response with oral or topical antifungals.
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Affiliation(s)
- Maxwell Green
- Tulane University School of Medicine, 131 S Robertson Ave, 15th Floor, New Orleans, LA, 70112, USA.
| | - Aileen M Feschuk
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland & Labrador, Canada
| | - Nadia Kashetsky
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland & Labrador, Canada
| | - Howard I Maibach
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
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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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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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Niode NJ, Suling PL, Adji A, Miranda E, Bramono K, Astari L, Ervianti E, Sondakh ORL, Rusmawardiana, Yenny SW, Widasmara D, Lubis FM, Widaty S. Clinico-Laboratory Findings of Malassezia Folliculitis in Indonesia: a Multicenter Study. Mycoses 2022; 65:953-959. [PMID: 35920036 DOI: 10.1111/myc.13511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Malassezia folliculitis (MF) is a humid-favored fungal skin disease caused by Malassezia species. Inaccurate treatments, changes in skin flora, and disease exacerbation are often occurred due to oversights in the diagnosis. Several diagnostic methods are established for MF. OBJECTIVE To identify clinico-laboratory findings of Malassezia folliculitis in Indonesia. METHODS The study was conducted from January 2014 to December 2018 in seven referral teaching hospitals. Medical records of MF-diagnosed patients were obtained and analyzed using the binomial test, chi-square test, and Cohen's Kappa coefficient in SPSS 26.0. RESULTS A total of 353 cases of MF were identified in seven referral teaching hospitals in Indonesia, 66.3% of which were males and 33.7% were females, dominated by the 17-25 years old group (44.5%). Itchy sensation (83.9%) was a major subjective complaint. Lesions were majorly found on the trunk-chest, back, and shoulder (68.3%), while the clinical manifestation are mostly follicular papule-pustular lesions (62.1%). Patients were 87.4% positive by KOH examination (modified Jacinto Jamora's criteria) and 69.1% positive by Wood's lamp. Generally, sex, age, subjective complaint, lesion location, clinical manifestation, and both examinations were statistically significant (p<0.001). A significant relationship between all the clinical criteria of the patients in the KOH; especially the clinical manifestation was significantly related to the Wood's lamp. The Cohen's Kappa assessment suggested that there was an agreement between KOH and Wood's lamp (κ = -0,272, p<0.001). CONCLUSION The clinical symptoms of Malassezia folliculitis are dominated by pruritus, papulopustular follicular lesions on the trunk, and the presence of spore load.
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Affiliation(s)
- Nurdjannah J Niode
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou Hospital Manado, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Pieter L Suling
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou Hospital Manado, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Aryani Adji
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou Hospital Manado, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Eliza Miranda
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Kusmarinah Bramono
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Linda Astari
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Hospital, Surabaya, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Evy Ervianti
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Hospital, Surabaya, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Oktavia R L Sondakh
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sam Ratulangi, Prof. Dr. R. D. Kandou Hospital Manado, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Rusmawardiana
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sriwijaya, Dr. Mohammad Hoesin Hospital, Palembang, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Satya W Yenny
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Andalas, M. Djamil Hospital, Padang, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Dhelya Widasmara
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Brawijaya, Saiful Anwar Hospital, Malang, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Flora M Lubis
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik Hospital, Medan, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
| | - Sandra Widaty
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Hospital, Surabaya, Indonesia.,Indonesian Dermatomycosis Study Group - Indonesian Society of Dermatology and Venereology, Jakarta, Indonesia
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