1
|
Zhang XE, Zheng P, Ye SZ, Ma X, Liu E, Pang YB, He QY, Zhang YX, Li WQ, Zeng JH, Guo J. Microbiome: Role in Inflammatory Skin Diseases. J Inflamm Res 2024; 17:1057-1082. [PMID: 38375021 PMCID: PMC10876011 DOI: 10.2147/jir.s441100] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
As the body's largest organ, the skin harbors a highly diverse microbiota, playing a crucial role in resisting foreign pathogens, nurturing the immune system, and metabolizing natural products. The dysregulation of human skin microbiota is implicated in immune dysregulation and inflammatory responses. This review delineates the microbial alterations and immune dysregulation features in common Inflammatory Skin Diseases (ISDs) such as psoriasis, rosacea, atopic dermatitis(AD), seborrheic dermatitis(SD), diaper dermatitis(DD), and Malassezia folliculitis(MF).The skin microbiota, a complex and evolving community, undergoes changes in composition and function that can compromise the skin microbial barrier. These alterations induce water loss and abnormal lipid metabolism, contributing to the onset of ISDs. Additionally, microorganisms release toxins, like Staphylococcus aureus secreted α toxins and proteases, which may dissolve the stratum corneum, impairing skin barrier function and allowing entry into the bloodstream. Microbes entering the bloodstream activate molecular signals, leading to immune disorders and subsequent skin inflammatory responses. For instance, Malassezia stimulates dendritic cells(DCs) to release IL-12 and IL-23, differentiating into a Th17 cell population and producing proinflammatory mediators such as IL-17, IL-22, TNF-α, and IFN-α.This review offers new insights into the role of the human skin microbiota in ISDs, paving the way for future skin microbiome-specific targeted therapies.
Collapse
Affiliation(s)
- Xue-Er Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu, 6610075, People’s Republic of China
| | - Pai Zheng
- Chengdu University of Traditional Chinese Medicine, Chengdu, 6610075, People’s Republic of China
| | - Sheng-Zhen Ye
- Chengdu University of Traditional Chinese Medicine, Chengdu, 6610075, People’s Republic of China
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 6610072, People’s Republic of China
| | - Xiao Ma
- State Key Laboratory of Southwestern Chinese Medicine Resources, School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, People’s Republic of China
| | - E Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu, 6610075, People’s Republic of China
| | - Yao-Bin Pang
- Chengdu University of Traditional Chinese Medicine, Chengdu, 6610075, People’s Republic of China
| | - Qing-Ying He
- Chengdu University of Traditional Chinese Medicine, Chengdu, 6610075, People’s Republic of China
| | - Yu-Xiao Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu, 6610075, People’s Republic of China
| | - Wen-Quan Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, 6610075, People’s Republic of China
| | - Jin-Hao Zeng
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610072, People’s Republic of China
| | - Jing Guo
- Department of Dermatology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 6610072, People’s Republic of China
| |
Collapse
|
2
|
Cassard L, Honari G, Tousi B. The Skin and Lewy Body Disease. J Alzheimers Dis 2024; 100:761-769. [PMID: 38968048 DOI: 10.3233/jad-240198] [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] [Indexed: 07/07/2024]
Abstract
This manuscript reviews the significant skin manifestations of Lewy body disease, including Parkinson's disease and dementia with Lewy bodies, and the diagnostic utility of skin biopsy. Besides classic motor and cognitive symptoms, non-motor manifestations, particularly dermatologic disorders, can play a crucial role in disease presentation and diagnosis. This review explores the intricate relationship between the skin and Lewy body disease. Seborrheic dermatitis, autoimmune blistering diseases (bullous pemphigoid and pemphigus), rosacea, and melanoma are scrutinized for their unique associations with Parkinson's disease, revealing potential links through shared pathophysiological mechanisms. Advances in diagnostic techniques allow the identification of promising biomarkers such as α-synuclein in samples obtained by skin punch biopsy. Understanding the dermatologic aspects of Lewy body disease not only contributes to its holistic characterization but also holds implications for innovative diagnostic approaches.
Collapse
Affiliation(s)
- Lydia Cassard
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Golara Honari
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Babak Tousi
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
- Lou Ruvo Center for Brain Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
3
|
Ugochukwu ICI, Rhimi W, Chebil W, Rizzo A, Tempesta M, Giusiano G, Tábora RFM, Otranto D, Cafarchia C. Part 2: Understanding the role of Malassezia spp. in skin disorders: pathogenesis of Malassezia associated skin infections. Expert Rev Anti Infect Ther 2023; 21:1245-1257. [PMID: 37883035 DOI: 10.1080/14787210.2023.2274500] [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: 08/18/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Malassezia is a major component of the skin microbiome, a lipophilic symbiotic organism of the mammalian skin, which can switch to opportunistic pathogens triggering multiple dermatological disorders in humans and animals. This phenomenon is favored by endogenous and exogenous host predisposing factors, which may switch Malassezia from a commensal to a pathogenic phenotype. AREA COVERED This review summarizes and discusses the most recent literature on the pathogenesis of Malassezia yeasts, which ultimately results in skin disorders with different clinical presentation. A literature search of Malassezia pathogenesis was performed via PubMed and Google scholar (up to May 2023), using the following keywords: Pathogenesis and Malassezia;host risk factors and Malassezia, Malassezia and skin disorders; Malassezia and virulence factors: Malassezia and metabolite production; Immunology and Malassezia. EXPERT OPINION Malassezia yeasts can maintain skin homeostasis being part of the cutaneous mycobiota; however, when the environmental or host conditions change, these yeasts are endowed with a remarkable plasticity and adaptation by modifying their metabolism and thus contributing to the appearance or aggravation of human and animal skin disorders.
Collapse
Affiliation(s)
- Iniobong Chukwuebuka Ikenna Ugochukwu
- Department of Veterinary Medicine, University of Bari Aldo Moro, Valenzano, Italy
- Department of Veterinary Pathology and Microbiology, University of Nigeria, Nsukka, Nigeria
| | - Wafa Rhimi
- Department of Veterinary Medicine, University of Bari Aldo Moro, Valenzano, Italy
| | - Wissal Chebil
- Laboratory of Medical and Molecular Parasitology-Mycology, Department of Clinical Biology, Faculty of Pharmacy, University of Monastir, Monastir, Tunisia
| | - Antonio Rizzo
- Department of Veterinary Medicine, University of Bari Aldo Moro, Valenzano, Italy
| | - Maria Tempesta
- Department of Veterinary Medicine, University of Bari Aldo Moro, Valenzano, Italy
| | - Gustavo Giusiano
- Departamento de Micología, Instituto de Medicina Regional, Facultad de Medicina, Universidad Nacional del Nordeste, Resistencia, Argentina
| | | | - Domenico Otranto
- Department of Veterinary Medicine, University of Bari Aldo Moro, Valenzano, Italy
- Faculty of Veterinary Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Claudia Cafarchia
- Department of Veterinary Medicine, University of Bari Aldo Moro, Valenzano, Italy
| |
Collapse
|
4
|
Kengmo Tchoupa A, Kretschmer D, Schittek B, Peschel A. The epidermal lipid barrier in microbiome-skin interaction. Trends Microbiol 2023:S0966-842X(23)00027-6. [PMID: 36822953 DOI: 10.1016/j.tim.2023.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
The corneocyte layers forming the upper surface of mammalian skin are embedded in a lamellar-membrane matrix which repels harmful molecules while retaining solutes from subcutaneous tissues. Only certain bacterial and fungal taxa colonize skin surfaces. They have ways to use epidermal lipids as nutrients while resisting antimicrobial fatty acids. Skin microorganisms release lipophilic microbe-associated molecular pattern (MAMP) molecules which are largely retained by the epidermal lipid barrier. Skin barrier defects, as in atopic dermatitis, impair lamellar-membrane integrity, resulting in altered skin microbiomes, which then include the pathogen Staphylococcus aureus. The resulting increased penetration of MAMPs and toxins promotes skin inflammation. Elucidating how microorganisms manipulate the epidermal lipid barrier will be key for better ways of preventing inflammatory skin disorders.
Collapse
Affiliation(s)
- Arnaud Kengmo Tchoupa
- Interfaculty Institute of Microbiology and Infection Medicine Tübingen, Infection Biology Section, University of Tübingen, Tübingen, Germany; Cluster of Excellence EXC 2124 Controlling Microbes to Fight Infections, University of Tübingen, Tübingen, Germany; German Center for Infection Research (DZIF), partner site Tübingen, Germany
| | - Dorothee Kretschmer
- Interfaculty Institute of Microbiology and Infection Medicine Tübingen, Infection Biology Section, University of Tübingen, Tübingen, Germany; Cluster of Excellence EXC 2124 Controlling Microbes to Fight Infections, University of Tübingen, Tübingen, Germany; German Center for Infection Research (DZIF), partner site Tübingen, Germany
| | - Birgit Schittek
- Cluster of Excellence EXC 2124 Controlling Microbes to Fight Infections, University of Tübingen, Tübingen, Germany; Dermatology Department, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Peschel
- Interfaculty Institute of Microbiology and Infection Medicine Tübingen, Infection Biology Section, University of Tübingen, Tübingen, Germany; Cluster of Excellence EXC 2124 Controlling Microbes to Fight Infections, University of Tübingen, Tübingen, Germany; German Center for Infection Research (DZIF), partner site Tübingen, Germany.
| |
Collapse
|
5
|
Hadrich I, Khemekhem N, Neji S, Trablesi H, Ilahi A, Sellami H, Makni F, Ayadi A. Production and Quantification of Virulence Factors in Malassezia Species. Pol J Microbiol 2022; 71:529-538. [PMID: 36473111 PMCID: PMC9944974 DOI: 10.33073/pjm-2022-047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/20/2022] [Indexed: 12/12/2022] Open
Abstract
Seventy-seven strains of Malassezia were included in this study. Biofilm and hydrolytic enzyme production were studied by using specific solid media. The Real-Time reverse transcriptase qPCR method was applied to determine the overexpression of genes encoding the extracellular enzymes. All included Malassezia species produced biofilms. No statistically significant difference was observed between Malassezia species in biofilm formation (p = 0.567). All Malassezia species produced lipase, and 95% of Malassezia globosa showed a strong enzymatic activity (Pz = 0.55 ± 0.02). A statistically significant difference was observed between the mean keratinase indices of Malassezia slooffiae and the other Malassezia species (p = 0.005). The overexpression of one or more genes was observed in 100% of strains isolated from patients with folliculitis, 87.5% - with pityriasis versicolor, and 57.14% of the control group isolates. A statistically significant difference in the lipase gene expression (p = 0.042) was between the strains from patients with folliculitis and the control group. This investigation provides more information about the frequency of the production of the major enzymes considered virulence factors of Malassezia species. Interestingly, the overexpression of one or more genes was observed in strains isolated from patients with Malassezia disorders.
Collapse
Affiliation(s)
- Inès Hadrich
- Laboratory of Fungal and Parasitic Molecular Biology, School of Medicine, University of Sfax, Sfax, Tunisia,Laboratory of Parasitology – Mycology, UH Habib Bourguiba, Sfax, Tunisia,Faculty of Science, University of Gabes, Gabes, Tunisia, Laboratory of Fungal and Parasitic Molecular Biology, School of Medicine, University of Sfax, Sfax, Tunisia; Laboratory of Parasitology – Mycology, UH Habib Bourguiba, Sfax, Tunisia; Faculty of Science, University of Gabes, Gabes, Tunisia
| | - Nahed Khemekhem
- Laboratory of Fungal and Parasitic Molecular Biology, School of Medicine, University of Sfax, Sfax, Tunisia,Laboratory of Parasitology – Mycology, UH Habib Bourguiba, Sfax, Tunisia
| | - Sourour Neji
- Laboratory of Fungal and Parasitic Molecular Biology, School of Medicine, University of Sfax, Sfax, Tunisia,Laboratory of Parasitology – Mycology, UH Habib Bourguiba, Sfax, Tunisia
| | - Houaida Trablesi
- Laboratory of Fungal and Parasitic Molecular Biology, School of Medicine, University of Sfax, Sfax, Tunisia,Laboratory of Parasitology – Mycology, UH Habib Bourguiba, Sfax, Tunisia
| | - Amin Ilahi
- Laboratory of Fungal and Parasitic Molecular Biology, School of Medicine, University of Sfax, Sfax, Tunisia,Laboratory of Parasitology – Mycology, UH Habib Bourguiba, Sfax, Tunisia
| | - Hayet Sellami
- Laboratory of Fungal and Parasitic Molecular Biology, School of Medicine, University of Sfax, Sfax, Tunisia,Laboratory of Parasitology – Mycology, UH Habib Bourguiba, Sfax, Tunisia
| | - Fattouma Makni
- Laboratory of Fungal and Parasitic Molecular Biology, School of Medicine, University of Sfax, Sfax, Tunisia,Laboratory of Parasitology – Mycology, UH Habib Bourguiba, Sfax, Tunisia
| | - Ali Ayadi
- Laboratory of Fungal and Parasitic Molecular Biology, School of Medicine, University of Sfax, Sfax, Tunisia,Laboratory of Parasitology – Mycology, UH Habib Bourguiba, Sfax, Tunisia
| |
Collapse
|
6
|
Abstract
Malassezia is a lipophilic cutaneous commensal yeast and associated with various skin disorders. The yeast also causes bloodstream infection via intravascular catheters and can be detected even in human gut microbiota. Ambient pH is one of the major factors that affect the physiology and metabolism of several pathogenic microorganisms. Although dynamic changes of pH environment in different parts of the body is a great challenge for Malassezia to confront, the role that ambient pH plays in Malassezia is largely unknown. In this study, we investigated the impact of ambient pH on physiology and expression of lipases in M. furfur grown under different pH conditions. The yeast was able to grow in media ranging from pH 4 to 10 without morphological alteration. Elevation in pH value enhanced the extracellular lipase activity but decreased that of intracellular lipase. The qPCR results revealed that a set of functional lipase genes, LIP3-6, were constitutively expressed regardless of pH conditions or exposure time. Based on the data, we conclude that the external pH plays a promotional role in the secretion of lipases but exerts less effect on transcription of the genes and morphology in M. furfur.
Collapse
|
7
|
Yu Y, Dunaway S, Champer J, Kim J, Alikhan A. Changing our microbiome: probiotics in dermatology. Br J Dermatol 2019; 182:39-46. [PMID: 31049923 DOI: 10.1111/bjd.18088] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Commensal bacteria are a major factor in human health and disease pathogenesis. Interest has recently expanded beyond the gastrointestinal microbiome to include the skin microbiome and its impact on various skin diseases. OBJECTIVES Here we present current data reviewing the role of the microbiome in dermatology, considering both the gut and skin microflora. Our objective was to evaluate whether the clinical data support the utility of oral and topical probiotics for certain dermatological diseases. METHODS The PubMed and ClinicalTrials.gov databases were searched for basic science, translational research and clinical studies that investigated differences in the cutaneous microbiome and the impact of probiotics in patients with atopic dermatitis, acne vulgaris, psoriasis, chronic wounds, seborrhoeic dermatitis and cutaneous neoplasms. RESULTS Few clinical trials exist that explore the utility of probiotics for the prevention and treatment of dermatological diseases, with the exception of atopic dermatitis. Most studies investigated oral probiotic interventions, and of those utilizing topical probiotics, few included skin commensals. In general, the available clinical trials yielded positive results with improvement of the skin conditions after probiotic intervention. CONCLUSIONS Oral and topical probiotics appear to be effective for the treatment of certain inflammatory skin diseases and demonstrate a promising role in wound healing and skin cancer. However, more studies are needed to confirm these results. What's already known about this topic? The microbiome plays a role in human health and disease pathogenesis. Probiotics can manipulate the host microbiome and may confer health benefits for patients. Research to date has already begun to explore the utility of oral and topical probiotics for certain dermatological diseases. What does this study add? This review presents basic science and clinical trial data to support the role of the gut and skin microbiome in dermatology. Current data are reviewed on the use of probiotics in the prevention and treatment of skin diseases, including atopic dermatitis, acne vulgaris, psoriasis, seborrhoeic dermatitis, chronic wounds and cutaneous neoplasms. Future probiotic interventions are proposed.
Collapse
Affiliation(s)
- Y Yu
- Department of Dermatology, University of Cincinnati, Cincinnati, OH, U.S.A
| | - S Dunaway
- Department of Dermatology, University of Cincinnati, Cincinnati, OH, U.S.A
| | - J Champer
- Department of Computational Biology and Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, U.S.A
| | - J Kim
- Division of Dermatology and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, U.S.A
| | - A Alikhan
- Sutter Medical Foundation, Sacramento, CA, U.S.A
| |
Collapse
|
8
|
Novel Non-Steroidal Facial Cream Demonstrates Antifungal and Anti-Inflammatory Properties in Ex Vivo Model for Seborrheic Dermatitis. Dermatol Ther (Heidelb) 2019; 9:571-578. [PMID: 31278482 PMCID: PMC6704224 DOI: 10.1007/s13555-019-0311-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Seborrheic dermatitis (SEBD) is a chronic, recurrent skin disorder that typically occurs as an inflammatory response to fungi of the genus Malassezia. The development of an ex vivo model that mimics the fungal proliferation and skin inflammation of SEBD would play an important role in screening formulations for their efficacy in treating SEBD. METHODS An ex vivo model for SEBD using human skin explants that had been mechanically manipulated to facilitate colonization of Malassezia furfur was developed. This model was used to evaluate the efficacy of a novel non-steroidal facial cream (NSFC) in inhibiting M. furfur proliferation and reducing inflammatory cytokine levels. RESULTS This model reproduced some of the key pathological features of SEBD, including M. furfur proliferation and inflammatory cytokine production. Topical application of NSFC facial cream reduced M. furfur counts by 92% (p < 0.05) and levels of interleukin 8 (IL-8) and tumor necrosis factor alpha (TNF-α) by 82% and 40%, respectively (p < 0.05, both). CONCLUSION The proposed ex vivo model for SEBD could be a useful tool to evaluate topical antifungal treatments. The novel NSFC tested in this study reduced M. furfur proliferation and inflammatory cytokine levels following topical application and may be helpful in the management of SEBD. FUNDING ISDIN.
Collapse
|
9
|
Tee CB, Sei Y, Kajiwara S. Secreted Hydrolytic and Haemolytic Activities of Malassezia Clinical Strains. Mycopathologia 2019; 184:227-238. [PMID: 30919309 DOI: 10.1007/s11046-019-00330-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/14/2019] [Indexed: 12/22/2022]
Abstract
Malassezia yeasts are opportunistic pathogens associated with a number of skin diseases in animals and humans. The free fatty acids released through these organisms' lipase and phospholipase activities trigger inflammation in the host; thus, these lipase and phospholipase activities are widely recognised as some of the most important factors in Malassezia pathogenesis. In this study, we sought to investigate and examine the relationship between these secreted hydrolytic activities and haemolytic activity in newly isolated Malassezia clinical strains. This characterisation was expected to elucidate pathogenicity of this fungus. We isolated 35 clinical strains of Malassezia spp.; the most frequently isolated species were M. sympodialis and M. furfur. Next, we analysed the hydrolytic activities of all of these clinical isolates; all of these strains (except for one M. dermatis isolate) showed detectable lipase and phospholipase activities against 4-nitrophenyl palmitate and L-α-phosphatidylcholine, dipalmitoyl, respectively. Most of the M. globosa isolates showed higher lipase activities than isolates of other Malassezia species. In terms of phospholipase activity, no significant difference was observed among species of Malassezia, although one isolate of M. globosa showed considerably higher phospholipase activity than the others. All tested strains also exhibited haemolytic activity, both as determined using 5% (v/v) sheep blood agar (halo assay) and by quantitative assay. Although all tested strains showed detectable haemolytic activity, we did not observe an apparent correlation between the secreted lipase and phospholipase activities and haemolytic activity. We infer that the haemolytic activities of Malassezia spp. are mediated by non-enzymatic factor(s) that are present in the secreted samples.
Collapse
Affiliation(s)
- Chui Boon Tee
- School of Life Science and Technology, Tokyo Institute of Technology, J3-7, 4259 Nagatsuta, Midori-ku, Yokohama, Kanagawa, 226-8501, Japan
| | - Yoshihiro Sei
- Department of Dermatology, Teikyo University School of Medicine, Mizonokuchi Hospital, Kawasaki, Japan
| | - Susumu Kajiwara
- School of Life Science and Technology, Tokyo Institute of Technology, J3-7, 4259 Nagatsuta, Midori-ku, Yokohama, Kanagawa, 226-8501, Japan.
| |
Collapse
|
10
|
Park M, Cho YJ, Lee YW, Jung WH. Understanding the Mechanism of Action of the Anti-Dandruff Agent Zinc Pyrithione against Malassezia restricta. Sci Rep 2018; 8:12086. [PMID: 30108245 PMCID: PMC6092343 DOI: 10.1038/s41598-018-30588-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/01/2018] [Indexed: 01/05/2023] Open
Abstract
Dandruff is known to be associated with Malassezia restricta. Zinc pyrithione (ZPT) has been used as an ingredient in anti-dandruff treatments. The mechanism of ZPT has been investigated in several studies; however, a non-pathogenic model yeast, such as Saccharomyces cerevisiae was most often used. The aim of the present study was to understand how ZPT inhibits the growth of M. restricta. We analyzed the cellular metal content and transcriptome profile of ZPT-treated M. restricta cells and found that ZPT treatment dramatically increased cellular zinc levels, along with a small increase in cellular copper levels. Moreover, our transcriptome analysis showed that ZPT inhibits Fe-S cluster synthesis in M. restricta. We also observed that ZPT treatment significantly reduced the expression of lipases, whose activities contribute to the survival and virulence of M. restricta on human skin. Therefore, the results of our study suggest that at least three inhibitory mechanisms are associated with the action of ZPT against M. restricta: (i) an increase in cellular zinc levels, (ii) inhibition of mitochondrial function, and (iii) a decrease in lipase expression.
Collapse
Affiliation(s)
- Minji Park
- Department of Systems Biotechnology, Chung-Ang University, Anseong, 17546, Korea
| | - Yong-Joon Cho
- Korea Polar Research Institute, Incheon, 21990, Korea
| | - Yang Won Lee
- Department of Dermatology, School of Medicine, Konkuk University, Seoul, 05029, Korea. .,Research Institute of Medicine, Konkuk University, Seoul, 05029, Korea.
| | - Won Hee Jung
- Department of Systems Biotechnology, Chung-Ang University, Anseong, 17546, Korea.
| |
Collapse
|
11
|
Keyhani NO. Lipid biology in fungal stress and virulence: Entomopathogenic fungi. Fungal Biol 2018; 122:420-429. [DOI: 10.1016/j.funbio.2017.07.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/11/2017] [Accepted: 07/13/2017] [Indexed: 12/17/2022]
|
12
|
Sparber F, LeibundGut-Landmann S. Host Responses to Malassezia spp. in the Mammalian Skin. Front Immunol 2017; 8:1614. [PMID: 29213272 PMCID: PMC5702624 DOI: 10.3389/fimmu.2017.01614] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/08/2017] [Indexed: 12/11/2022] Open
Abstract
The skin of mammalian organisms is home for a myriad of microbes. Many of these commensals are thought to have beneficial effects on the host by critically contributing to immune homeostasis. Consequently, dysbiosis can have detrimental effects for the host that may manifest with inflammatory diseases at the barrier tissue. Besides bacteria, fungi make an important contribution to the microbiota and among these, the yeast Malassezia widely dominates in most areas of the skin in healthy individuals. There is accumulating evidence that Malassezia spp. are involved in a variety of skin disorders in humans ranging from non- or mildly inflammatory conditions such as dandruff and pityriasis versicolor to more severe inflammatory skin diseases like seborrheic eczema and atopic dermatitis. In addition, Malassezia is strongly linked to the development of dermatitis and otitis externa in dogs. However, the association of Malassezia spp. with such diseases remains poorly characterized. Until now, studies on the fungus–host interaction remain sparse and they are mostly limited to experiments with isolated host cells in vitro. They suggest a multifaceted crosstalk of Malassezia spp. with the skin by direct activation of the host via conserved pattern recognition receptors and indirectly via the release of fungus-derived metabolites that can modulate the function of hematopoietic and/or non-hematopoietic cells in the barrier tissue. In this review, we discuss our current understanding of the host response to Malassezia spp. in the mammalian skin.
Collapse
Affiliation(s)
- Florian Sparber
- Section of Immunology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
| | | |
Collapse
|
13
|
Natural (Mineral, Vegetable, Coconut, Essential) Oils and Contact Dermatitis. Curr Allergy Asthma Rep 2017; 16:51. [PMID: 27373890 DOI: 10.1007/s11882-016-0630-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Natural oils include mineral oil with emollient, occlusive, and humectant properties and the plant-derived essential, coconut, and other vegetable oils, composed of triglycerides that microbiota lipases hydrolyze into glycerin, a potent humectant, and fatty acids (FAs) with varying physico-chemical properties. Unsaturated FAs have high linoleic acid used for synthesis of ceramide-I linoleate, a barrier lipid, but more pro-inflammatory omega-6:-3 ratios above 10:1, and their double bonds form less occlusive palisades. VCO FAs have a low linoleic acid content but shorter and saturated FAs that form a more compact palisade, more anti-inflammatory omega-6:-3 ratio of 2:1, close to 7:1 of olive oil, which disrupts the skin barrier, otherwise useful as a penetration enhancer. Updates on the stratum corneum illustrate how this review on the contrasting actions of NOs provide information on which to avoid and which to select for barrier repair and to lower inflammation in contact dermatitis genesis.
Collapse
|
14
|
Park M, Cho YJ, Lee YW, Jung WH. Whole genome sequencing analysis of the cutaneous pathogenic yeastMalassezia restrictaand identification of the major lipase expressed on the scalp of patients with dandruff. Mycoses 2016; 60:188-197. [DOI: 10.1111/myc.12586] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/10/2016] [Accepted: 10/28/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Minji Park
- Department of Systems Biotechnology; Chung-Ang University; Anseong Korea
| | - Yong-Joon Cho
- ChunLab, Inc.; Seoul National University; Seoul Korea
| | - Yang Won Lee
- Department of Dermatology; School of Medicine; Konkuk University; Seoul Korea
- Research Institute of Medical Science; Konkuk University; Seoul Korea
| | - Won Hee Jung
- Department of Systems Biotechnology; Chung-Ang University; Anseong Korea
| |
Collapse
|
15
|
Kim SY, Kim SH, Kim SN, Kim AR, Kim YR, Kim MJ, Park WS, Lee JH, Jung WH, Lee YW, Choe YB, Ahn KJ. Isolation and identification of Malassezia species from Chinese and Korean patients with seborrheic dermatitis and in vitro studies on their bioactivity on sebaceous lipids and IL-8 production. Mycoses 2016; 59:274-80. [PMID: 26786542 DOI: 10.1111/myc.12456] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 11/10/2015] [Accepted: 12/10/2015] [Indexed: 11/30/2022]
Abstract
We investigated the distribution of Malassezia yeast in 120 Chinese (20 patients from each of six cities) and 20 Korean patients with scalp seborrheic dermatitis (SD) and dandruff (SD/D) using ITS1 and ITS2 polymerase chain reaction-restriction fragment length polymorphism. Bioactivity was studied by quantifying sebum lipid production by human primary sebocytes and inflammatory cytokine, interleukin-8 (IL-8) production was studied by exposing HaCaT keratinocytes with extracts of five standard Malassezia strains; M. globosa, M. restricta, M. sympodialis, M. dermatis and M. slooffiae. M. restricta and M. globosa were the most frequently encountered species from both Chinese and Korean patients. These two Malassezia species also promoted neutral lipid synthesis although the result was not statistically significant and induced significant increase in IL-8 production among the five Malassezia species studied. The study suggests a possible role of these organisms in the pathogenesis of SD/D.
Collapse
Affiliation(s)
- Soo Young Kim
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | | | - Su Na Kim
- AMOREPACIFIC Corp. R&D Unit, Yongin, Korea
| | | | - Yu Ri Kim
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | | | | | - Won Hee Jung
- Department of Systems Biotechnology, Chung-Ang University, Anseong, Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea.,Research Institute of Medical Science, Konkuk University, Seoul, Korea
| | - Yong Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea.,Research Institute of Medical Science, Konkuk University, Seoul, Korea
| | - Kyu Joong Ahn
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea.,Research Institute of Medical Science, Konkuk University, Seoul, Korea
| |
Collapse
|
16
|
Prohic A, Jovovic Sadikovic T, Krupalija-Fazlic M, Kuskunovic-Vlahovljak S. Malasseziaspecies in healthy skin and in dermatological conditions. Int J Dermatol 2015; 55:494-504. [DOI: 10.1111/ijd.13116] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/17/2015] [Accepted: 06/09/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Asja Prohic
- Department of Dermatovenereology; University Clinical Center of Sarajevo; Sarajevo Bosnia and Herzegovina
| | - Tamara Jovovic Sadikovic
- Department of Dermatovenereology; University Clinical Center of Sarajevo; Sarajevo Bosnia and Herzegovina
| | - Mersiha Krupalija-Fazlic
- Department of Dermatovenereology; University Clinical Center of Sarajevo; Sarajevo Bosnia and Herzegovina
| | | |
Collapse
|
17
|
Kim SY, Lee YW, Choe YB, Ahn KJ. Progress in Malassezia Research in Korea. Ann Dermatol 2015; 27:647-57. [PMID: 26719632 PMCID: PMC4695415 DOI: 10.5021/ad.2015.27.6.647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 08/24/2015] [Accepted: 08/26/2015] [Indexed: 11/18/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Soo Young Kim
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Yong Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| | - Kyu Joong Ahn
- Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|
18
|
Wu G, Zhao H, Li C, Rajapakse MP, Wong WC, Xu J, Saunders CW, Reeder NL, Reilman RA, Scheynius A, Sun S, Billmyre BR, Li W, Averette AF, Mieczkowski P, Heitman J, Theelen B, Schröder MS, De Sessions PF, Butler G, Maurer-Stroh S, Boekhout T, Nagarajan N, Dawson TL. Genus-Wide Comparative Genomics of Malassezia Delineates Its Phylogeny, Physiology, and Niche Adaptation on Human Skin. PLoS Genet 2015; 11:e1005614. [PMID: 26539826 PMCID: PMC4634964 DOI: 10.1371/journal.pgen.1005614] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 09/27/2015] [Indexed: 01/27/2023] Open
Abstract
Malassezia is a unique lipophilic genus in class Malasseziomycetes in Ustilaginomycotina, (Basidiomycota, fungi) that otherwise consists almost exclusively of plant pathogens. Malassezia are typically isolated from warm-blooded animals, are dominant members of the human skin mycobiome and are associated with common skin disorders. To characterize the genetic basis of the unique phenotypes of Malassezia spp., we sequenced the genomes of all 14 accepted species and used comparative genomics against a broad panel of fungal genomes to comprehensively identify distinct features that define the Malassezia gene repertoire: gene gain and loss; selection signatures; and lineage-specific gene family expansions. Our analysis revealed key gene gain events (64) with a single gene conserved across all Malassezia but absent in all other sequenced Basidiomycota. These likely horizontally transferred genes provide intriguing gain-of-function events and prime candidates to explain the emergence of Malassezia. A larger set of genes (741) were lost, with enrichment for glycosyl hydrolases and carbohydrate metabolism, concordant with adaptation to skin’s carbohydrate-deficient environment. Gene family analysis revealed extensive turnover and underlined the importance of secretory lipases, phospholipases, aspartyl proteases, and other peptidases. Combining genomic analysis with a re-evaluation of culture characteristics, we establish the likely lipid-dependence of all Malassezia. Our phylogenetic analysis sheds new light on the relationship between Malassezia and other members of Ustilaginomycotina, as well as phylogenetic lineages within the genus. Overall, our study provides a unique genomic resource for understanding Malassezia niche-specificity and potential virulence, as well as their abundance and distribution in the environment and on human skin. Malassezia are the dominant eukaryotic residents of human skin and are associated with the most common skin disorders, including dandruff, atopic dermatitis, eczema, and others. Despite significant effort, the role of Malassezia in skin disease and homeostasis remains unclear. Malassezia are also unique among fungi by requiring lipids for growth, but the breadth and genetic basis of their lipophilic lifestyle has not been comprehensively studied. Here we report the complete genomes of all 14 Malassezia species (including multiple strains of the most common species found on humans) and systematically identify features that define the genus and its sub-lineages, including horizontally transferred genes likely to represent key gain-of-function events and which may have enabled evolution of the genus from plant to animal inhabitants. Genus wide expansion of lipid hydrolases and loss of carbohydrate metabolism genes underscore the entire genus’ gradual evolution to lipid-dependency, which was confirmed even in the previously thought to be lipophilic M. pachydermatis, via genomics with experimental confirmation. Finally, these reference genomes will serve as a valuable resource for future metagenomic investigations into the role of Malassezia species in normal healthy skin and diseases.
Collapse
Affiliation(s)
- Guangxi Wu
- Computational and Systems Biology, Genome Institute of Singapore, A*STAR, Singapore
| | - He Zhao
- Procter & Gamble Singapore Innovation Center, Singapore
| | - Chenhao Li
- Computational and Systems Biology, Genome Institute of Singapore, A*STAR, Singapore
| | | | | | - Jun Xu
- Procter & Gamble Mason Business Center, Mason, Ohio, United States of America
| | - Charles W. Saunders
- Procter & Gamble Mason Business Center, Mason, Ohio, United States of America
| | - Nancy L. Reeder
- Procter & Gamble Mason Business Center, Mason, Ohio, United States of America
| | - Raymond A. Reilman
- Procter & Gamble Mason Business Center, Mason, Ohio, United States of America
| | - Annika Scheynius
- Translational Immunology Unit, Department of Medicine Solna, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Sheng Sun
- Duke University Medical Center, Durham, North Carolina, United States of America
| | | | - Wenjun Li
- National Center for Biotechnology Information, Bethesda, Maryland, United States of America
| | - Anna Floyd Averette
- Duke University Medical Center, Durham, North Carolina, United States of America
| | - Piotr Mieczkowski
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Joseph Heitman
- Duke University Medical Center, Durham, North Carolina, United States of America
| | - Bart Theelen
- Fungal Biodiversity Centre, CBS-KNAW, Utrecht, The Netherlands
| | | | | | | | - Sebastian Maurer-Stroh
- Bioinformatics Institute, A*STAR, Singapore
- School of Biological Sciences, Nanyang Technological University (NTU), Singapore
| | - Teun Boekhout
- Fungal Biodiversity Centre, CBS-KNAW, Utrecht, The Netherlands
| | - Niranjan Nagarajan
- Computational and Systems Biology, Genome Institute of Singapore, A*STAR, Singapore
- * E-mail: (NN); (TLD)
| | - Thomas L. Dawson
- Institute of Medical Biology, A*STAR, Singapore
- * E-mail: (NN); (TLD)
| |
Collapse
|
19
|
Park M, Jung WH, Han SH, Lee YH, Lee YW. Characterisation and Expression Analysis of MrLip1, a Class 3 Family Lipase ofMalassezia restricta. Mycoses 2015; 58:671-8. [DOI: 10.1111/myc.12412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/23/2015] [Accepted: 08/26/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Minji Park
- Department of Systems Biotechnology; Chung-Ang University; Anseong Korea
| | - Won Hee Jung
- Department of Systems Biotechnology; Chung-Ang University; Anseong Korea
| | - Song Hee Han
- Department of Dermatology; School of Medicine; Konkuk University; Seoul Korea
| | | | - Yang Won Lee
- Department of Dermatology; School of Medicine; Konkuk University; Seoul Korea
- Research Institute of Medical Science; Konkuk University; Seoul Korea
| |
Collapse
|
20
|
Sommer B, Overy DP, Kerr RG. Identification and characterization of lipases fromMalassezia restricta, a causative agent of dandruff. FEMS Yeast Res 2015; 15:fov078. [DOI: 10.1093/femsyr/fov078] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 01/13/2023] Open
|
21
|
White TC, Findley K, Dawson TL, Scheynius A, Boekhout T, Cuomo CA, Xu J, Saunders CW. Fungi on the skin: dermatophytes and Malassezia. Cold Spring Harb Perspect Med 2014; 4:a019802. [PMID: 25085959 PMCID: PMC4109575 DOI: 10.1101/cshperspect.a019802] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Several human skin diseases and disorders are associated with two groups of fungi, the dermatophytes and Malassezia. Although these skin-related problems are not generally life threatening, they are among the most common diseases and disorders of mankind. These fungi are phylogenetically divergent, with the dermatophytes within the Ascomycota and Malassezia within Basidiomycota. Genome analysis indicates that the adaptations to the skin environment are different in these two groups of fungi. Malassezia are dependent on host lipids and secrete lipases and phospholipases that likely release host fatty acids. The dermatophytes encode multiple enzymes with potential roles in modulating host interactions: polyketide synthases, nonribosomal peptide synthetases, LysM, proteases, kinases, and pseudokinases. These two fungal groups have maximized their interactions with the host using two very different mechanisms.
Collapse
Affiliation(s)
- Theodore C White
- School of Biological Sciences, University of Missouri-Kansas City, Kansas City, Missouri 64110
| | - Keisha Findley
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892
| | | | - Annika Scheynius
- Department of Medicine Solna, Translational Immunology Unit, Karolinska Institutet and University Hospital, Stockholm, Sweden SE-141 86
| | - Teun Boekhout
- CBS-KNAW Fungal Biodiversity Centre, 3584 CT, Utrecht, The Netherlands
| | | | - Jun Xu
- Procter & Gamble Company, Mason, Ohio 45040
| | | |
Collapse
|
22
|
Affiliation(s)
- Oliver Bader
- Institute for Medical Microbiology; University Medical Center Göttingen; Göttingen, Germany
| |
Collapse
|
23
|
Genotype Analyses of Human Commensal Scalp Fungi, Malassezia globosa, and Malassezia restricta on the Scalps of Patients with Dandruff and Healthy Subjects. Mycopathologia 2014; 177:263-9. [DOI: 10.1007/s11046-014-9748-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/18/2014] [Indexed: 10/25/2022]
|
24
|
Arsic Arsenijevic VS, Milobratovic D, Barac AM, Vekic B, Marinkovic J, Kostic VS. A laboratory-based study on patients with Parkinson's disease and seborrheic dermatitis: the presence and density of Malassezia yeasts, their different species and enzymes production. BMC DERMATOLOGY 2014; 14:5. [PMID: 24628775 PMCID: PMC3995588 DOI: 10.1186/1471-5945-14-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 02/28/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Seborrheic dermatitis (SD) and Parkinson's disease (PD) are frequently associated conditions. Aims of this study were: to determine severity of SD, presence of different species and density of Malassezia yeasts; to assess yeast lipases and phosphatases production in vitro and to compare these results between SD patients with and without PD. METHODS This case-control prospective study was conducted at the Dermatology and Neurology Units, Clinical Centre of Serbia and at the National Medical Mycology Reference Laboratory, University of Belgrade Medical School, Serbia. A total of 90 patients and 70 healthy controls (HC) were investigated: 60 patients with SD (SDN) and 30 patients with SD and PD (SDP). Culture-based mycological examination was carried out on lesional skin (LS) and non-lesional skin (NLS). A yeasts density was determined by counting the Malassezia colony forming units per tape (CFU/tape). Enzymes production by isolated Malassezia was investigated. RESULTS The most patients with SD were male (76.7%; SDP and 63.3%; SDN) and the intensity of SD was dominantly severe or moderate (76.7%; SDP and 75%; SDN). The presence of Malasseziа was high on LS in both groups (87.3%; SDP and 86.7%; SDN) (p=0.667).The highest yeasts density (mean CFU/tape=67.8) was detected on LS in 53% of SDP group and in 21.7% of SDN group (mean CFU/tape=31.9) (p < 0.01). The presence of negative cultures was lower in SDP group (13.3%) in comparison to HC and SDN groups (37% and 31.7%, respectively). Malassezia density on NLS in SDP group (mean CFU/tape=44.3) was significantly higher in comparison to SDN and HC (p=0.018). M. globosa was the most abundant species identified amongst isolates from the SDP group (42.3%) and exhibited high production of phosphatase and lipase in vitro. CONCLUSION From this laboratory-based study a positive correlation between SD, PD, M. globosa incidence, high yeast density and high phosphatase and lipase activity was established. Our data lead to conclusion that local skin performance of PD patient's characterized with increased sebum excretion ratio play a role in SD by stimulation of yeasts replication and enzyme production.
Collapse
|