1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
2
|
Lindsø Andersen P, Jemec GB, Erikstrup C, Didriksen M, Dinh KM, Mikkelsen S, Sørensen E, Nielsen KR, Bruun MT, Hjalgrim H, Hansen TF, Sækmose SG, Ostrowski SR, Saunte DML, Pedersen OB. Human leukocyte antigen system associations in Malassezia-related skin diseases. Arch Dermatol Res 2022; 315:895-902. [PMID: 36394635 DOI: 10.1007/s00403-022-02454-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The human leukocyte antigen system (HLA) is divided into two classes involved in antigen presentation: class I presenting intracellular antigens and class II presenting extracellular antigens. While susceptibility to infections is correlated with the HLA system, data on associations between HLA genotypes and Malassezia-related skin diseases (MRSD) are lacking. Thus, the objective of this study was to investigate associations between HLA alleles and MRSD. MATERIALS AND METHODS Participants in The Danish Blood Donor Study (2010-2018) provided questionnaire data on life style, anthropometric measures, and registry data on filled prescriptions. Genotyping was done using Illumina Infinium Global Screening Array, and HLA alleles were imputed using the HIBAG algorithm. Cases and controls were defined using filled prescriptions on topical ketoconazole 2% as a proxy of MRSD. Logistic regressions assessed associations between HLA alleles and MRSD adjusted for confounders and Bonferroni corrected for multiple tests. RESULTS A total of 9455 participants were considered MRSD cases and 24,144 participants as controls. We identified four risk alleles B*57:01, OR 1.19 (95% CI: 1.09-1.31), C*01:02, OR 1.19 (95% CI: 1.08-1.32), C*06:02, OR 1.14 (95% CI: 1.08-1.22), and DRB1*01:01, OR 1.10 (95% CI: 1.04-1.17), and two protective alleles, DQB1*02:01, OR 0.89 (95% CI: 0.85-0.94), and DRB1*03:01, OR 0.89 (95% CI: 0.85-0.94). CONCLUSION Five novel associations between HLA alleles and MRSD were identified in our cohort, and one previous association was confirmed. Future studies should assess the correlation between Malassezia antigens and antigen-binding properties of the associated HLA alleles.
Collapse
Affiliation(s)
- P Lindsø Andersen
- Department of Dermatology, Zealand University Hospital Roskilde, Sygehusvej 5, 4000, Roskilde, Denmark.
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark.
| | - G B Jemec
- Department of Dermatology, Zealand University Hospital Roskilde, Sygehusvej 5, 4000, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - C Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - M Didriksen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K M Dinh
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - S Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - E Sørensen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K R Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - M T Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - H Hjalgrim
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Haematology, Rigshospitalet, Copenhagen, Denmark
| | - T F Hansen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark
- The Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - S G Sækmose
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - S R Ostrowski
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - D M L Saunte
- Department of Dermatology, Zealand University Hospital Roskilde, Sygehusvej 5, 4000, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - O B Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Aharaz A, Jemec GBE, Hay RJ, Saunte DML. Tinea capitis asymptomatic carriers: what is the evidence behind treatment? J Eur Acad Dermatol Venereol 2021; 35:2199-2207. [PMID: 34146430 DOI: 10.1111/jdv.17462] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/09/2021] [Indexed: 12/26/2022]
Abstract
Tinea capitis is a fungal infection mostly affecting children. Epidemiology is changing over time due to migration, and it has been estimated that up to 40% of children from certain developing countries are affected. The mechanism of transmission is still unclear although asymptomatic carriage seems to have an influence in establishing persistent reservoirs that can cause or fuel epidemics. Screening and prophylactic treatment of close contacts of tinea capitis patients are therefore recommended by several international guidelines, but vaguely and not consistent. The treatments involved can be expensive, hard to integrate in everyday life, have well-known side effects and some are not approved for the treatment of children. The aim of this review was to clarify the evidence behind treatment of human asymptomatic carriers of tinea capitis. Databases were searched for the 'tinea capitis', 'carriers' and 'treatment'. Inclusion criteria were clinical trials, observational and interventional studies including case series (10+ cases) and case reports in English, Danish, Swedish, Norwegian and French. Reviews, guidelines, unclear reports and in vitro trials were excluded. A systematic review identified 10 studies with low to moderate evidence levels. The topical treatments ketoconazole, povidone-iodine, miconazole and the systemic antifungals terbinafine and itraconazole have all shown significant effects in the mycological eradication of fungal conidia. General prophylactic hygienic measures may have a benefit. The scientific evidence behind the treatment of asymptomatic carriage of scalp dermatophytes is sparse and not of high quality. Yet, both topical and systemic antifungal agents show treatment efficacy. Considering the possible adverse effects, topical agents are preferable, but with necessary attention to the compliance of asymptomatic contacts with treatment.
Collapse
Affiliation(s)
- A Aharaz
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| | - R J Hay
- St John's Institute of Dermatology, Kings College London, London, UK
| | - D M L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark
| |
Collapse
|
4
|
Kursawe Larsen C, Kjaersgaard Andersen R, Kirby JS, Tan J, Saunte DML, Jemec GBE. Convergent Validity of Suffering and Quality of Life as Measured by The Hidradenitis Suppurativa Quality of Life. J Eur Acad Dermatol Venereol 2021; 35:1577-1581. [PMID: 33539563 DOI: 10.1111/jdv.17148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a painful chronic, recurrent inflammatory skin disease with great impact on health-related quality of life (HRQOL). Recently, Hidradenitis SuppuraTiva cORe outcomes set International Collaboration (HISTORIC) established HRQOL as a core domain set for HS clinical trials and developed the Hidradenitis Suppurativa Quality of Life (HiSQOL) as a validated outcome measurement instrument. OBJECTIVES To provide further convergent validity of HiSQOL by comparing it to Dermatology Life Quality Index (DLQI) and Pictorial Representation of Illness and Self Measure-Revised 2 (PRISM-R2). METHODS In this cross-sectional study, 103 participants completed HiSQOL, PRISM-R2 and DLQI. PRISM-R2 is an instrument designed to measure suffering and reports the two measures, Illness Perception Measure (IPM) and Self-Illness Separation (SIS). Correlation analyses were performed including a sub-analysis for a subgroup of patients with high scores in the HS-specific domains of HiSQOL. RESULTS A very strong correlation was found between HiSQOL and DLQI (ρ = 0.93, P < 2.2 × 10-16 , (95% CI: 0.89;0.95)), and moderately strong correlations were found between HiSQOL and SIS (ρ = -0.73, P < 2.2 × 10-16 , (95% CI: -0.81; -0.62)) and DLQI and SIS (ρ = -0.70, P < 2.2 × 10-16 , (95% CI: -0.79; -0.59)). IPM was positively associated with HiSQOL and DLQI and negatively with SIS. CONCLUSIONS HiSQOL is a valid measure of quality of life for HS patients, and we suggest that HiSQOL can be used as a measure of suffering as well.
Collapse
Affiliation(s)
- C Kursawe Larsen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | | | - J S Kirby
- Department of Dermatology, Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - J Tan
- University of Western Ontario, London, Canada
| | - D M L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health Science, Institute of Clinical Medicine, University of Copenhagen, Denmark
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Faculty of Health Science, Institute of Clinical Medicine, University of Copenhagen, Denmark
| |
Collapse
|
5
|
Taudorf EH, Jemec GBE, Hay RJ, Saunte DML. Cutaneous candidiasis - an evidence-based review of topical and systemic treatments to inform clinical practice. J Eur Acad Dermatol Venereol 2019; 33:1863-1873. [PMID: 31287594 DOI: 10.1111/jdv.15782] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/27/2019] [Indexed: 11/30/2022]
Abstract
Cutaneous candidiasis is a common skin disease, and several treatments have been investigated within the last fifty years. Yet, systematic reviews are lacking, and evidence-based topical and systemic treatment strategies remain unclear. Thus, the aim of this review was to summarize efficacy and adverse effects of topical and oral therapies for cutaneous candidiasis in all age groups. Two individual researchers searched PubMed and EMBASE for 'cutaneous candidiasis' and 'cutaneous candidiasis treatment', 'intertrigo', 'diaper dermatitis' and 'cheilitis'. Searches were limited to 'English language', 'clinical trials' and 'human subjects', and prospective clinical trials published in abstracts or articles were included. In total, 149 studies were identified, of which 44 were eligible, comprising 41 studies of 19 topical therapies and four studies of three systemic therapies for cutaneous candidiasis. Topical therapies were investigated in infants, children, adolescents, adults and elderly, while studies of systemic therapies were limited to adolescents and adults. Clotrimazole, nystatin and miconazole were the most studied topical drugs and demonstrated similar efficacy with complete cure rates of 73%-100%. Single-drug therapy was as effective as combinations of antifungal, antibacterial and topical corticosteroid. Four studies investigated systemic therapy, and oral fluconazole demonstrated similar efficacy to oral ketoconazole and topical clotrimazole. Limitations to this review were mainly that heterogeneity of studies hindered meta-analyses. In conclusions, clotrimazole, nystatin and miconazole were the most studied topical drugs and demonstrated equal good efficacy and mild adverse effects similar to combinations of antifungal, antibacterial and topical corticosteroids. Oral fluconazole was as effective as topical clotrimazole and is the only commercially available evidence-based option for systemic treatment of cutaneous candidiasis.
Collapse
Affiliation(s)
- E H Taudorf
- Department of Dermato-Venereology, Zealand University Hospital, Roskilde Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - G B E Jemec
- Department of Dermato-Venereology, Zealand University Hospital, Roskilde Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - R J Hay
- Department of Dermatology, King's College London, London, UK
| | - D M L Saunte
- Department of Dermato-Venereology, Zealand University Hospital, Roskilde Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
6
|
Saunte DML, Piraccini BM, Sergeev AY, Prohić A, Sigurgeirsson B, Rodríguez-Cerdeira C, Szepietowski JC, Faergemann J, Arabatzis M, Pereiro M, Skerlev M, Lecerf P, Schmid-Grendelmeier P, Nenoff P, Nowicki RJ, Emtestam L, Hay RJ. A survey among dermatologists: diagnostics of superficial fungal infections - what is used and what is needed to initiate therapy and assess efficacy? J Eur Acad Dermatol Venereol 2018; 33:421-427. [PMID: 30468532 DOI: 10.1111/jdv.15361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/18/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Superficial fungal infections are common. It is important to confirm the clinical diagnosis by mycological laboratory methods before initiating systemic antifungal treatment, especially as antifungal sensitivity and in vitro susceptibility may differ between different genera and species. For many years, the gold standard for diagnosis of superficial fungal infections has been direct fungal detection in the clinical specimen (microscopy) supplemented by culturing. Lately, newer molecular based methods for fungal identification have been developed. OBJECTIVE This study was initiated to focus on the current usage of mycological diagnostics for superficial fungal infections by dermatologists. It was designed to investigate whether it was necessary to differentiate between initial diagnostic tests and those used at treatment follow-up in specific superficial fungal infections. METHODS An online questionnaire was distributed among members of the EADV mycology Task Force and other dermatologists with a special interest in mycology and nail disease. RESULTS The survey was distributed to 62 dermatologists of whom 38 (61%) completed the whole survey, 7 (11%) partially completed and 17 (27%) did not respond. Nearly, all respondents (82-100%) said that ideally they would use the result of direct microscopy (or histology) combined with a genus/species directed treatment of onychomycosis, dermatophytosis, Candida- and Malassezia-related infections. The majority of the dermatologists used a combination of clinical assessment and direct microscopy for treatment assessment and the viability of the fungus was considered more important at this visit than when initiating the treatment. Molecular based methods were not available for all responders. CONCLUSION The available diagnostic methods are heterogeneous and their usage differs between different practices as well as between countries. The survey confirmed that dermatologists find it important to make a mycological diagnosis, particularly prior to starting oral antifungal treatment in order to confirm the diagnose and target the therapy according to genus and species.
Collapse
Affiliation(s)
- D M L Saunte
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - B M Piraccini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - A Y Sergeev
- Department of Clinical Immunology, Sechenov University, Moscow, Russia
| | - A Prohić
- Department of Dermatovenerology, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - B Sigurgeirsson
- Department of Dermatology, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - C Rodríguez-Cerdeira
- Department of Dermatology, Meixoeiro hospital and University of Vigo, Vigo, Spain
| | - J C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - J Faergemann
- Department of Dermatology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Arabatzis
- Department of Dermatology, Medical School, Aristotle University, Thessaloniki, Greece
| | - M Pereiro
- Dermatología, Faculty of Medicine, University of Santiago de Compostela, A Coruña, Spain
| | - M Skerlev
- Department of Dermatology and Venereology, Zagreb University School of Medicine and Zagreb University Hospital, Zagreb, Croatia
| | - P Lecerf
- Department of Dermatology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | | | - P Nenoff
- Laboratory for Medical Microbiology, Mölbis, Germany
| | - R J Nowicki
- Department of Dermatology, Venereology & Allergology, Medical University of Gdansk, Gdansk, Poland
| | - L Emtestam
- Section of Infectious Diseases & Dermatology, Department of Medicine Huddinge, Karolinska Instituttet, Stockholm, Sweden
| | - R J Hay
- Department of Dermatology, Kings College Hospital NHS Trust, London, UK
| |
Collapse
|