Clinical ReviewSkin diseases associated with Malassezia species☆
Section snippets
SD/D
SD/D is perhaps the most common disease associated with Malassezia yeasts, occurring in 1% to 3% of the general population.19., 20. The incidence of SD/D is much higher in patients who are immunocompromised, especially those with AIDS, ranging from 30% to 33%.21., 22. Dandruff has recently received much attention, as its presence can lead to loss of self-esteem and a negative social image.20 It is a disorder that is generally discussed alongside SD because of the scaling effect of the scalp.
Pityriasis versicolor
Pityriasis versicolor is a chronic superficial fungal disease that is characterized by the appearance of round to oval lesions, most commonly found on the trunk and upper aspects of the arms. These lesions vary in color, and can be hypopigmented (white) or hyperpigmented (pink, tan, brown, or black). Flaking is evident, although in larger lesions this may occur only at the border. Lesions may be round or oval, becoming confluent in advanced cases of the disorder. Generally, pityriasis
Malassezia (pityrosporum) folliculitis
Like pityriasis versicolor, Malassezia folliculitis is associated with a clear pattern of Malassezia colonization. Although the transformation of the yeast cells to their hyphal form is unique to pityriasis versicolor, histologic examination of patients with Malassezia folliculitis shows, as the name suggests, invasion of the hair follicles with large numbers of Malassezia yeasts.80 This invasion results in the development of erythematous papules, and sometimes pustules, which may be either
AD
AD is a chronic inflammatory disorder marked by pruritus (often intense) and characteristic eczematous lesions with erythema, fine scaling, and thickening of the epidermis. Genetic factors are known to play an important role in the development of this disorder and many patients have a family history of AD, allergic rhinitis, asthma, or a combination of these. If both parents are carriers of the disease, the risk for children is as high as 70%.97 In many patients, AD is present from childhood
Psoriasis
The role of Malassezia species in psoriasis is still undetermined, but several reports have associated these lipophilic yeasts with the development of skin lesions in psoriasis. Psoriasis is characterized by hyperproliferation and hyperkeratinization of the epidermis. The cases most commonly associated with the yeasts are those that tend to involve the scalp.140 Again, this hypothesis is supported by the response of scalp psoriasis to ketoconazole,141 and also by analysis of the association
Other dermatolgic disorders
There have been a few scattered case reports in the literature associating Malassezia yeasts with various other skin conditions. In particular, Malassezia has been shown to be involved in at least some cases of confluent and reticulated papillomatosis.149., 150., 151. In one case, the patient was successfully treated using selenium sulfide, a traditional topical treatment for pityriasis versicolor. A possible link between Malassezia and transient acantholytic dermatosis has also been suggested,
Treatment
Most of the literature addressing the treatment of the conditions discussed in this article is concerned with those diseases most closely linked to Malassezia yeasts: pityriasis versicolor; SD/D; and Malassezia folliculitis. In the case of the other conditions, there are isolated reports of the efficacy of selenium sulfide (for confluent and reticulated papillomatosis and for transient acantholytic dermatosis) or ketoconazole (for AD and scalp psoriasis), as described above.
Malassezia yeasts
Conclusions
Our knowledge about the pathogenesis of Malassezia-related diseases has increased tremendously during the last decade. Although 7 of the 8 lipophilic Malassezia species can be isolated, with varying frequency, from human skin, it appears that the pathologic response is species-specific. The ninth species, M pachydermatis, does not need a source of lipid to sustain growth, is able to grow on routine laboratory media, and is rarely implicated in disease of human beings who are immunocompetent.
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Supported in part by a grant from Proctor and Gamble.
Disclosure: Supported in part by a grant from Proctor and Gamble.