A case of anti- pityriasis versicolor therapy that preserves healthy mycobiome

Abstract

Background The impact of Malassezia yeasts on skin mycobiome and health has received considerable attention recently. Pityriasis versicolor (PV), a common dermatosis caused by Malassezia genus worldwide, is a manifestation of dysbiosis. PV can be associated with hyper- and/or hypopigmented skin lesions. This disease entity is characterized by high percentage of relapses, which demands a proper antifungal therapy that is based on unambiguous species identification and drug susceptibility testing. Case presentation Comprehensive analysis of PV case in man presenting simultaneously hyper- and hypopigmented skin lesions was performed. Conventional and molecular diagnostic procedures revealed Malassezia furfur and Malassezia sympodialis, respectively as etiological agents of skin lesions observed. Susceptibility tests showed significantly lowered sensitivity of M. furfur cells to fluconazole. Based on susceptibility profiles local antifungal therapy with drugs characterized by entirely different mechanism of action was included. Conclusions Our study indicates that cases of PV represented by two types of skin lesions in one patient may be associated with distinct Malassezia species. Moreover, as observed in this case, each of the isolated etiological agents of PV may differ significantly in susceptibility to antifungals. This can significantly complicate the treatment of dermatosis, which by definition is associated with a significant percentage of relapses. In the presented case localized topical treatment was sufficient and successful while allowing maintaining the physiological mycobiome.

The Human Mycobiome: Colonization, Composition and the Role in Health and Disease

“…Inter-kingdom and inter-species microbial interactions can worsen the disease or change relationships from opportunistic to pathogenic [ 131 , 134 , 135 ]. Fungal dysbiosis could be associated with numerous skin diseases often present in a site-specific manner, including atopic dermatitis in the arm and leg creases [ 136 ], psoriasis on the elbows and knees [ 132 ], pityriasis versicolor [ 137 ], seborrheic dermatitis [ 138 ], etc. The prevalence of fungal infections on the skin, hair and nails varies from 20 to 25% worldwide [ 139 ].…”

Communication between immune system and mycobiota impacts health and disease

“…The preliminary study concluded that the morphological transformation of Malassezia along with other factors such as hormonal imbalance, excessive use of antibiotics and high temperature can promote the susceptibility towards disease. Another study suggests that Pityriasis Versicolor (PV) triggers the development of hyperpigmentation or hypopigmented skin lesions (Dyląg et al 2020 ). Specifically, in hypopigmented PV, Malassezia releases azelaic acid and malassezin that promotes apoptosis of melanocytes and subsequently halts the synthesis of melanin (Dolenc-Voljč 2017 ).…”

“…Specifically, in hypopigmented PV, Malassezia releases azelaic acid and malassezin that promotes apoptosis of melanocytes and subsequently halts the synthesis of melanin (Dolenc-Voljč 2017 ). However, the treatment of PV is possible through antifungal drugs, but results won’t appear spontaneously due to persistence of dead fungal cells on the skin (Dyląg et al 2020 ).…”

Human Mycobiome In Normobiosis And Dysbiosis States Characteristics And Analysis Methods

“…W mykobiomach skóry osób zdrowych, w odróżnieniu od pacjentów z łupieżem pstrym, dominują w zależności od regionu geograficznego Malassezia restricta, M. globosa i M. sympodialis [51], przy czym wyraźną dominację ostatniego z wymienionych gatunków obserwowano w Polsce [56]. Ostatnio zwraca się też uwagę na znaczenie dysbiozy mykobiomu skóry, jak również odpowiedniej miejscowej terapii przeciwgrzybiczej gwarantującej przywrócenie naturalnego stanu tej swoistej niszy ekologicznej [32].…”

“…Dzięki lepszemu poznaniu specyfiki mykobiomów oraz ich interakcji z systemem odpornościowym gospodarza, a także umiejętności skorelowania tych danych z chorobą na różnych jej etapach, możliwe będzie przyspieszenie samej diagnozy i podjęcie bardziej ukierunkowanych terapii. Nowatorskie podejście i nowsze metody leczenia mogą wynikać z lepszego doboru grupy pacjentów w oparciu o profile mykobiomów, podczas gdy manipulowanie lub przywracanie "zdrowego" mykobiomu również stanowi potencjalnie i realne postępowanie medyczne [32]. Obecny postęp technologiczny w połączeniu z rosnącą ilością danych z sekwencjonowania mykobiomów, mogą w przysz łości przyczynić się do rozwoju diagnostyki "punktowej" w zakresie chorób grzybiczych [103].…”