Malassezia Folliculitis versus Truncal Acne Vulgaris (Clinical and Histopathological Study)

Abstract

<p> <b><span>Background:</span></b><span> <i>Malassezia</i> folliculitis is an infection of the hair follicle, </span><span>which</span><span> commonly affects young adult, and is often misdiagnosed as truncal acne.</span><span> </span><b><span>Objectives</span><span>:</span></b><b><span> </span></b><span>To shed light on different clinical, histopathological, and microbiological aspects of <i>Malassezia</i> folliculitis and to be compared with truncal acne. <b><span>Patients and Methods</span>: </b>This is a descriptive comparative cross sectional, out patient based study, </span><span>which</span><span> was conducted at the Department of Dermatology, Basrah Teaching Hospital from October 2008 to October 2009.</span><span> </span><span>Total number of 113 patients with papular and/or pustular follicular skin lesions on the trunk were enrolled in this study. They were divided according to the clinical features, Wood’s light examination, direct microscopic examination, PAS stained skin biopsy and the response to a trial of antifungal drugs into two groups:</span><span> </span><span>group</span><span> </span><span>1:</span><span> </span><span>patient with <i>Malassezia</i> folliculitis and group</span><span> </span><span>2: patient with truncal acne vulgaris. <b><span>Results</span>:</b> Group</span><span> </span><span>1: They were 53(46.9%) out of a total 113, 33(62.3%) males and 20(37.7%) females</span><span>, </span><span>their ages ranged from 19</span><span> </span><span>-</span><span> </span><span>40 years. Group</span><span> </span><span>2 consisted of 60(53.1%) patients, 25(41.6%) males and 35(58.4%) females, </span><span>whose</span><span> ages ranged from 14</span><span> - </span><span>29</span><span> </span><span>years.</span><span> </span><span>The ages were earlier in the acne group in comparison with MF group (p < 0.0001). The <i>Malassezia</i> folliculitis was more common among males than females, while in truncal acne, females predominated males. The center of the back was the predominant site among MF group affecting (90.6%) of patients with sparing the face, in contrast to truncal acne where the periphery of the back was involved in (91.7%) and the face in (75%) (p <</span><span> </span><span>0.0001).</span><span> </span><span>Wood’s light examination,</span><span> </span><span>skin scrapping and PAS stained skin biopsies were also ...

Foliculitis por Malassezia spp.: características clínicas y epidemiológicas de pacientes del Centro Dermatológico de Yucatán

“…La fm es una enfermedad crónica y benigna que se caracteriza por la presencia de múltiples pápulas y pústulas foliculares pruriginosas, que afectan principalmente el tronco superior y las extremidades superiores (Chanussot y Arenas, 2006). Es una condición observada en adolescentes y adultos entre 20 y 30 años de edad (Abdel-Razek et al, 1995;Bäck et al,1985;Guzmán et al, 2006), con predominio del sexo masculino (Lévy et al, 2007;Lim et al, 1987;Sharquie et al, 2012), aunque a diferencia de nuestro estudio, algunos autores han reportado una mayor frecuencia de la enfermedad en mujeres (Abdel-Razek et al;1995;Bäck et al, 1985) y otros no han encontrado predominio por algún sexo (Guzmán et al, 2006). La diferencia en los resultados de estos estudios puede ser consecuencia la diversidad en los hábitos culturales de cada población analizada, como lo es el caso de la población de Arabia Saudita, en donde las mujeres utilizan prendas que cubren el cuerpo completo (Abdel-Razek et al, 1995, Guzmán et al, 2006.…”

“…La fm se considera una enfermedad subdiagnosticada, debido a que se suele confundir con otras entidades como foliculitis bacteriana, foliculitis por Candida spp., acné vulgar o reacción acneiforme por medicamentos (Recio et al, 2003;Sharquie et al, 2012), aunque se han descrito cuadros concomitantes (Jacinto-Jamora et al,1991). Algunos autores han sugerido datos clínicos para diferenciar el acné troncal de la fm, tales como el inicio más tardío de la enfermedad, presencia de lesiones en el centro de la espalda y ausencia de afección de la cara en los pacientes con fm (Sharquie et al, 2012), lo cual contrasta con lo observado en nuestro estudio y por otros autores en el que la cara se encuentra afectada (Abdel-Razek et al, 1995). En cuanto al diagnóstico existe controversia para determinar si la detección de Malassezia spp.…”

Dermoscopic Examination in Malassezia folliculitis

“…1 The diagnosis of MF can be identified by usual clinical presentation, which should include direct microscopy and culture of the specimen, Wood's lamp examination, histopathological examination, and confirmed by rapid efficacy of oral antifungal treatments. 4,5 Its typical clinical features are numerous dome-shaped erythematous papules or pustules, 2-3 mm in size, usually pruritic, and distributed over the neck, chest, back (middle part), the extensor side of the upper arm, and rarely present on the face. 6 Microscopic examination, especially potassium hydroxide (KOH) staining, is routinely performed to diagnose MF in a dermatology practice, but further analysis using histopathological examination or culture is sometimes needed in cases with unclear results.…”

“…Direct microscopical examination by 10%-20% KOH of pustules and follicular hairs can be used to confirm the diagnosis of MF, where an examination reveals abundant round spores budding yeast cells which supports the diagnosis (Figure 3). 5,19 Jacinto-Jamora et al graded the spore load per high-power field as shown in Table 1. Suzuki et al stated that MF was diagnosed when 10 or more yeast organisms per follicle (≥10 per visual field at 400 × magnification) were observed under direct microscopic examination.…”

“…In contrast, the red reflection indicates acne lesions infected with Propionibacterium acnes. 5 Biopsy plus histopathological examination is an invasive examination requiring a long time with lower sensitivity and accuracy than cytologic examination. 6,19 Cultures of Malassezia are rarely required for diagnosis and not clinically relevant because those species are part of skin normal flora.…”