Utility of Gram staining for diagnosis of <i>Malassezia</i> folliculitis

Tu, Wei-Ting; Chin, Shy-Chyi; Chou, Chia Lun; Hsu, Che Yuan; Chen, Yu Tsung; Liu, Donald; Lee, William R.; Shih, Yang Hsin

doi:10.1111/1346-8138.14120

Cited by 11 publications

(14 citation statements)

References 14 publications

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“…Different sampling methods have been used to confirm the presence of Malassezia yeasts in skin conditions and these include tape stripping, skin scraping, swabs, and contact plates (Darabi et al, 2009). Direct microcopy is used frequently in clinical settings (Saunte et al, 2018) as it can be used to detect fungal elements after application of potassium hydroxide and adding a dye such as e.g., Parker ink, methylene blue, lactophenol blue, May-Grunwald-Giemsa, Gram staining or a fluorescence dye such as Calcofluor white and Blancophor (Rubenstein and Malerich, 2014;Tu et al, 2018). Malassezia is Abbreviations: AD, atopic dermatitis; M, Malassezia; HND, Head and neck dermatitis; PCR, Polymerase Chain Reaction; PV, pityriasis versicolor; SD, seborrheic dermatitis.…”

Section: Diagnosticsmentioning

confidence: 99%

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Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment

Saunte

Gaitanis

Hay

2020

Front. Cell. Infect. Microbiol.

112

110

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Yeasts of the genus, Malassezia, formerly known as Pityrosporum, are lipophilic yeasts, which are a part of the normal skin flora (microbiome). Malassezia colonize the human skin after birth and must therefore, as commensals, be normally tolerated by the human immune system. The Malassezia yeasts also have a pathogenic potential where they can, under appropriate conditions, invade the stratum corneum and interact with the host immune system, both directly but also through chemical mediators. The species distribution on the skin and the pathogenetic potential of the yeast varies between different Malassezia related diseases such as head and neck dermatitis, seborrheic dermatitis, pityriasis versicolor, and Malassezia folliculitis. The diagnostic methods used to confirm the presence of Malassezia yeasts include direct microcopy, culture based methods (often a combination of morphological features of the isolate combined with biochemical test), molecular based methods such as Polymerase Chain Reaction techniques, and Matrix Assisted Laser Desorption/Ionization-Time Of Flight mass spectrometry and the chemical imprint method Raman spectroscopy. Skin diseases caused by Malassezia are usually treated with antifungal therapy and if there are associated inflammatory skin mechanisms this is often supplemented by anti-inflammatory therapy. The aim of this paper is to provide an overview of Malassezia related skin disease, diagnostic methods and treatment options.

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Section: Diagnosticsmentioning

confidence: 99%

“…Biopsy with Malassezia in inflamed hair follicle, 3. Treatment response to antifungal therapy (Tu et al, 2018). This suggests that direct microscopy which is both rapid, simple and non-invasive is an alternative to histology.…”

Section: Diagnosismentioning

confidence: 99%

Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment

Saunte

Gaitanis

Hay

2020

Front. Cell. Infect. Microbiol.

112

110

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“…For examination, 5 ml of sterile distilled water was mixed with a loopful of actively growing yeast, and the concentration was adjusted to about 105 cell/ml Smears from the colonies were stained with Gram’s stain and examined under a microscope for identification of Malassezia [9]. Lactophenol cotton blue stain used for microscopic observation of yeast cells, the suspension of yeast cells were prepared, loopful of culture were stained with lactophenol cotton blue on a sterile glass slide.…”

Section: Methodsmentioning

confidence: 99%

Phenotypic Identification and Molecular Characterization of Malassezia Spp. Isolated from Pityriasis Versicolor Patients with Special Emphasis to Risk Factors in Diyala Province, Iraq

Awad¹,

Al-Ezzy²,

Jameel³

2019

Open Access Maced J Med Sci

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AIM: The main objective is isolation and molecular characterisation of Malassezia spp. from pityriasis versicolor (PV) patients with special emphasis to risk factors in Diyala province, Iraq. METHODS: Fifty patients (32 males and 18 females) presented with PV, the age ranged (15-45) years were included. Direct wet mount using KOH 10%, culture of skin scraping and PCR were used for confirmatory diagnosis. RESULTS: Malassezia spp. was isolated from (54%) of skin scraping; M. furfur (32%); M. pachydermatis (8%) and M. globosa (14%). The age group (15-22) years were frequently exposed to Malassezia infection. A significant inverse correlation was reported between age and exposure to Malassezia spp. Infection. Males were frequently exposed to Malassezia infection, (40%). A significant correlation was reported between gender and exposure to Malassezia spp. Infection. Females were at risk of getting Malassezia infection (2.619) time than males. Patient resident in the urban area frequently exposed to Malassezia infection, (34%). Patients resident in the rural area appears to be at risk of getting Malassezia infection (1.093) time than those in an urban area. Patient with good economic status was frequently exposed to Malassezia infection, (36%). Patients with middle economic status appear to be at risk of getting Malassezia infection (0.42) time than those with good economic status. Patients with primary education were frequently exposed to Malassezia infection, (22%). A significant correlation was reported between education level and exposure to Malassezia spp. Infection. No significant correlation was reported between economic status; type of job; source of water; contact with dogs and birds and Malassezia spp. Infection. CONCLUSION: M. furfur, M. pachydermatis and M. globosa represent the most common Malassezia spp. causing PV. Using of PCR is very critical to confirm the diagnosis of Malassezia spp. Malassezia infection inversely correlated with age and positively correlated with females gender and education. The residency in a rural area and middle economic status increase the possibility of infection. Infection was not affected by the source of water; job and contact with dogs and birds.

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“…Gram stain has been used successfully for the confirmation of Malassezia folliculitis and the recognition of mixed (Malassezia and bacterial) folliculitis cases with high sensitivity and specificity (84.6% and 100%, respectively). 47 Calcofluor white or other fluorescent dyes can be used in addition to KOH allowing an easier visualization; however, this method requires a fluorescence microscope. 48 It should be noted that multiple samplings from different lesions or tapestripping after 'opening' the comedone are needed to increase the sensitivity of microscopy and also it is preferable to use a comedo extractor instead of swabs or scrapes.…”

Section: Diagnosismentioning

confidence: 99%

“…Eosinophils were predominant in samples obtained from patients with severe pruritus. Gram stain has been used successfully for the confirmation of Malassezia folliculitis and the recognition of mixed ( Malassezia and bacterial) folliculitis cases with high sensitivity and specificity (84.6% and 100%, respectively) . Calcofluor white or other fluorescent dyes can be used in addition to KOH allowing an easier visualization; however, this method requires a fluorescence microscope .…”

Section: Diagnosismentioning

confidence: 99%

Critical synthesis of available data in Malassezia folliculitis and a systematic review of treatments

Vlachos

Henning

Gaitanis

et al. 2020

Acad Dermatol Venereol

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Folliculitis is an inflammatory process involving the hair follicle, frequently attributed to infectious causes. Malassezia, an established symbiotic yeast that can evolve to a skin pathogen with opportunistic attributes, is a common source of folliculitis, especially when intrinsic (e.g. immunosuppression) or extrinsic (high ambient temperature and humidity, clothing) impact on the hair follicle and the overlying skin microenvironment. Our aim was to critically review the pathophysiology and clinical characteristics of Malassezia folliculitis, to describe laboratory methods that facilitate diagnosis and to systematically review treatment options. Malassezia folliculitis manifests as a pruritic, follicular papulopustular eruption distributed on the upper trunk. It commonly affects young to middle-aged adults and immunosuppressed individuals. Inclusion into the differential diagnosis of folliculitis is regularly oversighted, and the prerequisite-targeted diagnostic procedures are not always performed. Sampling by tape stripping or comedo extractor and microscopic examination of the sample usually identifies the monopolar budding yeast cells of Malassezia without the presence of hyphae. However, confirmation of the diagnosis with anatomical association with the hair follicle is performed by biopsy. For systematic review of therapies, PubMed was searched using the search string "(malassezia" [MeSH Terms] OR "malassezia" [All Fields] OR pityrosporum [All Fields]) AND "folliculitis" [MeSH Terms] and EMBASE was searched using the search string: 'malassezia folliculitis.mp OR pityrosporum folliculitis.mp'. In total, 28 full-length studies were assessed for eligibility and 21 were selected for inclusion in therapy evaluation. Conclusively Malassezia folliculitis should be considered in the assessment of truncal, follicular skin lesions. Patient's history, comorbidities and clinical presentation are usually indicative, but microscopically and histological examination is needed to confirm the diagnosis. Adequate samples obtained with comedo extractor and serial sections in the histological material are critical for proper diagnosis. Therapy should include systemic or topical measures for the control of the inflammation, as well as the prevention of recurrences.

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Utility of Gram staining for diagnosis of Malassezia folliculitis

Cited by 11 publications

References 14 publications

Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment

Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment

Phenotypic Identification and Molecular Characterization of Malassezia Spp. Isolated from Pityriasis Versicolor Patients with Special Emphasis to Risk Factors in Diyala Province, Iraq

Critical synthesis of available data in Malassezia folliculitis and a systematic review of treatments

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