Cold atmospheric plasma therapy for Malassezia folliculitis: Laboratory investigations and a randomized clinical trial.

BACKGROUND: Current treatment options for Malassezia folliculitis (MF) are limited. Recent research has demonstrated the inhibitory effect of cold atmospheric plasma (CAP) on the growth of Malassezia pachydermatis in vitro, suggesting CAP as a potential therapeutic approach for managing MF. OBJECTIVES: The objective of our study is to assess the in vitro antifungal susceptibility of Malassezia yeasts to CAP. Additionally, we aim to evaluate the efficacy and tolerability of CAP in treating patients with MF. METHODS: We initially studied the antifungal effect of CAP on planktonic and biofilm forms of Malassezia yeasts, using well-established techniques such as zone of inhibition, transmission electron microscopy, colony count assay and 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide salt assay. Subsequently, a randomized (1:1 ratio), active comparator-controlled, observer-blind study was conducted comparing daily CAP therapy versus itraconazole 200 mg/day for 2 weeks in 50 patients with MF. Efficacy outcomes were measured by success rate, negative microscopy rate and changes in Dermatology Life Quality Index (DLQI) and Global Aesthetic Improvement Scale (GAIS) scores. Safety was assessed by monitoring adverse events (AEs) and local tolerability. RESULTS: In laboratory investigations, CAP time-dependently inhibited the growth of Malassezia yeasts in both planktonic and biofilm forms. Forty-nine patients completed the clinical study. At week 2, success was achieved by 40.0% of subjects in the CAP group versus 58.3% in the itraconazole group (p = 0.199). The negative direct microscopy rates of follicular samples were 56.0% in the CAP group versus 66.7% in the itraconazole group (p = 0.444). No significant differences were found in the proportion of subjects achieving DLQI scores of 0/1 (p = 0.456) or in the GAIS responder rates (p = 0.588) between the two groups. Three patients in the CAP group and one patient in the itraconazole group reported mild AEs. CONCLUSION: CAP demonstrated significant antifungal activity against Malassezia yeasts in vitro and exhibited comparable efficacy to itraconazole in treating MF patients. Without the associated adverse effects of oral antifungal drugs, CAP can be considered a promising and safe treatment modality for MF.

Scalp microbiome: a guide to better understanding scalp diseases and treatments.

The scalp microbiome represents an array of microorganisms important in maintaining scalp homeostasis and mediating inflammation. Scalp microbial dysregulation has been implicated in dermatologic conditions including alopecia areata (AA), dandruff/seborrheic dermatitis (D/SD), scalp psoriasis (SP) and folliculitis decalvans (FD). Understanding the impact of scalp microbial dysbiosis gives insight on disease pathophysiology and guides therapeutic decision making. Herein we review the scalp microbiome and its functional role in scalp conditions by analysis of metagenomic medical literature in alopecia, D/SD, SP, and other dermatologic disease.Increased abundance of Malassezia, Staphylococcus, and Brevibacterium was associated with SD compared to healthy controls. A higher proportion of Corynebacterium, actinobacteria, and firmicutes are present in AA patients, and lower proportions of Staphylococcus caprae are associated with worse clinical outcomes. Decreased prevalence of actinobacteria and Propionibacterium and increased firmicutes, staphylococcus, and streptococcus are associated with scalp psoriasis. Studies of central centrifugal cicatricial alopecia (CCCA) suggest scalp microbial composition contributes to CCCA's pro-inflammatory status. The most common organisms associated with FD include methicillin-resistant S. aureus and S. lugdunensis. Antifungals have been a mainstay treatment for these diseases, while other alternatives including coconut oils and shampoos with heat-killed probiotics have shown considerable potential efficacy by replenishing the scalp microbiome.

Common Skin Conditions in Children and Adolescents: Bacterial Infections.

Bacterial skin infections represent a significant health care burden. Cellulitis and erysipelas are rapidly spreading, painful, superficial skin infections, usually caused by streptococci or Staphylococcus aureus. Folliculitis is an infection of hair follicles mostly caused by S aureus. Simple folliculitis typically is self-limited. Topical benzoyl peroxide is a first-line nonantibiotic treatment. Mupirocin and clindamycin are topical antibiotic options. For treatment-resistant cases, oral cephalexin or dicloxacillin is an appropriate option. Impetigo is a common, self-limited infection in children. Bullous impetigo is caused by S aureus, and nonbullous impetigo is caused by beta-hemolytic streptococci, S aureus, or both. In most cases, topical mupirocin or retapamulin (Altabax) is effective. Oral antibiotics should be considered for household outbreaks or patients with multiple lesions. Abscesses are red, painful collections of purulence in the dermis and deeper tissues caused by S aureus or polymicrobial infections. Furuncles are abscesses of a hair follicle, whereas carbuncles involve several hair follicles. In recurrent cases of these lesions, culture of the exudate is recommended. Abscess, furuncle, and carbuncle management consists of incision and drainage. Oral antibiotics are not necessary in most cases but should be prescribed for patients with severe immunocompromise or systemic signs of infection. In bacterial skin infections, methicillin-resistant S aureus coverage should be considered for patients with infections that have not improved with treatment.

Dermoscopy: a useful tool for assisting the diagnosis of Pseudomonas folliculitis

Abstract This report describes the usefulness of dermoscopy as a supportive diagnostic tool in a pseudomonas folliculitis case.

Exuberant clinical presentation of probable Malassezia folliculitis in a young nonimmunosuppressed patient / Apresentação clinica exuberante de provável foliculite por Malassezia em jovem imunocompetente

Malassezia folliculitis is an inflammatory disorder observed in both immunocompetent and immunosuppressed patients. The authors describe an unusual and exuberant presumed case affecting the face, trunk and upper limbs of a 12-year-old nonimmunosuppressed patient. Although the agent was not identified by culture, the clinical and histopathological aspects plus the response to specific treatment support the diagnosis of Malassezia folliculitis. The only possible predisponent cause observed on the patient was greasy skin. Repetitive cultures were negative. Treatment with itraconazol promoted apparent cure, however, the patient relapsed twelve months later.

Foliculite por Malassezia é processo inflamatório observado em pacientes imunocompetentes e imunossuprimidos. Os autores relatam um provável caso exuberante e incomum comprometendo a face, tronco e membros superiores de paciente de 12 anos de idade, não imunossuprimido. Embora o agente não tenha sido cultivado, os achados clínicos e histopatológicos aliados à resposta terapêutica sugerem o diagnóstico de foliculite por Malassezia. A única possivel causa predisponente demonstrada no paciente foi a pele oleosa. Tentativas de cultivo do agente foram negativas. O tratamento com itraconazol promoveu cura aparente, entretanto, houve recaída após 12 meses.