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 as an Auxiliary Tool in the Assessment of Malassezia Folliculitis: An Observational Study / Dermatoscopia como herramienta auxiliar en la evaluación de foliculitis por Malassezia: estudio observacional

Malassezia folliculitis is an under-recognizedentity commonly affecting the face and upper trunk. Clinical picture mimics acne vulgaris and diagnosis is challenging at times. 10% potassium hydroxide examination is usually performed to confirm the diagnosis. This study sought to describe the dermoscopic features in Malassezia folliculitis. Patients diagnosed clinically with Malassezia folliculitis and confirmed by 10% potassium hydroxide preparation were included in the study. Dermoscopy was performed with a videodermatoscope [Dinolite AM413ZT; Polarising] from the most representative lesion. A total of 45 patients (M:F = 1:0.8 ) were recruited. All patients had monomorphic papulo-pustular lesions. Itching was present in 64.4% patients. Dermoscopy reveled folliculocentricity (100%), perilesional background erythema (100%), dotted/linear/tortous vessels (88.9%), dirty white scaling (77.8%), hypo pigmentation of hair follicle (64.4%), coiled/looped hairs (57.8%) and broken hairs (13.3%). In conclusion, dermoscopy shows typical features in Malassezia folliculitis and can serve as a office based tool for identification of this entity (AU)

La foliculitis por Malassezia es una entidad que no está debidamente reconocida y que afecta normalmente a la cara y tronco superior. El cuadro clínico remeda el acné vulgar, siendo a veces difícil su diagnóstico. Normalmente se realiza un examen con hidróxido de potasio al 10% para confirmar el mismo. El objetivo de este estudio fue describir las características dermatoscópicas de la foliculitis por Malassezia, incluyéndose en el mismo a los pacientes diagnosticados clínicamente y confirmados mediante aplicación de hidróxido de potasio al 10%. La dermatoscopia fue realizada con un videodermatoscopio [Dinolite AM413ZT; Polarising] en la lesión más representativa. Se incluyó a un total de 45 pacientes (V:M = 1:0.8). Todos los pacientes tenían lesiones monomórficas papulopustulosas. El 64% de los pacientes presentó prurito. La dermatoscopia reveló foliculocentricidad (100%), eritema circundante perilesional (100%), vasos punteados/lineales/tortuosos (88,9%), escamas de color gris parduzco (77,8%), hipopigmentación del folículo piloso (64,4%), pelos en espiral/enrollados (57,8%) y rotura del pelo (13,3%). En conclusión, la dermatoscopia muestra las características típicas de la foliculitis por Malassezia, pudiendo servir de ayuda en consulta como herramienta para la identificación de esta entidad (AU)

[Artículo traducido] Dermatoscopia como herramienta auxiliar en la evaluación de foliculitis por Malassezia: estudio observacional / Dermoscopy as an Auxiliary Tool in the Assessment of Malassezia Folliculitis: An Observational Study

La foliculitis por Malassezia es una entidad que no está debidamente reconocida y que afecta normalmente a la cara y tronco superior. El cuadro clínico remeda el acné vulgar, siendo a veces difícil su diagnóstico. Normalmente se realiza un examen con hidróxido de potasio al 10% para confirmar el mismo. El objetivo de este estudio fue describir las características dermatoscópicas de la foliculitis por Malassezia, incluyéndose en el mismo a los pacientes diagnosticados clínicamente y confirmados mediante aplicación de hidróxido de potasio al 10%. La dermatoscopia fue realizada con un videodermatoscopio [Dinolite AM413ZT; Polarising] en la lesión más representativa. Se incluyó a un total de 45 pacientes (V:M = 1:0.8). Todos los pacientes tenían lesiones monomórficas papulopustulosas. El 64% de los pacientes presentó prurito. La dermatoscopia reveló foliculocentricidad (100%), eritema circundante perilesional (100%), vasos punteados/lineales/tortuosos (88,9%), escamas de color gris parduzco (77,8%), hipopigmentación del folículo piloso (64,4%), pelos en espiral/enrollados (57,8%) y rotura del pelo (13,3%). En conclusión, la dermatoscopia muestra las características típicas de la foliculitis por Malassezia, pudiendo servir de ayuda en consulta como herramienta para la identificación de esta entidad (AU)

Malassezia folliculitis is an under-recognizedentity commonly affecting the face and upper trunk. Clinical picture mimics acne vulgaris and diagnosis is challenging at times. 10% potassium hydroxide examination is usually performed to confirm the diagnosis. This study sought to describe the dermoscopic features in Malassezia folliculitis. Patients diagnosed clinically with Malassezia folliculitis and confirmed by 10% potassium hydroxide preparation were included in the study. Dermoscopy was performed with a videodermatoscope [Dinolite AM413ZT; Polarising] from the most representative lesion. A total of 45 patients (M:F = 1:0.8 ) were recruited. All patients had monomorphic papulo-pustular lesions. Itching was present in 64.4% patients. Dermoscopy reveled folliculocentricity (100%), perilesional background erythema (100%), dotted/linear/tortous vessels (88.9%), dirty white scaling (77.8%), hypo pigmentation of hair follicle (64.4%), coiled/looped hairs (57.8%) and broken hairs (13.3%). In conclusion, dermoscopy shows typical features in Malassezia folliculitis and can serve as a office based tool for identification of this entity (AU)

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.

Paciente con blefaritis crónica resistente a los tratamientos oftalmológicos habituales / Resistance to routine ophthalmological treatments in a patient with chronic blepharitis

No disponible

Brote comunitario de foliculitis por Pseudomonas aeruginosa asociado a un spa / Community outbreak of Pseudomonas aeruginosa folliculitis associated with a spa

No disponible

Foliculitis del jacuzzi: descripción de un brote de 6 casos / Whirlpool folliculitis: 6 cases outbreak report

No disponible

Foliculitis por Pseudomonas aeruginosa tras depilación / Pseudomonas aeruginosa folliculitis after depilation

No disponible

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.

Foliculitis de la barba candidomicética / Folliculitis barbae candidomycetica

La foliculitis de la barba candidomicética es una infección muy poco frecuente. Aunque se han citado diferentes factores predisponentes, la mayoríade los casos ocurren en personas sanas. Presentamos un caso de foliculitis de la barba candidomicética en un individuo sano de 41 años, tratado satisfactoriamentecon itraconazol durante 4 semanas. Sugerimos que en este paciente pudiera tratarse de una infección de transmisión sexual por contactoorogenital (AU)

Folliculitis barbae candidomycetica is a very rare infection. Although many predisposing factors have been cited, most cases occur in healthy individuals.We present a case of folliculitis barbae candidomycetica in a 41-year-old healthy man, successfully treated with itraconazole during 4 weeks. Wesuggest in this patient it could be a sexually transmitted infection due to orogenital contact (AU)

Foliculitis por candida albicansen drogadicto intravenoso / Folliculitis due to candida albicans in an intravenous drug-abuser

La foliculitis candidiásica es casi exclusiva de los consumidores de heroína marrón por vía intravenosa. Es debida a una infección sistémica por Candidaalbicans.Describimos el caso de un varón de 42 años de edad, HIV negativo, adicto a drogas por vía parenteral, que consultó por la presencia de pápulas y pústulasfoliculares dolorosas localizadas en regiones pilosas, la barba, el cuero cabelludo, zona centrotorácica y genital, de 48 horas de evolución, junto afiebre, malestar general y artromialgias desde hacía una semana. En el estudio oftalmológico se demostró la existencia de retinitis bilateral candidiásicajunto a uveítis anterior aguda en el ojo izquierdo. En el estudio histopatológico de las lesiones cutáneas se demostró la presencia de microabcesosfoliculares, y un leve infiltrado inflamatorio perifolicular compuesto por linfocitos y polimorfonucleares. En el cultivo de las lesiones cutáneas enmedios Saboreaud, se aisló Candida albicans.En la década de los noventa la incidencia de la candidiasis sistémica, en drogadictos intravenosos disminuyó notablemente, siendo en la actualidaduna entidad excepcional que aún hoy, hay que tenerla presente (AU)

Candidiasic folliculitis is an almost exclusive disease of intravenous brown heroin abusers. This entity is due to a systemic infection by Cándida albicans.A 42 year- old man, HIV negative and intravenous drug abuser, who was referred with painful, follicular papules and pustules located on hairs regions,of the beard, scalp, thoracic and genital areas is reported. The patient had also fever, general discomfort and arthromialgias. The ophthalmologicexamination demostrated bilateral, candidiasic retinitis and left acute anterior uveitis. Histopathological study showed follicular microabcess andslight inflammatory infiltrate with perifollicular arrangement and composed of lymphocytes and neutrophils. Culture of the biopsy specimen isolatedCandida albicans.In the decade of the nineties the incidence of the systemic candidiasis, diminished notably, being at present an exceptional entity although still it is necessaryto be aware the process (AU)

Infecciones cutáneas primarias por estafilococos y estreptococos / Primary cutaneous infections due to staphylococcus and streptococcus

Las piodermitis son un capítulo importante de la práctica dermatológica. La patogenia de las mismas, en especial la causada por Staphylococcus aureus, ha avanzado notablemente al conocerse el papel desempeñado por las defensinas del huésped, la señalización por densidad celular y el gen de la leucocidina Panton Valentine, entre otros. Asimismo se han clonado las exfoliatinas y enterotoxinas responsables del síndrome de las 4 S, y del síndrome del shock tóxico respectivamente. Se vio también que el impétigo ampolloso, el síndrome de las 4 S y el pénfigo foliáceo compartían una diana común, que era la desmogleína-1. El gen de la leucocidina Panton Valentine se ha relacionado con la aparición de abscesos, lesiones necróticas y forúnculos en personas jóvenes causados por S. aureus resistente a meticilina, con sus correspondientes implicaciones epidemiológicas. Finalmente, algunas formas atípicas de erisipela suponen un reto diagnóstico para el dermatólogo. Palabras clave: piodermitis, exfoliatinas, enterotoxinas, gen de la leucocidina Panton Valentine, SARM-AC, desmogleína-1, estafilococo y estreptococo (AU)

Pyodermitis constitutes a very important chapter in dermatological practice. Its pathogenesis, in special the one caused by S. aureus, has improved due to the knowledge of the role developed by the host defensins, quorum-sensing signaling and the Panton-Valentine leucocidin gene among others. As well, exfoliative toxins and enterotoxins responsible for the staphylococal scalded skin syndrome (SSSS) and toxic shock syndrome, respectively, have been cloned. Also, it has been seen that bullous impetigo, SSSS and pemphigus foliaceus share a common target: desmoglein-1. The Panton-Valentine leucocidin gene has been related to the appearance of abscesses, necrotic cutaneous lesions and furuncles in young persons caused by meticillin resistant S. aureus, with its epidemiological implications. Finally, some atypical forms of erysipela suppose a diagnostic challenge for the dermatologist (AU)