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This paper is a review of two conditions (pityriasis versicolor and seborrheic dermatitis) which appear to both have a strong relationship to malassezia fungi.

General Information on Malassezia

  • Malassezia is a lipophilic yeast family that requires lipids for optimal growth [1]
  • It is a member of normal human skin flora and can be collected from almost all body areas
  • All individuals have both a humoral and cellular immune response to malassezia [2]
  • In certain conditions it has the ability to become pathogenic
  • It has been blamed for a number of skin conditions
  • Non-lipophilic malassezia have been identified (M. pachydermatis)
  • It was first described in 1874 by Malassez (hence the name)
  • Some researches still use it’s alias, pityrosporum ovale

Basics of Pityriasis Versicolor

  • Pityriasis versicolor is considered a chronic superficial fungal disease [3]
  • It is most common on the chest, neck and upper arms (in the tropics it is often seen on the face)
  • In this condition the malassezia appears to change from it’s round blastospore form to the mycelial form
  • High heat and high relative humidity are strong predisposing factors
  • Incidence rates in tropical areas are estimated between 30% to 40% of the population, while the rate in lower temperature climates is estimated at only 1% to 4% [4]
  • The disease is most common in the years when sebaceous glands are most active
  • Recurrence rates after treatment are very high (60% after 1 year and 80% after 2 years)
  • It is most often diagnosed through general clinical examination, but direct microscopy is much more effective
  • Both internal and external factors are likely to play a big role in the disease

Common Pityriasis Versicolor Treatment Options

  • A 50/50 mix of propylene glycol and water applied twice daily for two weeks is a simple, inexpensive and highly effective treatment method [5]
  • Various topical anti-fungal shampoos and preparations have been shown to be effective. This includes:
  • ketoconazole [6] and other azoles (bifonazole [7], clotrimazole [8], econazole, and miconazole [])
  • zinc pyrithione [10]
  • selenium sulfide (complaints regarding odor and stinging sensation exist)
  • Ciclopiroxolamine 0.1%
  • Terbinafine 1% cream formulation
  • System therapy (oral anti-fungals) is typically on prescribed for more aggressive cases. Long term usage has serious risk of negative side effects. Some options include:
  • Ketoconazole (oral)
  • Itraconazole
  • Fluconazole
  • Even after successful treatment, it is recommended to continue a prophylactic regimen (due to high recurrence rates)

Basics of Seborrheic Dermatitis

  • Seborrheic dermatitis most commonly affects the scalp, eyebrows, nasolabial folds, cheeks, ears, upper chest, and groin region
  • Seborrheic dermatitis lesions are often red and covered with greasy scales
  • Incidence rates are reported between 2 to 5%
  • Incidence rates are much higher in individuals with pityriasis versicolor, malassezia folliculitis, parkinson’s disease, major truncal paralysis, mood depression, AIDS and HIV infection
  • It is typically starts during puberty and can return during the later stages of life
  • It is commonly referred viewed a s a chronic condition with recurring flare ups
  • Stress, dry air and a genetic predisposition appear to be important factors in disease progression and state
  • Many studies indicate malassezia plays an important role [11]
  • Studies examining the connection between seborrheic dermatitis, malassezia and the immune system are abundant, but much of the results conflict one another
  • The immune system’s response in seborrheic dermatitis is likely altered and plays a significant role [12]
  • In individuals with neurological diseases (particularly immunosuppressive disorders) the condition is more resistant to treatment

Common Seborrheic Dermatitis Treatment Options

  • Mild corticosteroids are effective, but symptoms usually rapidly relapse following treatment
  • Antifungal therapy is the current preferred treatment approach and has been shown to be better suited for long term treatment. Common anti-fungals include:
  • Ketoconazole appears to have some of the best anti malassezia activity in the lab
  • Zinc pyrithione
  • Selenium sulfide
  • Bifonazole
  • A propylene glycol solution and a shampoo have also been shown to produce good results [13]
  • In severe cases of seborrheic dermatitis, topical anti-fungal treatment alone may not be as effective. Oral treatment attempts may be prescribed
  • Maintenance treatment is often recommended to prevent recurrence

Research Paper Details

November 12th, 2001
J Faergemann
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