Ann Dermatol.  2014 Oct;26(5):598-602. 10.5021/ad.2014.26.5.598.

Comparison between Malassezia Folliculitis and Non-Malassezia Folliculitis

• Song HS
• Kim SK
• Kim YC

• KMID: 2265493
• DOI: http://doi.org/10.5021/ad.2014.26.5.598

Abstract

BACKGROUND
Among the various types of folliculitis, differentiation of Malassezia folliculitis (MF) from other forms of folliculitis is important because it is usually treated with antifungal agents.
OBJECTIVE
We attempted to find a method to enhance the detection rate of MF, and examined the differences in the clinical manifestation between MF and non-MF (NMF).
METHODS
We performed a retrospective study involving patients with folliculitis who were previously diagnosed with MF or NMF on the basis of serial tissue sectioning and diastase-Periodic acid-Schiff (d-PAS) staining findings. The clinical features of MF and NMF were compared.
RESULTS
Among a total of 100 folliculitis patients, 20 were diagnosed with MF and 80 with NMF. Tissues from the 80 patients with NMF were sectioned serially into 10 slices and stained with hematoxylin and eosin stain; among these, 10 had many round-to-oval yeast organisms in the hair follicles that confirmed MF. Finally, d-PAS staining was used to detect the presence of yeast in the NMF slides. Notably, among the 70 d-PAS-stained samples, yeast organisms were found in 6 samples, confirming MF. As a result, the diagnosis of 16 patients changed from NMF to MF. Compared with NMF, MF showed major involvement of the trunk and low involvement of the face and legs as well as male predilection.
CONCLUSION
Physicians should consider serial sectioning and/or d-PAS staining of folliculitis lesions, particularly of those on the trunk of male patients, even if no yeast organisms are detected initially.

Keyword

Folliculitis; Malassezia folliculitis; Serial section

MeSH Terms

Antifungal Agents
Diagnosis
Eosine Yellowish-(YS)
Folliculitis*
Hair Follicle
Hematoxylin
Humans
Leg
Malassezia*
Male
Retrospective Studies
Yeasts
Antifungal Agents
Eosine Yellowish-(YS)
Hematoxylin

Figure

• 

  Fig. 1 Scheme of evaluation of Malassezia folliculitis (MF) and non-MF (NMF). Through serial section and histochemical study, additional Malassezia species could be visualized, and the previous diagnosis of NMF was changed to MF. H&E: hematoxylin and eosin, d-PAS: diastase-Periodic acid-Schiff.

• 

  Fig. 2 Through serial ttisue sections stained with hematoxylin and eosin, Malassezia are seen in the hair follicle (B, C) resulting in s change in the diagnosis from non-Malassezia folliculitis (A) to Malassezia folliculitis.

• 

  Fig. 3 (A) Initial slide diagnosed as non-Malassezia folliculitis. Malassezia microorganisms, not found by serial tissue section (B), but visible on diastase-Peridoc acid-Schiff (d-PAS) staining (C).

Reference

1. Luelmo-Aguilar J, Santandreu MS. Folliculitis: recognition and management. Am J Clin Dermatol. 2004; 5:301–310.

2. Durdu M, Ilkit M. First step in the differential diagnosis of folliculitis: cytology. Crit Rev Microbiol. 2013; 39:9–25.

3. Gupta AK, Batra R, Bluhm R, Boekhout T, Dawson TL Jr. Skin diseases associated with Malassezia species. J Am Acad Dermatol. 2004; 51:785–798.

4. Lévy A, Feuilhade de Chauvin M, Dubertret L, Morel P, Flageul B. Malassezia folliculitis: characteristics and therapeutic response in 26 patients. Ann Dermatol Venereol. 2007; 134:823–828.

5. Sigg C, Pelloni F, Schnyder UW. Focal melanocytic atypia in dysplastic nevus cell nevi. Results of a serial section study. Hautarzt. 1989; 40:701–707.

6. Cuadra Oyanguren J, Barbera Montesinos E, Sánchez Carazo JL, Aliaga Boniche A. Folliculitis caused by Pityrosporum. Med Cutan Ibero Lat Am. 1985; 13:357–361.

7. Lim KB, Giam YC, Tan T. The epidemiology of Malassezia (Pityrosporon) folliculitis in Singapore. Int J Dermatol. 1987; 26:438–441.

8. Budavari JM, Grayson W. Papular follicular eruptions in human immunodeficiency virus-positive patients in South Africa. Int J Dermatol. 2007; 46:706–710.

9. Bäck O, Faergemann J, Hörnqvist R. Pityrosporum folliculitis: a common disease of the young and middle-aged. J Am Acad Dermatol. 1985; 12:56–61.

10. Bäck O, Scheynius A, Johansson SG. Ketoconazole in atopic dermatitis: therapeutic response is correlated with decrease in serum IgE. Arch Dermatol Res. 1995; 287:448–451.

11. Jacinto-Jamora S, Tamesis J, Katigbak ML. Pityrosporum folliculitis in the Philippines: diagnosis, prevalence, and management. J Am Acad Dermatol. 1991; 24:693–696.