A Comparative Study on Clinical and Therapeutic Features Between Malassezia Folliculitis and Steroid Acne

Seo, Young Joon; Piao, Youg Jun; Suhr, Ki Beom; Lee, Jeung Hoon; Park, Jang Kyu

Abstract

BACKGROUND: Steroid acne have similar clinical manifestations with Malassezia folliculitis, so it is not easy to distinguish between these disease entities clinically. And there have been few reports about them and the therapeutic efficacy of antifungal agent for steroid acne.
OBJECTIVE
We aimed to find out different points clinically between steroid-using acneiform eruption group and the group without use, and describe the results of direct-microscopic examinations and establish the relationships between therapeutic responses to oral antifungal agent and some variables like use of corticosteroids, grade of direct-microscopically positive score.
METHODS
With 91 patients according to the protocol prepared, we described characteristics of the lesions, sites, and distributions, use of corticosteroids, then examined Malassezia spores with 10% KOH/Parker blue black ink mount from patient's skin lesions. And finally we compared the reponses to antifungal agent. For objective evaluation we used direct microscopic grading method to count spores introduced by Jacinto-Jamora et al.
RESULTS
In both groups with and without use of corticosteroids, most had characteristics of papules and pustules, symmetric distributions except the patients using topical corticosteroids. In all positive groups, there was no significant difference in therapeutic responses regardless of the previous use of corticosteroids. Interestingly therapeutic response rate of (1+) group to itraconazole are similar with that of higher scoring groups.
CONCLUSION
We suggest that not in a tropical area like Korea, direct-microscopically low score ((1+) or (2+)) and even negatives with typical manifestations of Malassezia folliculitis has a clinical significance and both steroid acne and Malassezia folliculitis may be one spectrum of the same disease.