Malassezia Yeasts in Acne Vulgaris

Youn, Nyoung Hoon; Cha, Seung Hoon; Park, Seok Don

Abstract

BACKGROUND: Acne is a common follicular inflammatory dermatoses affecting sebaceous glands. It has been known that Malassezia, the lipophilic normal human skin flora, contribute to the development of acne lesion, but the detailed clinical features and effective treatment methods are lacking.
OBJECTIVE
In order to elucidate clinical features and efficacy of antifungal treatment in acne associated with Malassezia, we conducted a prospective clinical study with mild to moderate acne patients.
METHODS
Twenty eight patients (13 men and 15 women, mean age 19.1+/-4.4 years) with the acneiform eruptions on their face and upper trunk who showed Malassezia from comedo on the KOH/Parker ink examination (spore load 3+ over) were included in this study. Oral itraconazole, 200mg/day, was given at the beginning of treatment for one week. Clinical assessment for the acne lesions(Cunliffe score by Leeds technique and Global acne grading system) and mycological examination were done at the beginning, 2 and 4 weeks of treatment.
RESULTS
Acne associated with Malassezia showed polymorphous eruption composed of open and closed comedo, inflammatory papules and pustules. Acneiform eruptions were found on the forehead(67%), cheek(64%), submental(60%) and temple area of the face. Among the patients, seborrhea(21%) and seborrheic dermatitis(14%) were accompanied. The acneiform eruption was aggravated during the summer season(18%). Systemic corticosteroids(14%) and menstruation(27% in women) were also mentioned as the aggravating factors. Systemic itraconazole significantly improved acne lesions from 2 weeks after treatment.
CONCLUSION
The results imply that Malassezia should be examined in patients with mild to moderate acne on the face and upper trunk, simultaneously. Use of anti-Malassezia agent such as itraconazole can be considered as an initial treatment in those patients.