A case of anti- pityriasis versicolor therapy that preserves healthy mycobiome
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CASE REPORT
Open Access
A case of anti- pityriasis versicolor therapy that preserves healthy mycobiome Mariusz Dyląg1* , Ewa Leniak2, Sebastian Gnat3, Jacek C. Szepietowski4 and Lukasz Kozubowski5
Abstract Background: The impact of Malassezia yeasts on skin mycobiome and health has received considerable attention recently. Pityriasis versicolor (PV), a common dermatosis caused by Malassezia genus worldwide, is a manifestation of dysbiosis. PV can be associated with hyper- and/or hypopigmented skin lesions. This disease entity is characterized by high percentage of relapses, which demands a proper antifungal therapy that is based on unambiguous species identification and drug susceptibility testing. Case presentation: Comprehensive analysis of PV case in man presenting simultaneously hyper- and hypopigmented skin lesions was performed. Conventional and molecular diagnostic procedures revealed Malassezia furfur and Malassezia sympodialis, respectively as etiological agents of skin lesions observed. Susceptibility tests showed significantly lowered sensitivity of M. furfur cells to fluconazole. Based on susceptibility profiles local antifungal therapy with drugs characterized by entirely different mechanism of action was included. Conclusions: Our study indicates that cases of PV represented by two types of skin lesions in one patient may be associated with distinct Malassezia species. Moreover, as observed in this case, each of the isolated etiological agents of PV may differ significantly in susceptibility to antifungals. This can significantly complicate the treatment of dermatosis, which by definition is associated with a significant percentage of relapses. In the presented case localized topical treatment was sufficient and successful while allowing maintaining the physiological mycobiome. Keywords: Malassezia, Hyperpigmentation, Hypopigmentation, Dysbiosis, Treatment
Background Pityriasis versicolor (PV) also known as tinea versicolor is caused by basidiomycetous yeasts of the genus Malassezia, characterized by lipid-dependent growth [1–3] and narrow specialization in the context of occupied ecological niches [2]. With respect to human skin, species of the genus Malassezia may have positive as well as negative health impact [4–6]. These lipophilic fungi are the most important components of human skin mycobiome [6–8]. It is widely accepted that the composition of the skin microbiome is critical for its health and condition [6, 7]. Malassezia * Correspondence: [email protected] 1 Department of Mycology and Genetics, Institute of Genetics and Microbiology, University of Wroclaw, Wroclaw, Poland Full list of author information is available at the end of the article
restricta, Malassezia globosa and Malassezia sympodialis are the most often isolated species from the skin of healthy individuals [8–11]. Under certain conditions, however these Malassezia species, similar to other opportunistic pathogens, break out of the internal control of the host and overgrow leading to skin infections [5]. While on health
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