Malassezia Folliculitis: Prevalence, Clinical Features Risk Factors and Treatment: A Prospective Randomized Comparative Study

Background: Malassezia folliculitis (MF) is an opportunistic fungal infection of the sebaceous glands caused by yeasts of the genus Malassezia. The objective: The aim is to review the epidemiological and clinical characteristics of MF focusing particularly on therapeutic features of Itraconazole (ITZ) and Ketoconazole shampoo (KTZ). Methods: We performed a prospective randomized comparative study conducted over a period of 10 months. The diagnosis of MF was suspected clinically and confirmed by mycological examination. Patients were put in turn under KTZ 2 times per week for 2 months, ITZ 200 mg per day for a week, or both. A clinical and mycological assessment was carried out on 15th day, 30th day and 60th day. Results: 41 patients (mean age: 24 years) were included in the study. The ratio of men to women was 0.46. Skin lesions were pustular in all cases, papulopustular in 87% and keloid in 7%. MF was located at the back in 78%, the arm (70.7%), the chest (61%), and associated with acne (61%) dandruff (58%) and pityriasis versicolor (26.8%). Seborrhea was noted in 97% and excessive exercise in 29%. Hair removal and daily shaving were the main precipitating factors incriminated. Only 2 patients were immuno-compromised. The outcome of patients after treatment was assessed in 85.4%. All patients were improved with complete recovery in 45.7% and partial improvement in 54.3%. Mycological sample were performed in 19 patients and it were negative in 10 cases. Patients treated with ITZ alone or with the KTZ had similar results of complete recovery and partial improvement. Our patients treated only with KTZ had more regression cases. Conclusion: The hot and wet climate, excessive sweating and seborrhea are the main predisposing factors for MF. Hair removal and daily shaving may also be precipitating factors. KTZ and ITZ are efficacious in MF treatment.

Author(s): Emna Bahlou, Masmoudi Abderrahmen, Frikha Fatma, Khadija Sellami, Boudaya Sonia, Madiha Mseddi, Mariem Amouri,Hamida Turki, Cheikhrouhou Fatma and Ali Ayedi

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