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Unveiling the Enigma of Fungal Acne: How Does the Skin Microbiome Cause Malassezia Folliculitis?


malassezia microbiome

Often colloquially termed "fungal acne," Malassezia folliculitis (MF) is an infection of the hair follicle triggered by yeasts belonging to the Malassezia genus (formerly known as Pityrosporum). While these lipophilic yeasts are typically part of the natural skin microbiome, under specific conditions, they can become pathogenic causing acne-like symptoms. 


What We Know:


  • Following birth, Malassezia typically establishes residence on the skin and is usually well-tolerated by the immune system. However, its pathogenic capabilities emerge when it infiltrates the stratum corneum under conducive conditions, such as hot and humid climates, engaging directly with the host immune system and via chemical mediators (Saunte, Gaitanis & Hay, 2020).


  • Essentially, the transformation of Malassezia from commensal to pathogenic is driven by a complex interaction between the host and the fungus, resulting in the production of virulence factors such as indoles, reactive oxygen species, azelaic acid, hyphae formation and biofilm formation (Kurniadi, Hendra Wijaya & Timotius, 2022).


  • The primary species linked to MF include M. furfur, M. globosa, M. restricta, M. sympodialis and M. pachydermatis (Henning et al., 2023).


  • These species penetrate the pilo-sebaceous unit, resulting in follicular dilation and the accumulation of Malassezia cells. If follicular walls rupture, it triggers an inflammatory response. This can be misdiagnosed as acne, steroid acne, bacterial folliculitis, eosinophilic folliculitis, pustular drug eruptions or lymphomatoid papulosis (Saunte, Gaitanis & Hay, 2020).


Industry Impact and Potential:


  • While systemic antifungal monotherapy typically yields better results, topical therapy is useful in conjunction and is beneficial in situations where systemic treatment is not feasible. Topical antifungals, tretinoin, benzoyl peroxide azoles, selenium sulphide, and propylene glycol are viable topical options for managing MF (Saunte, Gaitanis & Hay, 2020).


  • Currently, there is no internationally approved treatment guideline for managing MF. This presents an exciting opportunity to explore microbiome-focused treatment approaches, tailoring therapies to restore microbial balance and target Malassezia overgrowth effectively (Saunte, Gaitanis & Hay, 2020).


Our Solution:


With a vast database of over 20,000 microbiome samples and 4,000 ingredients, Sequential offers comprehensive services to tackle issues like MF. Our customisable microbiome studies and product formulation support ensure effective product development. 


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