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[Fungi and atopic dermatitis]
M Hiruma1, D J Maeng, M Kobayashi
1Department of Dermatology, Juntendo University School of Medicine, 2-1-2 Hongo, Bunkyo, Tokyo 113-8421, Japan.
Abstract:
Attention has recently been centered on fungi as aggravating factors of atopic dermatitis (AD) due to the frequent detection of IgE antibodies to fungi in patients with severe AD and to positive response of some cases of AD to antifungal therapy. Malassezia sp.: In AD patients with prominent symptoms in the head and neck, areas prone to colonization by Malassezia, the titers of specific anti-Malassezia IgE antibodies are high, which positively correlate with the total IgE value and the severity of AD. The patch test against Malassezia antigens is positive. The rate of isolation of Malassezia from the skin of AD patients is higher than that from the skin of healthy control subjects. Candida sp.: In patients with severe AD, the rate of positive skin prick tests for Candida is high, and a correlation exists between positive skin prick test results and the presence of Candida albicans in nasopharynx. However, the reactivity to Candida antigens in the patch tests is reduced, and a negative correlation is seen. There is no difference between the isolation rate of C. albicans from patients with adult-type AD and normal controls. However, AD patients give a significantly greater number of separate colonies. The range of efficacy rate of antifungal therapy of AD is reported to be 50-65 %. The efficacy rate of our own trial falls within this range. Following treatment, the rate of isolation of fungi decrease significantly, and the titers of specific antifungal IgE antibodies are not statistically significant. The clearance of fungi from the tissue following antifungal therapy probably results in the suppression of direct or indirect inflammatory reaction caused by the fungi. We therefore consider antifungal therapy as one of the second-line therapies to be administered in AD cases resistant to conventional basic therapy.
Insights
Fungi like Malassezia and Candida can worsen atopic dermatitis (AD). Antifungal therapy shows promise, reducing fungal presence and IgE antibody titers in AD patients, suggesting it as a potential second-line treatment.
Area of Science:
- Mycology
- Dermatology
- Immunology
Background:
- Fungi are increasingly recognized as potential contributors to atopic dermatitis (AD).
- Elevated IgE antibodies to fungi and positive responses to antifungal treatments in some AD cases highlight this connection.
- Specific fungal species, Malassezia and Candida, are frequently implicated in AD exacerbations.
Purpose of the Study:
- To investigate the role of Malassezia and Candida species in atopic dermatitis.
- To evaluate the efficacy of antifungal therapy in managing AD symptoms and fungal colonization.
- To correlate fungal presence and IgE antibody levels with AD severity.
Main Methods:
- Assessing IgE antibody titers against Malassezia and Candida antigens.
- Performing skin prick and patch tests for fungal sensitization.
- Quantifying fungal isolation rates from the skin and nasopharynx of AD patients and controls.
- Monitoring changes in fungal load and IgE levels post-antifungal treatment.
Main Results:
- High anti-Malassezia IgE titers and positive patch tests were observed in AD patients, correlating with disease severity.
- Increased isolation rates of Malassezia were found on the skin of AD patients compared to controls.
- While skin prick tests for Candida were often positive, patch test reactivity was reduced.
- Antifungal therapy demonstrated a 50-65% efficacy rate, significantly decreasing fungal isolation and specific IgE antibody titers.
Conclusions:
- Fungal colonization, particularly by Malassezia, plays a significant role in atopic dermatitis.
- Antifungal therapy can effectively reduce fungal burden and associated IgE responses in AD.
- Antifungal treatment is a viable second-line option for refractory atopic dermatitis cases.