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Abstract Malassezia spp. dermatitis, a rare disorder in cats, has previously been associated with immune suppression and internal malignancies. This study evaluates the presence and importance of Malassezia spp. in feline
biopsy specimens submitted for histopathological examination. Five hundred and fifty haematoxylin and eosinstained skin biopsy specimens received for histopathological examination between January 1999 and November
2000 were reviewed. Fifteen (2.7%) submissions contained Malassezia organisms in the stratum corneum of the
epidermis or follicular infundibulum. Eleven of 15 cats presented with an acute onset of multifocal to generalized
skin lesions. All 11 cats were euthanized or died within 2 months of the onset of clinical signs. Seven cats had
dermatopathological changes and clinical signs supportive of paraneoplastic alopecia, and three cats had an
interface dermatitis suggestive of erythema multiforme or thymoma-associated dermatosis. Histopathological
changes were nonspecific in one cat that was euthanized 2 weeks following onset of severe pruritus and alopecia.
In three cats, Malassezia spp. were found in localized sites (two chin, one footpads) and appeared inconsequential
to their overall health status. One cat had Malassezia spp. in association with cutaneous demodicosis. These
findings suggest that Malassezia yeast in dermatopathological specimens from multifocal or generalized lesions
should prompt a thorough clinical work-up for internal neoplasia.
Keywords: alopecia, carcinoma, feline, Malassezia, pancreas, paraneoplastic, thymoma.
INTRODUCTION
Malassezia dermatitis is a commonly diagnosed dermatopathy in dogs. The overgrowth of Malassezia pachydermatis on the skin of dogs has been associated with
allergic disease, cornification defects and the corticosteroids or antibiotics used to treat these disorders. Most
dogs respond well to treatment if an underlying disorder
is identified and addressed.18 In cats, the association
between Malassezia and allergic disorders is not established and far fewer cases of Malassezia infection have
been documented. Veterinary practitioners occasionally
encounter cats with waxy otitis externa or refractory
chin acne due to Malassezia.13,911 However, cutaneous infections beyond these sites are quite rare. Cats
can harbour Malassezia organisms within the auditory
canal, anus and skin. Malassezia organisms of several
species have been cultured from normal and abnormal
feline skin.1214 Cats with feline immunodeficiency
virus and diabetes mellitus could be predisposed to
developing Malassezia infection.11 A recent study
showed that Malassezia yeast could be cultured more
commonly from retroviral-infected cats than from
normal cats.15
Correspondence: Elizabeth A. Mauldin, Department of Clinical
Studies, Veterinary Hospital of the University of Pennsylvania, 3850
Spruce Street, Philadelphia, PA 19104, USA. Fax: 215 898 0719,
E-mail: emauldin@vet.upenn.edu
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15
13
10
14
14
10
10
2
17
2.5
10
11
12
13
14
15
chin
chin
footpads
ventrum, medial
hindlimbs
ventrum, medial limbs,
dorsal neck
trunk, head, limbs,
mucocutaneous junctions,
pinnae, footpads and claw
head, periocular, nasal
planum, neck, footpads
periocular/periaural,
pinnae, footpads
ventrum, footpads,
perioral
ventrum, thighs,
head, footpads
generalized
ventrum
ventrum, medial
hindlimbs
ventrum
Site
alopecia, excoriations
comedones
erythema, ulcers, crusts
focal ulcers
complete alopecia,
shiny skin
complete alopecia,
shiny skin
erythema, thick crusts
and scale, erosions,
fissures
alopecia, erythema,
sloughing
erythema, crusts,
erosions
erythema, crusts
alopecia, erythma,
scaling
alopecia, scaling
alopecia, erosions,
erythema
Dermatological
lesions
yes
focal
focal
no
yes
no
unknown
no
yes
no
no
yes
yes
yes
yes
Pruritus
anorexia, leukocytosis
Clinical findings
demodicosis
chin acne
SCC in situ
footpad hyperkeratosis
interface dermatitis
interface dermatitis
interface dermatitis
follicular atrophy
alive/1.0 years
euthanized 6 months
after biopsy
alive/1.25 years
alive/1.5 years
euthanized 4 weeks
after onset
euthanized 4 weeks
after onset
euthanized 4 weeks
after onset
euthanized 8 weeks
after onset
died 8 weeks
after onset
euthanized 8 weeks
after onset
euthanized 3 weeks
after onset
follicular atrophy
follicular atrophy
euthanized 9 days
after onset
euthanized 4 weeks
after onset
euthanized 8 weeks
after onset
euthanized 4 weeks
after onset
Follow-up
follicular atrophy
follicular atrophy
follicular atrophy,
SND
follicular atrophy
Skin diagnosis
N/A
N/A
not performed
N/A
not performed
not performed
not performed
biopsy, metastatic
carcinoma in liver
not performed
not performed
pancreatic carcinoma,
liver metastasis
not performed
pancreatic
carcinoma,
liver metastasis
pancreatic carcinoma
in situ, hepatopathy,
intestinal lymphoma
not performed
Post mortem
ALT alanine aminotransferase; ALP alkaline phosphatase; u/s ultrasound; SND superficial necrolytic dermatitis; SCC squamous cell carcinoma
Group 1: cases 17; Group 2: cases 811; Group 3: cases 1215
Age
Case
RESULTS
Fifteen of 550 (2.7%) cases contained Malassezia yeast
in the stratum corneum of the epidermis (14/15) or
Figure 1. Cat 1, paraneoplastic alopecia; severe symmetrical alopecia and erythema on ventrum and limbs (Courtesy of Dr Jean Greek,
Overland Park, KS).
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DISCUSSION
Recent interest in canine Malassezia dermatitis has led
to a dramatic increase in research into the clinical and
immunological manifestations of this disorder. In contrast, few studies have reported the incidence or significance of Malassezia in the cat. This may be due to the
rarity of the disease in the cat compared with the dog.
In this study, we found Malassezia in very few of the
feline biopsies (2.7%) submitted over a 23-month period.
In general, the diagnostic pathology service may be
a better estimation of skin disease in a cat population
than a clinical referral practice. Eleven of the biopsies
in our series were from veterinarians in general practice.
Two were submitted from board-certified veterinary
dermatologists in private practice, and only two were
seen at the Veterinary Hospital of the University of
Pennsylvania. In this study, Malassezia was not found
in association with feline allergic disorders. The authors
estimate that at least 75% of the 550 skin biopsies
reviewed had eosinophilic dermatitides suspicious of
allergic disease. This differs slightly from a previous
histological study, which found Malassezia in 3 of 338
feline skin biopsies two with eosinophilic granuloma
complex and one case of lichenoid dermatitis.25 The
authors recognize that biopsies with few organisms could
have been overlooked during the histopathological review.
However, neither study demonstrates a propensity of
Malassezia infection in cats with allergic disease. This
is in sharp contrast to the dog in which M. pachydermatis
infection typically occurs in association with atopy or
other allergic disorders.18 Perhaps, the failure to detect
yeast in allergic cats was a result of the sampling technique. Histopathology is an insensitive method to detect
yeast organisms because of the processing of the tissue
and loss of stratum corneum. Smaller populations of
yeast may be more readily identified with tape stripping
or impression smears.25,26
In this study, the presence of Malassezia was not
associated with retroviral infections. None of the 11/15
cats tested for FIV and/or FELV were positive. This
finding contrasts a recent study, which showed that
Malassezia could be recovered more readily from
cats with retroviral infections than normal cats.15 However, this study did not document skin lesions in cats
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ACKNOWLEDGEMENTS
The authors thank Drs Jean Greek and James Jeffers
and the many veterinarians in private practice for their
case submissions and assistance.
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Malassezia sympodialis and Malassezia globosa from
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Resolution of exfoliative dermatitis and Malassezia
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24. Yager, J. A., Wilcock, B. P. Color Atlas and Text of Surgical Pathology of the Dog and Cat. Dermatopathology
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Rsum La dermatite Malassezia spp. est rare chez le chat, et a t rapporte dans cette espce en association
avec un immunodficit et des tumeurs internes. Cette tude sest intresse valuer la prsence et limportance
de Malassezia spp. dans des prlvements biopsiques soumis pour examen histopathologique. Cinq cent cinquante biopsies, reues pour examen histopathologique entre janvier 1999 et novembre 2000, ont t values.
Quinze (2.7%) contenaient des Malassezia dans la couche corne de lpiderme ou dans linfundibulum folliculaire. Onze des 15 chats taient prsents pour des lsions cutanes, dapparition brutale, multifocales ou
gnralises. Les 11 chats ont t euthanasis ou sont morts 2 mois aprs lapparition des signes cliniques. Sept
chats prsentaient des modifications histologiques et des signes cliniques vocateurs dune alopcie paranoplasique et trois chats prsentaient une dermatite dinterface voquant un rythme polymorphe ou une dermatite
exfoliative associe un thymome. Les lsions histologiques taient peu spcifiques dans un cas, qui a t euthanasi 2 semaines aprs un pisode de prurit svre et dalopcie. Pour trois chats, les levures ont t retrouves
sur des zones localises (deux fois au niveau du menton, une fois sur les coussinets) sans implication clinique.
Un chat prsentait la fois des Malassezia spp. et une dmodcie cutane. Ces observations suggrent que la
prsence de levures Malassezia lexamen histopathologique de lsions multifocales ou gnralises doit saccompagner dune recherche approfondie de tumeur interne.
Resumen La dermatitis por Malassezia spp., una presentacin infrecuente en gatos, se ha asociado previamente
a inmunosupresin y a procesos malignos internos. Este estudio evalua la presencia e importancia de Malassezia
spp. en las muestras de biopsia cutnea remitidas para examen histopatolgico. Se revisaron quinientas cincuenta
muestras de biopsia cutnea teidas con hematoxilina/eosina, remitidas para estudio histopatolgico entre enero
de 1999 y noviembre de 2000. Quince muestras (2.7%) contenan organismos de Malassezia en el estrato crneo
de la epidermis o el infundbulo folicular. Once de 15 gatos presentaban con lesiones de forma aguda de distribucin multifocal a generalizada. Los 11 gatos fueron eutanasiados o murieron durante los 2 meses siguientes
al inicio de los sntomas clnicos. Siete gatos tenan cambios dermatopatolgicos y sntomas clnicos que apoyaban una alopecia paraneoplsica, y tres gatos tenan una dermatitis de la unin dermo-epidrmica sugestiva
de eritema multiforme o dermatosis asociada a timoma. Los cambios histopatolgicos fueron inespecficos en
un gato que fue eutanasiado 2 semanas despus del inicio de prurito intenso y alopecia. En tres gatos, se encontraron Malassezia spp. en reas localizadas (dos barbillas, una almohadilla) y parecan no tener consecuencias
en su salud general. Un gato tena Malassezia spp. asociada demodicosis cutnea. Estos hallazgos sugieren que
la presencia de la levadura Malassezia en muestras dermatopatolgicas de lesiones multifocales o generalizadas,
debera mover a realizar una analtica completa para investigar una posible neoplasia interna.
Zusammenfassung Fnfhundertundfnfzig mit Hmatoxylin und Eosin gefrbte Hautbiopsieproben, die
zwischen Januar 1999 und November 2000 eingereicht wurden, wurden untersucht. Fnfzehn (2.7%) eingereichte
Proben enthielten Malassezia Organismen im Stratum corneum der Epidermis oder im follikulren Infundibulum. Elf dieser 15 Katzen wurden mit akuten, multifokalen bis generalisierten Hautlsionen vorgestellt. Alle 11
Katzen wurden euthanasiert oder starben innerhalb von 2 Monaten nach Beginn der klinischen Symptomatik.
Sieben Katzen hatten dermatopathologische Vernderungen und Symptome, die mit paraneoplastischer Alopezie in Einklang standen und 3 Katzen hatten eine auf Erythema multiforme oder Thymom-assoziierte Dermatitis
hindeutende Entzndung der dermo-epidermalen Grenzzone. Bei einer Katze, die 2 Wochen nach Beginn von
2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 714
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