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Original article
2,
Soo Young Kim, * Se Hyun Kim, * Su Na Kim, Ah-Reum Kim, Yu Ri Kim, Min Jung Kim,
2
2
3
1,4
1,4
Won-Seok Park, John Hwan Lee, Won Hee Jung, Yang Won Lee, Yong Beom Choe and
1,4
Kyu Joong Ahn
1
Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea, 2AMOREPACIFIC Corp. R&D Unit, Yongin, Korea, 3Department of
Systems Biotechnology, Chung-Ang University, Anseong, Korea and 4Research Institute of Medical Science, Konkuk University, Seoul, Korea
Summary
We investigated the distribution of Malassezia yeast in 120 Chinese (20 patients from
each of six cities) and 20 Korean patients with scalp seborrheic dermatitis (SD) and
dandruff (SD/D) using ITS1 and ITS2 polymerase chain reaction-restriction fragment
length polymorphism. Bioactivity was studied by quantifying sebum lipid production
by human primary sebocytes and inflammatory cytokine, interleukin-8 (IL-8) production was studied by exposing HaCaT keratinocytes with extracts of five standard
Malassezia strains; M. globosa, M. restricta, M. sympodialis, M. dermatis and M.
sloof- fiae. M. restricta and M. globosa were the most frequently encountered species
from both Chinese and Korean patients. These two Malassezia species also promoted
neu- tral lipid synthesis although the result was not statistically significant and
induced significant increase in IL-8 production among the five Malassezia species
studied. The study suggests a possible role of these organisms in the pathogenesis of
SD/D.
Key words: dandruff, seborrheic dermatitis, Malassezia yeast, ITS1 and ITS2 PCR-RFLP, neutral lipid synthesis,
IL-8.
Introduction
Seborrheic dermatitis (SD) and dandruff (D) are common diseases of the scalp characterised by flaking and
itching. Both the clinical conditions are believed to be
basically same, but differing in their severity. It is said
that about 13% of the general population suffer from
SD, while more than 50% of them from D.1 For
more than a century, Malassezia yeast have been
Correspondence: Yang Won Lee, MD, PhD, Department of Dermatology,
Konkuk University School of Medicine, 120-1
Neungdong-ro,
Gwangjin-gu, Seoul 143-729, Korea.
Tel.: +82 2 2030 5172. Fax: +82 2 2030 5179.
E-mail: 20050078@kuh.ac.kr
*These authors contributed equally to this work.
Submitted for publication 13 February 2015
Revised 10 November 2015
Accepted for publication 10 December 2015
doi:10.1111/myc.12456
incriminated to be the cause of SD/D and a large number of studies as well as clinical response as well as
reduction in the yeast population following antifungal
therapy support this hypothesis.2,3 Among the 14
Malassezia species identified to date, Malassezia restricta
and M. globosa are considered to be the predominant
species in the pathogenesis of SD/D, although the discrepancies exist between the studies, they can be
attributed to the methodological as well as geographical and ethnic variations in the population studied.46
It is not clear which virulence factor or factors of
Malassezia species initiates the development or exacerbation of SD. Probably, it is the interplay between
Malassezia, keratinocytes and immune mechanism
determines the transformation of a commensal Malassezia into a pathogen.7 Malassezia utilise the sebum
present on the scalp as a source of nutrient.8 Lipases
produced by Malassezia degrade the sebum, releasing
free fatty acids from triglycerides (TGs) and a part of
(EDTA), 100 lg ml
RNase A] in a 1.5-ml tube. All
sam- ples were stored at 20 C until used.
Standard strains
19
RFLP analysis
Students t-test was used to compare variables. Analyses were performed using SPSS software (version 21.0
for Windows; SPSS, Chicago, IL, USA). The cut off for
statistical significance was set at P < 0.05.
Results
Identification of Malassezia yeast in scalp SD
Discussion
This study revealed that M. restricta and M. globosa
are the two prevalent species on the scalps of Chinese
and Korean patients with SD/D. This is in agreement
46,1014
with the findings of several other studies.
Gemmer et al. [10] and Crespo-Erchiga et al. [11]
reported M. restricta as the most common species in
SD patients, whereas Gupta et al. [12] and Gaitanis
et al. [13] reported M. globosa as the most common. A
recent study from China has shown M. globosa and
M. restricta are almost equally distributed (87.0% and
81.5% respectively).14 The disparity in the prevalence
rates between different studies could be attributed to
the variations in the sampling and identification techniques adopted by the workers as well as geographical
and ethnicity differences in the population.4,6,1014
Several studies have demonstrated that Malassezia
yeast are the normal inhabitants of healthy human
skin and their distribution varies depending on the
12,1519
body sites.
On the scalp and forehead,
Table 1 Isolation of Malassezia species from the scalp of patients with SD in Korea and China (%).
M. restricta
M. globosa
M. sympodialis
M. dermatis
M. furfur
M. slooffiae
Others
None
Korea
China
Guangzhou
Chengdu
Wuhan
Shanghai
Beijing
Shenyang
100.0
100.0
11.1
0.0
0.0
0.0
0.0
0.0
82.8
82.8
3.4
0.0
0.0
0.0
5.2
5.2
100.0
77.8
11.1
0.0
0.0
0.0
0.0
0.0
100.0
100.0
11.1
0.0
0.0
0.0
0.0
0.0
90.0
60.0
0.0
0.0
0.0
0.0
0.0
0.0
60.0
60.0
0.0
0.0
0.0
0.0
0.0
40.0
70.0
100.0
0.0
0.0
0.0
0.0
30.0
0.0
80.0
100.0
0.0
0.0
0.0
0.0
0.0
0.0
cies. NC: normal control. *P < 0.05; **P < 0.005; ***P < 0.001,
as compared to normal control.
Acknowledgements
This work was supported by the Basic Science
Research Program through the National Research
Foundation of Korea (NRF), funded by the Ministry
of
Science,
ICT,
Future
Planning
NRF2013R1A1A2007863 and AMOREPACIFIC Corp., and
the grant of Paul-Janssen from Korean Dermatologic
Association (2015).
The authors thank Professor Xuemin Wang at the
Shanghai Skin Disease Hospital, Professor Li Li at the
West China Hospital of Sichuan University, Professor
Wei Lai at The Third Affiliated Hospital of Sun YatSen University, Professor Hong Liang at the Renmin
Hospital of Wuhan University, Professor Xinghua Gao
at The First Hospital of China Medical University, and
Professor Wei Liu at The General Hospital of Air Force
for their clinical support in China.
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