| [Objectives] 1. To study the correlation between Malassezia yeast at different body sites and acne occurrence.2. To identify Malasssezia yeast from papular content of acne on face, chest, back and to establish their strong association with acne.3. To identify the association of Malassezia yeast infection with different duration of acne.[Methods] 1. It is a cross-sectional study, where data were collected from OPD (out patient department) based patients in First Affiliated Hospital of Kunming Medical University, Yunnan, China.2. Total 258 acne patients were enrolled, out of which, in 114 patients samples were taken from face, in 32 patients from chest, in 41 patients from back and in 71 patients from both face and chest/back.35 controls for each site i.e. face, chest and back were also selected.3. Study was divided into three parts, Part one comprises of comparison between two sites:face and chest, face and back, chest and back, face and chest/back provided each sample from particular one site was taken from different acne patients. In part two, samples from two sites i.e. face and chest/back was obtained from same individual. Lastly in part three, cases and controls were compared as well as three sites of controls were compared. In each part, age, sex and duration of acne lesions from each patient were noted and analysed.4. Direct microscopy and Culture was done for samples obtained from each site and the result was compared between different examined sites.5. SPSS 17.0 was used to analyse and compare the data obtained from different site.[Result] 1. In part I, There was no significant difference in between male and female population affected by acne lesion on face (P= 0.77> 0.05) and chest/back (P= 0.779> 0.05), however those in puberty and twenties were highly affected in both sex. The recovery rate of Malassezia yeast from acne lesions on face were higher in males (DM:33.3%, Culture: 33.3%) than females (DM:21.1%, Culture:14.4%), Similarly, The recovery rate of Malassezia yeast from acne lesions on chest/back were higher in males (DM:65.9%, Culture: 46.3%) than females (DM:34.4%, Culture:31.3%), however these results as well as difference in the distribution of Malassezia in different age groups were not statistically significant (P> 0.05). There was significant difference in the distribution of Malassezia yeast between lesions on face and chest (DM:P= 0.018< 0.05, Culture:P= 0.023< 0.05), face and back (DM:P< 0.001, Culture:P= 0.002< 0.05), face and chest/back (DM:P< 0.001< 0.05, Culture:P= 0.001< 0.05) but no difference between chest and back (DM:P= 0.334> 0.05, Culture:P= 0.655> 0.05). Under both direct microscopy and culture the positivity rate for Malassezia yeast was highest for chest and back lesion (DM:53.4%, Culture:39.7%) than face (DM:24.6%, Culture:17.5). Patients with acne lesions (face, chest/back) for< 2 years were higher (F:64.0%, C/B:58.9%) than for 2-5 years (F:28.9%, C/B:27.4%) and> 5 years (F:7.0%, C/B:13.7%). Malassezia were highly seen in those having acne for> 5 years followed by 2-5 years and< 2 years, but statistically there was no significant difference for facial acne (DM:P= 0.938> 0.05, Culture:P= 0.253> 0.05) as well as for chest/back lesions (DM:P= 0.095> 0.05, Culture:P= 0.144> 0.05).2. In part 2, There was significant difference in the distribution of male and female acne patients in different age groups (P= 0.002< 0.05), male being higher in puberty (63.0%) and females in their twenties (63.6%). There was no significant difference in the distribution of Malassezia in different age groups (P> 0.05) both under direct microscopy as well as in culture. There was significant difference in the distribution of Malassezia yeast in acne lesions between face and chest/back of same individual (DM:P= 0.0001< 0.05, Culture:P= 0.0002< 0.05), positivity being high for chest/back lesions (DM:74.6%, Culture:33.8%) compared to facial lesion (DM:28.1%, Culture:14.1%). Patients with acne lesions for< 2 years were higher (53.5%) than for 2-5 years (29.6%), and> 5 years (16.9%). Although patients with history of prolonged acne lesions (> 5 years) showed high positivity for Malassezia than those with short duration, statistically these differences were insignificant (DM:P= 0.119>0.05, Culture:P=0.075>0.05).3. In part 3, There was significant difference in the distribution of Malassezia between face and back (P<0.001), chest and back (P=0.002<0.05) but no difference between face and chest(P=0.081>0.05). There was no significant difference in the distribution of Malassezia yeast in different age groups. For each site there was difference in Malassezia recovery rate between patients lesion and normal skin of controls, face (P=0.001<0.05), chest (P=0.023<0.05) and back (P<0.001<0.05), recovery rate of yeast being high in controls.[Conclusion] Malassezia yeast were recovered from acne lesions which gives the impression of positive relationship between this yeast and acne occurrence. When two different sites of the body were compared, the detection rate of Malassezia yeast from acne lesions were high in the chest/back compared to face. Prolonged duration of acne especially of more than 2 years have strong positive relation with Malassezia than acne of short duration. Thus, in order to rule out mixed Malassezia infection, one must consider of doing fungus examination on acne patients especially those having lesions on chest and back and with more than 2 years of duration including recurrent or refractory acne. The detection rate of Malassezia was high in the control group which indicates higher number of Malassezia yeast on the skin surface than inside the follicles. |
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