BACKGROUND: Current treatment options for Malassezia folliculitis (MF) are limited. Recent research has demonstrated the inhibitory effect of cold atmospheric plasma (CAP) on the growth of Malassezia pachydermatis in vitro, suggesting CAP as a potential therapeutic approach for managing MF.
OBJECTIVE: The objective of our study is to assess the in vitro antifungal susceptibility of Malassezia yeasts to CAP. Additionally, we aim to evaluate the efficacy and tolerability of CAP in treating patients with MF.
METHODS: We initially studied the antifungal effect of CAP on planktonic and biofilm forms of Malassezia yeasts, using well-established techniques such as zone of inhibition, transmission electron microscopy, colony count assay and 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide salt assay. Subsequently, a randomized (1:1 ratio), active comparator-controlled, observer-blind study was conducted comparing daily CAP therapy versus itraconazole 200 mg/day for 2 weeks in 50 patients with MF. Efficacy outcomes were measured by success rate, negative microscopy rate and changes in Dermatology Life Quality Index (DLQI) and Global Aesthetic Improvement Scale (GAIS) scores. Safety was assessed by monitoring adverse events (AEs) and local tolerability.
RESULTS: In laboratory investigations, CAP time-dependently inhibited the growth of Malassezia yeasts in both planktonic and biofilm forms. Forty-nine patients completed the clinical study. At week 2, success was achieved by 40.0% of subjects in the CAP group versus 58.3% in the itraconazole group (p = 0.199). The negative direct microscopy rates of follicular samples were 56.0% in the CAP group versus 66.7% in the itraconazole group (p = 0.444). No significant differences were found in the proportion of subjects achieving DLQI scores of 0/1 (p = 0.456) or in the GAIS responder rates (p = 0.588) between the two groups. Three patients in the CAP group and one patient in the itraconazole group reported mild AEs.
CONCLUSIONS: CAP demonstrated significant antifungal activity against Malassezia yeasts in vitro and exhibited comparable efficacy to itraconazole in treating MF patients. Without the associated adverse effects of oral antifungal drugs, CAP can be considered a promising and safe treatment modality for MF.

We present the case of a 53-year-old Caucasian man with a history of intravenous drug use who presented with fever and multiple pustules predominantly affecting hairy areas of the body, with no clinical improvement despite previous antibiotic treatment. Culture of the pustules confirmed Candida albicans infection and histological examination of skin biopsies revealed suppurative granulomas compatible with candidomycetic folliculitis. The patient was successfully treated with systemic antifungals and discharged with resolution of symptoms. Candidomycetic folliculitis is a condition typically associated with brown heroin consumption due to the use of acidic solvent that promotes Candida growth. Clinical manifestations include fever followed by skin lesions, with possible systemic involvement if untreated. Extensive folliculitis with associated fever in an IVDU should raise suspicion of this pathology since early diagnosis and appropriate treatment are crucial to prevent complications.

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Bacterial skin infections represent a significant health care burden. Cellulitis and erysipelas are rapidly spreading, painful, superficial skin infections, usually caused by streptococci or Staphylococcus aureus. Folliculitis is an infection of hair follicles mostly caused by S aureus. Simple folliculitis typically is self-limited. Topical benzoyl peroxide is a first-line nonantibiotic treatment. Mupirocin and clindamycin are topical antibiotic options. For treatment-resistant cases, oral cephalexin or dicloxacillin is an appropriate option. Impetigo is a common, self-limited infection in children. Bullous impetigo is caused by S aureus, and nonbullous impetigo is caused by beta-hemolytic streptococci, S aureus, or both. In most cases, topical mupirocin or retapamulin (Altabax) is effective. Oral antibiotics should be considered for household outbreaks or patients with multiple lesions. Abscesses are red, painful collections of purulence in the dermis and deeper tissues caused by S aureus or polymicrobial infections. Furuncles are abscesses of a hair follicle, whereas carbuncles involve several hair follicles. In recurrent cases of these lesions, culture of the exudate is recommended. Abscess, furuncle, and carbuncle management consists of incision and drainage. Oral antibiotics are not necessary in most cases but should be prescribed for patients with severe immunocompromise or systemic signs of infection. In bacterial skin infections, methicillin-resistant S aureus coverage should be considered for patients with infections that have not improved with treatment.

Keloid scars and folliculitis keloidalis nuchae (FKN) are benign fibroproliferative dermal lesions of unknown aetiology and ill-defined treatment, which typically present in genetically susceptible individuals. Their pathognomonic hallmarks include local aggressive invasive behaviour plus high recurrence post-therapy. In view of this, we investigated proliferative and key parameters of bioenergetic cellular characteristics of site-specific keloid-derived fibroblasts (intra(centre)- and peri(margin)-lesional) and FKN compared to normal skin and normal flat non-hypertrophic scar fibroblasts as negative controls.The results showed statistically significant (P < 0.01) and variable growth dynamics with increased proliferation and migration in keloid fibroblasts, while FKN fibroblasts showed a significant (P < 0.001) increase in proliferation but similar migration profile to controls. A statistically significant metabolic switch towards aerobic glycolysis in the fibroblasts from the disease conditions was noted. Furthermore, an increase in basal glycolysis with a concomitant increase in the cellular maximum glycolytic capacity was also demonstrated in perilesional keloid and FKN fibroblasts (P < 0.05). Mitochondrial function parameters showed increased oxidative phosphorylation in the disease conditions (P < 0.05) indicating functional mitochondria. These findings further suggest that Keloids and FKN demonstrate a switch to a metabolic phenotype of aerobic glycolysis. Increased glycolytic flux inhibition is a potential mechanistic basis for future therapy.

Scars commonly give rise to unpredictable, potentially irritating, cutaneous complications including pruritis, folliculitis, and pigment changes. These problems can be self-limiting and are prevalent in many burn cases, although their expression varies among individuals. A better understanding of the presentation, risk factors, and pathophysiology of these long-term sequelae allows for more comprehensive care of burn survivors.

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Background: Scalp-related symptoms such as dandruff and itching are common with diverse underlying etiologies. We previously proposed a novel classification and scoring system for scalp conditions, called the scalp photographic index (SPI); it grades five scalp features using trichoscopic images with good reliability. However, it requires trained evaluators.Aim: To develop artificial intelligence (AI) algorithms for assessment of scalp conditions and to assess the feasibility of AI-based recommendations on personalized scalp cosmetics.Methods: Using EfficientNet, convolutional neural network (CNN) models (SPI-AI) ofeach scalp feature were established. 101,027 magnified scalp images graded according to the SPI scoring were used for training, validation, and testing the model Adults with scalp discomfort were prescribed shampoos and scalp serums personalized according to their SPI-AI-defined scalp types. Using the SPI, the scalp conditions were evaluated at baseline and at weeks 4, 8, and 12 of treatment.Results: The accuracies of the SPI-AI for dryness, oiliness, erythema, folliculitis, and dandruff were 91.3%, 90.5%, 89.6%, 87.3%, and 95.2%, respectively. Overall, 100 individuals completed the 4-week study; 43 of these participated in an extension study until week 12. The total SPI score decreased from 32.70 ± 7.40 at baseline to 15.97 ± 4.68 at week 4 (p < 0.001). The efficacy was maintained throughout 12 weeks.Conclusions: SPI-AI accurately assessed the scalp condition. AI-based prescription of tailored scalp cosmetics could significantly improve scalp health.

Necrotizing infundibular crystalline folliculitis (NICF) is a rare type of necrotizing folliculitis. The disease typically manifests as folliculocentric papules arising in a seborrheic distribution. Only 23 cases exist in the literature. Most reported cases have arisen spontaneously, but a small number of drug-induced cases in the setting of epidermal-derived growth factor, vascular endothelial-derived growth factor, or PD-1 inhibitor therapy have been reported. Colonization by bacteria and/or yeast occurs frequently. The etiology remains unknown, but some suggest a complex interplay with an aberrant microbiome, sebaceous gland dysfunction, and perturbed EGFR signaling in follicular infundibula. Histopathologic findings include rupture of follicular epithelium, neutrophilic inflammation, and nodular cup-shaped crystal deposits. We present a case of spontaneous, recurrent NICF in an inverse pattern in the inguinal region.