Lisätietoa ihon sieni-infektioista atooppisessa ekseemassa

• Ihon normaalifooraan kuuluvat Malassezia-hiivat (Pityrosporum-hiivat) ovat lipofiilisia ja esiintyvät yleensä seborrooisilla ihoalueilla, joissa on runsaasti talirauhasia: kasvot, kaula, hiuspohja ja ylävartalo.
• Lasten iholta Malasseziaa löytyy harvemmin, yleensä iho kolonisoituu hiivalla puberteetin jälkeen «Scheynius A, Johansson C, Buentke E ym. Atopic eczema/dermatitis syndrome and Malassezia. Int Arch Allergy Immunol 2002;127:161-9 »1.
• Malassezia-hiivoilla voi olla atooppista ekseemaa pahentavaa vaikutusta, sillä ne voivat heikentyneen ihon läpäisyesteen kautta aktivoida keratinosyyttejä ja dendriittisiä soluja aiheuttaen proinflammatoristen sytokiinien vapautumista (IL-4, IL-13, IL-17). Malassezia-hiivat saattavat aiheuttaa spesifistä IgE-tuotantoa aikuisilla atooppista ekseemaa sairastavilla potilailla «Scheynius A, Johansson C, Buentke E ym. Atopic eczema/dermatitis syndrome and Malassezia. Int Arch Allergy Immunol 2002;127:161-9 »1, «Casagrande BF, Flückiger S, Linder MT ym. Sensitization to the yeast Malassezia sympodialis is specific for extrinsic and intrinsic atopic eczema. J Invest Dermatol 2006;126:2414-21 »2, «Kekki OM, Scheynius A, Poikonen S ym. Sensitization to Malassezia in children with atopic dermatitis combined with food allergy. Pediatr Allergy Immunol 2013;24:244-9 »3, «Sparber F, De Gregorio C, Steckholzer S ym. The Skin Commensal Yeast Malassezia Triggers a Type 17 Response that Coordinates Anti-fungal Immunity and Exacerbates Skin Inflammation. Cell Host Microbe 2»4, «Thammahong A, Kiatsurayanon C, Edwards SW ym. The clinical significance of fungi in atopic dermatitis. Int J Dermatol 2020;59:926-935 »5, «Glatz M, Bosshard PP, Hoetzenecker W ym. The Role of Malassezia spp. in Atopic Dermatitis. J Clin Med 2015;4:1217-28 »6. Ilmiön kliininen merkitys on epäselvä.
• Paikallisten sienivoiteiden hyödystä atooppisen ekseeman hoidossa on ristiriitaista näyttöä «Wong AW, Hon EK, Zee B. Is topical antimycotic treatment useful as adjuvant therapy for flexural atopic dermatitis: randomized, double-blind, controlled trial using one side of the elbow or knee as a »7, «Svejgaard El, Larsen PØ, Deleuran M ym. Treatment of head and neck dermatitis comparing itraconazole 200 mg and 400 mg daily for 1 week with placebo. J Eur Acad Dermatol Venereol 2004;18:445-9 »8, «Kaffenberger BH, Mathis J, Zirwas MJ. A retrospective descriptive study of oral azole antifungal agents in patients with patch test-negative head and neck predominant atopic dermatitis. J Am Acad Derm»9.
• Joillakin potilailla peroraalinen atsolihoito saattaa rauhoittaa kasvoihin ja kaulaan painottuvaa ekseemaa riippumatta Pityrosporum-yliherkkyysvasteesta «Svejgaard El, Larsen PØ, Deleuran M ym. Treatment of head and neck dermatitis comparing itraconazole 200 mg and 400 mg daily for 1 week with placebo. J Eur Acad Dermatol Venereol 2004;18:445-9 »8, «Kaffenberger BH, Mathis J, Zirwas MJ. A retrospective descriptive study of oral azole antifungal agents in patients with patch test-negative head and neck predominant atopic dermatitis. J Am Acad Derm»9, «Lintu P, Savolainen J, Kortekangas-Savolainen O ym. Systemic ketoconazole is an effective treatment of atopic dermatitis with IgE-mediated hypersensitivity to yeasts. Allergy 2001;56:512-7 »10, «Bäck O, Bartosik J. Systemic ketoconazole for yeast allergic patients with atopic dermatitis. J Eur Acad Dermatol Venereol 2001;15:34-8 »11.

Kirjallisuutta

1. Scheynius A, Johansson C, Buentke E ym. Atopic eczema/dermatitis syndrome and Malassezia. Int Arch Allergy Immunol 2002;127:161-9 «PMID: 11979041»PubMed
2. Casagrande BF, Flückiger S, Linder MT ym. Sensitization to the yeast Malassezia sympodialis is specific for extrinsic and intrinsic atopic eczema. J Invest Dermatol 2006;126:2414-21 «PMID: 16778796»PubMed
3. Kekki OM, Scheynius A, Poikonen S ym. Sensitization to Malassezia in children with atopic dermatitis combined with food allergy. Pediatr Allergy Immunol 2013;24:244-9 «PMID: 23551180»PubMed
4. Sparber F, De Gregorio C, Steckholzer S ym. The Skin Commensal Yeast Malassezia Triggers a Type 17 Response that Coordinates Anti-fungal Immunity and Exacerbates Skin Inflammation. Cell Host Microbe 2019;25:389-403.e6 «PMID: 30870621»PubMed
5. Thammahong A, Kiatsurayanon C, Edwards SW ym. The clinical significance of fungi in atopic dermatitis. Int J Dermatol 2020;59:926-935 «PMID: 32441807»PubMed
6. Glatz M, Bosshard PP, Hoetzenecker W ym. The Role of Malassezia spp. in Atopic Dermatitis. J Clin Med 2015;4:1217-28 «PMID: 26239555»PubMed
7. Wong AW, Hon EK, Zee B. Is topical antimycotic treatment useful as adjuvant therapy for flexural atopic dermatitis: randomized, double-blind, controlled trial using one side of the elbow or knee as a control. Int J Dermatol 2008;47:187-91 «PMID: 18211496»PubMed
8. Svejgaard El, Larsen PØ, Deleuran M ym. Treatment of head and neck dermatitis comparing itraconazole 200 mg and 400 mg daily for 1 week with placebo. J Eur Acad Dermatol Venereol 2004;18:445-9 «PMID: 15196159»PubMed
9. Kaffenberger BH, Mathis J, Zirwas MJ. A retrospective descriptive study of oral azole antifungal agents in patients with patch test-negative head and neck predominant atopic dermatitis. J Am Acad Dermatol 2014;71:480-3 «PMID: 24925733»PubMed
10. Lintu P, Savolainen J, Kortekangas-Savolainen O ym. Systemic ketoconazole is an effective treatment of atopic dermatitis with IgE-mediated hypersensitivity to yeasts. Allergy 2001;56:512-7 «PMID: 11421895»PubMed
11. Bäck O, Bartosik J. Systemic ketoconazole for yeast allergic patients with atopic dermatitis. J Eur Acad Dermatol Venereol 2001;15:34-8 «PMID: 11451319»PubMed