【診 治】本人作皮膚檢查, 見眾多散在性單一形態的紅色毛囊丘疹和小膿疱,分布於胸部、雙肩和上背部,但不發生在臉部和頭皮. 並無黑頭粉刺.
基於病史和臨床表現( 丘疹的形態, 及其分布部位,甚少發生於臉部, 又沒有黑頭粉刺 ), 可以作出上述診斷.
我給患者口服Itraconazole和外用抗真菌药膏14天後回來復診, 發現有超過70%的改善, 於是我再給他兩星期抗真菌药物治療以預防復發. 其後再復診,發覺已有95%的改善, 於是停止所有葯物.
【討 論】Michael Chan 醫生於 《Acne care Newsletter,August 2012》 報告一例非典型馬拉色菌毛囊炎,其皮疹發生於臉部, 之前曾當作暗瘡治療無效.他給予病人一星期Itraconazole口服而奏效.有趣的是,馬拉色菌毛囊炎皮疹典型的分佈位置是胸、背和上臂而甚少在臉部.相反,M Chan醫生的病例,其皮疹分佈於臉部. 因此,我們須牢記,對於抗葯性或非典型性暗瘡的鑒別診斷,馬拉色菌毛囊炎應是其中一個考慮.
This was a 19 year old gentleman who complained of chest wall, both shoulders, and upper back skin rash for 2 -3 months. The eruption was mildly pruritic and not painful.
During dermatological examination of the patient, I found multiple discrete monomorphic erythematous papules and pustules. No comedones were found. The eruption distributed on his chest wall, both shoulders and upper back. There was no involvement of his face nor the scalp.
Based on the history and examination (morphology or the papules, lack of comedones and sparing of face), a clinical diagnosis of malassezia folliculitis (or pityrosporum folliculitis) was made. He was given 2 weeks of oral itraconazole plus antifungal cream.
He was seen after 2 weeks and was found to have over 70% improvement and I gave him 2 more weeks of antifungal treatment to prevent relapse. Subsequent follow up showed over 95% improvement and all the medication was stopped.
This one is a very typical case of malassezia folliculitis.
I found a quite atypical case in a medical newsletter. In a case report by Dr Michael Chan (Acne care Newsletter, August 2012), he described a malassezia folliculitis with distribution of eruption over the patient’s face and was treated previously as ordinary acne with no response. Dr M Chan gave him oral itraconazole for one weeks and the patient was cured of the problem. This is an interesting case because malassezia folliculitis eruption typically involves chest, back and upper arm and spare the face. But Dr Chan’s case had a distribution over patient’s face and sparing his trunk. We should always remember malassezia folliculitis as one of the differential diagnosis in resistant or atypical acne case.
皮膚科醫生常見皮膚疾病 – 馬拉色菌毛囊炎(不是暗瘡!)。