Malassezia yeasts (chiefly M. pachydermatis) have been associated with a greasy seborrhoeic dermatitis in cats with or without concurrent paronychia.391 Predisposing diseases include poorly defined genetic factors (in Devon Rex and sphynx cats),80, 86, 115, 116 feline atopic dermatitis (which may present with concurrent bacterial pyoderma),85, 259, 284, 392 adverse food reaction,259, 284 flea bite hypersensitivity,284 although some recurrent cases are idiopathic despite diagnostic investigation.74, 284 There is conflicting evidence for diabetes mellitus as a predisposing cause.82, 284, 393 Feline immunodeficiency virus‐positive cats have been shown to carry more Malassezia organisms compared with normal cats but this was not associated with any clinical signs.394, Affected Devon Rex and sphynx cats typically show mild to marked greasy seborrhoea with alopecia (in Devon Rex) and hyperpigmentation or reddish‐brown surface discolouration and variable erythema affecting the axillae, groin, ventral neck and predominantly ventral interdigital regions. 7.3.1. Using the swab wash technique, the anus was the most frequently colonised site in healthy mixed breed and beagle dogs,257 whereas M. pachydermatis was more frequently isolated in higher populations at nasal and buccal sites in both healthy and seborrhoeic basset hounds.98 Swab‐wash counts from the claw fold of sphynx cats and seborrhoeic Devon rex cats exceeded those of healthy domestic short haired, Cornish rex and Devon rex cats, whereas ear and anus populations were comparable.116. A concurrent bilateral erythematous otitis with black waxy exudate was reported in seven of 13 cats.395, Malassezia overgrowth has been found with cytology methods in approximately half of the reported cases, and more often with concurrent coccoid and/or rod bacterial overgrowth.395-397 In one study five of 12 cats partly responded to antimicrobial agents. The history of the association between Malassezia yeasts and its animal hosts has been long mired in controversy. Firstly, we performed a systematic search and review of relevant published trial data with grading of the study quality to provide evidence based conclusions on the strength of recommendation, updating a previous review.425 Secondly, we provided summary practice guidelines that are primarily evidence‐based and drawn from part one and included a component of expert opinion where the evidence based data is limited or absent. Diseases of dogs characterized histopathologicaly by parakeratotic hyperkeratosis – such as zinc‐responsive dermatosis and hepatocutaneous syndrome/superficial necrolytic dermatitis – have been anecdotally reported to promote yeast overgrowth (Section 10).247 The presence of Malassezia overgrowth is associated with pruritus in American bulldogs with autosomal recessive congenital ichthyosis caused by a single base deletion in the gene NIPAL4.248-250 In cats, a histological study of 550 skin biopsy cases identified Malassezia overgrowth most commonly with thymoma‐associated dermatosis (TAD) and paraneoplastic alopecia (PNA) associated with internal neoplasia.83 In TAD, parakeratosis is a common histopathological feature, while PNA presents either with absence of a stratum corneum or some degree of parakeratosis.83 In one cat with TAD, resolution of Malassezia dermatitis was reported to occur after its thymoma was surgically excised.251 It is important to recognize that these diseases are not typically pruritic unless Malassezia overgrowth is present. In some cases, histopathological approaches might be best employed after the yeast has been removed by appropriate therapy to enhance the characterisation of underlying disease. To the best of the authors’ knowledge, reduced susceptibility to chlorhexidine in vitro has not been reported. Dogs with Malassezia dermatitis often have concurrent hypersensitivity disorders, cornification defects or endocrinopathies. A 0.2% enilconazole lotion is licensed in some countries for the topical therapy of dermatophytosis in dogs, cattle and horses. In humans, three species (M. globosa, M. restricta and M. sympodialis) predominate.87 Interestingly human‐related species may have a different geographical distribution; M. dermatis has been isolated in East Asia, M. arunalokei in India, whereas M. obtusa was mostly reported from Sweden, Canada, Bosnia and Herzegovina.27, 33, Malassezia yeasts have been isolated from almost all domestic animals, different wild animals in captivity and also from wildlife. In cats without skin disease, retroviral infection was associated with increased density of Malassezia spp. Summary of reports on susceptibility testing of Malassezia pachydermatis using the broth microdilution method. Cells have a thick cell wall with characteristic inner spiralling. Veterinary clinicians in speciality clinical practice are accustomed to systematically evaluating M. pachydermatis populations in inflammatory skin lesions in the majority of their canine and feline patients, most often with cytology; they will frequently record “elevated populations” or “overgrowth” in their clinical records. Breeds identified to be at increased risk by these studies include West Highland white terriers (WHWT), English setters, shih tzus, basset hounds, American cocker spaniels, boxers, dachshunds, poodles and Australian silky terriers. fungal disease) or not. In the absence of standard methods appropriate for M. pachydermatis the CLSI M27‐A2 and A3 protocols have been adapted by various modifications of the process (Table S5).329, 330, 333-336 Technical specifics were usefully reviewed in detail, including a discussion of the effects of medium and conditions of incubation, lipid supplementation, inoculum preparation, end‐point determination and quality control aspects.337. There appears to be no published data on the comparative efficacy of different topical formulations containing the same or similar ingredients. Furthermore, the addition of recently identified species resulted in similar physiological patterns and thus in a doubtful identification (M. arunalokei and M. brasiliensis are closely related to M. restricta and M. furfur, respectively) (Table S1). The genus Malassezia (Baillon) was created in 1889 for a single species, M. furfur, observed in lesions of pityriasis versicolor, a common dermatological condition in humans.17 It took a long time to understand the lipid dependence of this kind of fungus and, as a consequence, to obtain and maintain Malassezia yeasts in culture.18 Conventional laboratory techniques could not be used and despite the description of numerous species, their accurate identification was not possible. In a RCT, a 3% chlorhexidine shampoo was reported to be more than 50% effective in 18 of 22 treated dogs268 (Table 6; LoE 1; SoR B‐moderate) and was judged not inferior to 2% miconazole and 2% chlorhexidine. Cryptogamic Diseases], Uber das wesen des sogenannten Unnaschen Flaschenbazillus [The nature of the so‐called Unna's bottle bacillus], Exfoliative dermatitis in the Indian Rhinoceros (Rhinoceros unicornis) with description of a new yeast species, Pityrosporum pachydermatis, An experimental study of the pityrosporon of Malassez: its morphology, cultivation and pathogenicity, Epidermal infectiosn with yeast‐like organisms, An experimental study of the pityrosporon of Malassez: Its morphology, cultivation and pathogenicity, International Commision on the Taxonomy of Fungi (ICTF): name changes in fungi of microbiological, industrial and medical importance. The external (macro‐) environment may also play a role in predisposing dogs to Malassezia overgrowth. This may be especially relevant with over‐the‐counter formulations where regulatory assessment of product quality may be less exacting and with molecules such as chlorhexidine whose stability may vary under different conditions.446 Both published RCT of a 2% miconazole and 2% chlorhexidine shampoo with strong evidence of efficacy utilised the same innovator‐formulated licensed product (Malaseb, Derm‐care Vet, Slacks Creek, Queensland, Australia);145, 268 one of these studies also showed good activity from a licensed 3% chlorhexidine shampoo (Microbex®, VIRBAC SA, Carros, France).268. 1987: Mason66 spoke about three canine Malassezia dermatitis cases at the American Academy/College of Veterinary Dermatology meeting, creating objection and controversy, although another speaker from private speciality practice advised that he has seen a similar case. The standard clinical approach is identification and treatment of underlying causes, whenever possible,388, 391, 447-449 though there is surprisingly limited reported evidence to document its efficacy (Table S8). Concurrent use of cefalexin in both treatment groups limits full clinical interpretation (LoE 2; SoR B‐moderate). Routine cytological sampling of skin sites in the veterinary clinic is best achieved by light microscopical examination (50× or 100x oil objectives) of tape‐strips or dry scrapes stained with modified Wright Giemsa stain (“Diff‐Quik” or generic equivalents). Devon rex and sphynx cats are also predisposed. O documento foi apresentado em duas reuniões internacionais de sociedades de dermatologia veterinária e em um curso internacional de micologia; foi disponibilizado para comentários no site da WAVD por um período de seis meses. Figure S1. Malassezia overgrowth in the ears typically results in a pruritic, erythematous, ceruminous otitis externa which results in the accumulation of a brownish discharge. are therefore urgently required. Hyperpigmentation can also occur with chronicity, depending on the breed; for example, West Highland white terriers typically develop this change with chronic disease (Figure 6), whereas basset hounds typically do not.145 Dogs with generalised lesions often have an offensive, rancid odour. Stronger reactions are typically seen in patients with generalised atopic dermatitis,193, 204, 212 or those with lesions predominantly on the head and neck.218, 221, 232 The SPT results have also been found to correlate with levels of Malassezia‐specific IgE in the serum204, 233 and with results of basophil histamine release tests232 but not with the severity of atopic dermatitis.233, Positive IDT results to Malassezia extracts have also been reported in atopic dogs.191 Immediate hypersensitivity responses to intradermal injections of M. pachydermatis extracts at concentrations which caused no reaction in healthy dogs have been observed in atopic dogs with Malassezia dermatitis, although they were also seen in some atopic dogs without Malassezia dermatitis.234 Nevertheless, the reactivity to the extracts in atopic dogs with cytological evidence of Malassezia overgrowth was significantly higher than that in atopic dogs without.191 Additionally, positive immediate hypersensitivity reactions to extracts from M. pachydermatis using Prausnitz‐Küstner tests have been demonstrated.235 Clinically normal dogs received pooled sera from atopic dogs with Malassezia dermatitis that were IDT positive to Malassezia extracts and serum from an atopic dog with Malassezia dermatitis exhibiting high levels of anti‐Malassezia IgE on an ELISA assay. Les GP ont préparé une revue de la littérature détaillée et des recommandations ont été faites sur des sujets choisis. Die AutorInnen wirkten als Guideline Panel (GP) und führten eine Review der Literatur durch, die vor Oktober 2018 zur Verfügung stand. Furthermore, in lesional atopic skin, the majority of the T cell clones that were reactive for P. orbiculare showed a Th2 or Th2/Th0 like cytokine profile195 and atopic human patients that are sensitised to Malassezia yeasts typically show increased synthesis of the Th2‐related cytokines IL‐4, IL‐5, IL‐10 and IL‐13 by Pityrosporum [Malassezia]‐stimulated PBMCs.196, 198, 199 Taken together, these findings provide compelling evidence that T lymphocytes play a pivotal role in the generation of hypersensitivity reactions to Malassezia species in genetically susceptible individuals. Das Wissen über Malassezia Hefen und ihrer Rolle bei Krankheiten von Tieren hat sich bemerkenswert erweitert, vor allem seit den frühen 1990ern. Pathogenic roles for various Malassezia species have been described in association with several human skin diseases including atopic dermatitis, seborrhoeic dermatitis, folliculitis, psoriasis and pityriasis versicolor.88, 459 Among these diseases, M. pachydermatis has been most commonly isolated from human patients with seborrhoeic dermatitis.460, 465, 466 However, it is difficult to assign a truly pathogenic role to M. pachydermatis in the context of these studies and its identification from surface samples of human skin is typically ascribed to contact with dogs (even though epidemiological data on pet contact is not always available). but not other fungi.172 In co‐operation with Dectin‐2, another C‐type lectin that recognises a distinct hydrophilic O mannobiose‐rich protein, Mincle and Dectin‐2 collaborate to enhance production of inflammatory cytokines such as TNF‐α, MIP‐2 and IL‐10 from mouse activated phagocytes exposed to Malassezia furfur.171 C‐type lectin‐mediated innate immune mechanisms are discussed further in Section 6. The before and after clinical photographs left no doubt about the dramatic health and welfare benefits of the antifungal therapy in these cases. Malassezia cell wall carbohydrates have been long‐recognised as IgE binding epitopes in humans with AD166, 167 while other studies have highlighted their importance in fungal cell recognition by host phagocytic cells.168 C‐type lectins are proteins that bind carbohydrates in a calcium‐dependent (hence C) manner via highly‐conserved carbohydrate‐recognition domains.168 Langerin, a C‐type lectin expressed by Langerhans cells that recognises mannose and beta‐glucans, has a strong affinity for Malassezia and Candida spp. that will effectively eliminate carriage of Malassezia yeasts from human hands. However, enhanced IgG responses can be seen in dogs with Malassezia dermatitis and in humans and dogs with atopic dermatitis. 1925: Weidman reported bottle shaped yeast from the scale of the single horned Indian rhinoceros (Rhinoceros unicornis) with a generalised exfoliative dermatitis.47 In contrast to M. furfur this yeast cultivated readily on routine media without lipid supplementation. II. Readers need to bear this in mind and be aware of the prescribing laws pertaining to their own countries. La dermatite à levures est une infection de la peau causée par Malassezia pachydermatis. Serological and skin test reactivity is also seen in a proportion of unaffected dogs; thus immunological tests must be assessed in the context of clinical and cytological data; they should not be used as stand‐alone ‘diagnostic’ tests. 1846: Karl Ferdinand Eichstedt was the first to observe hyphal elements and blastoconidia in scale from his patients and attributed these to cause a human skin disease he called “Pityriasis versicolor”.38, 1853: Charles Robin named Eichstedt's fungus as Microsporon furfur, believing it to be a dermatophyte, and termed the associated skin disease “Tinea versicolor”.39, 1873: Sebastiano Rivolta, an Italian veterinarian, noticed a double‐contour budding yeast in human “psoriatic” scales and gave them the name Cryptococcus psoriasis.40, 1874: Frenchman Louis Charles Malassez41 suggested that Microsporon furfur caused dandruff and correctly differentiated the yeast into genus of single cell fungi (“Saccharomyces”) rather than the dermatophyte complex. Si vous souhaitez lire plus d'articles semblables à Comment traiter la dermatite chez mon chien , nous vous recommandons de consulter la catégorie Animaux de compagnie . Twice weekly topical hydrocortisone aceponate shows promise in the prevention of Malassezia otitis externa associated with allergic skin diseases. O objetivo deste documento é fornecer à comunidade veterinária e outros grupos interessados informações atualizadas sobre ecologia, fisiopatologia, diagnóstico, tratamento e prevenção de doenças de pele associadas à Malassezia em cães e gatos. pronounced irregular epidermal and infundibular hyperplasia; prominent epidermal and infundibular parakeratotic hyperkeratosis; diffuse epidermal and infundibular intercellular oedema (spongiosis); diffuse epidermal and infundibular lymphocytic exocytosis; superficial perivascular to interstitial dermatitis wherein lymphocytes are a prominent inflammatory cell type. Le diagnostic se fait au cours d’une consultation spécialisée de dermatologie. 1889: Baillon created the genus Malassezia to accommodate M. furfur, in honour of Malassez, who was already acknowledged as having described the new species – at least in the French‐speaking scientific community.17 However this particular yeast could not be grown and isolated in laboratory conditions because its lipid requirement in culture media were as yet unknown. Cytology using swabs is normally best restricted to use in the ear canal. Interestingly, Swiss white mice developed skin lesions whereas the nude (nu/nu) mouse, the hairless mice and nude rats did not.321 Inoculation of suspensions of M. pachydermatis into the middle ear and dermis of immunosuppressed mice led to transient infection that resolved within 21 days.325. traitement des dermatophytoses et des dermatites à Malassezia et la prévention de l’infection des animaux ou ... à la prolifération des levures Malassezia. Only one retrospective study of 12 cases of generalised Malassezia dermatitis reported treatment with a 0.2% enilconazole lotion (frequency of application not detailed) in association with oral ketoconazole.437 Although a complete mycological recovery was described, no specific report of clinical improvement was available (LoE 3; SoR not applicable). In a randomised cross‐over study involving nine healthy beagle dogs, neither generic nor compounded itraconazole was bioequivalent to the innovator‐formulated product.440 Pharmacokinetic analyses showed that the compounded formulation had very low absorption and bioavailability (5% of innovator product), yielding likely ineffective plasma concentrations, whereas the generic and reference products were broadly similar to each other. David Robinson has received funding from or otherwise collaborated with MSD Animal Health, Virbac Animal Health and Elanco. Complete clinical resolution in only 3/20 dogs at d21. No clinical response, complete mycological ‐ consider yeast presence incidental to other inflammatory disease. Les symptômes peuvent varier selon la cause, la zone touchée et la gravité. The document was presented at two international meetings of veterinary dermatology societies and one international mycology workshop; it was made available for comment on the WAVD website for a period of six months. Certaines races sont considérées comme prédisposées, notamment : American cocker spaniel, Berger allemand, Caniche, Cavalier King Charles spaniel, Chihuahua, Jack Russell, Teckel, West Highland White Terrier. According to a standard textbook,326 Malassezia may feature in cases of bacterial intertrigo, feline hypersensitivity reactions, acrodermatitis of bull terrier dogs, atopic dermatitis, congenital follicular parakeratosis, facial dermatitis of Persian and Himalayan cats, familial paw pad hyperkeratosis, feline acne, feline paraneoplastic alopecia, feline thymoma‐associated exfoliative dermatitis, female hyperoestrogenism, food allergy, hypothyroidism, ichthyosis, interdigital furunculosis, mucinosis, nasodigital hyperkeratosis, sarcoptic mange, seborrhoeic dermatitis, Sertoli cell tumour‐associated skin disease, superficial necrolytic dermatitis and zinc‐responsive dermatosis (Table S4). An unusual feature of this study was reported lack of relapse 150 days post‐treatment in all of the essential oil‐treated dogs. Eighteen species have been described so far but many other species are most probably present on the skin or mucosal sites of warm‐blooded animals. En général le rythme est de deux shampoings par semaine pendant un mois and is regarded as a major pattern recognition receptor for both commensal and pathogenic fungi.169, 170 By contrast, Mincle, a C‐type lectin expressed by activated phagocytes that binds glucosyl and mannosyl‐glycolipids from M. pachydermatis and M. sympodialis,171 selectively recognises Malassezia spp. 1970: The systematics were rectified when Sloff in Lodder's ‘The Yeasts, a taxonomic study’ assigned all Pityrosporum that grew on media without lipid enrichment as single species of P. pachydermatis.52, 1984: The third edition of “The Yeasts, a Taxonomic Study” (Yarrow and Ahearn) referred to the new genus Malassezia and confirmed that one species grew without lipid enrichment.53, 54 This was later officially added into the taxonomical order.55, 1990: A new species, Malassezia sympodialis was described19 and by 1996 four new species were added to the genus.20 This species was later isolated from a cat by Bond et al. In one RCT study, clinical efficacy was associated with marked reductions in skin population densities of both M. pachydermatis and total bacteria/ staphylococci, assessed using a detergent scrub technique.145 In the second RCT, yeast counts were assessed by tape‐strips whereas bacterial populations were not assessed.268 Adverse effects to miconazole/ chlorhexidine were not reported amongst the 48 dogs treated in these two studies,145, 268 although the UK data sheet of the product used mentions ‘very rare’ or ‘exceptional’ pruritic or erythematous reactions (http://www.noahcompendium.co.uk/?xml:id=-449936). Secondary excoriations may be present in severe cases. Malassezia dermatitis affecting the axillae of an atopic West Highland white terrier. L’objectif de ce document est de fournir à la communauté vétérinaire et aux parties intéressées toute l’information actuelle sur l’écologie, la pathophysiologie, le diagnostic, le traitement et la prévention des maladies cutanées associées aux levures Malassezia chez le chien et le chat. MacLeod and Dowling regarded these pyogenic micrococci as secondary invaders, even accepting it was constantly associated with seborrhoeic dermatitis.50 Interestingly, MacLeod and Dowling referred to three names of the yeast in their work: the “spore of Malassez”, “Pityrosporum of Sabouraud” or the “flask bacillus of Unna”. 2002: Mauldin et al.83 evaluated the presence of Malassezia yeasts in feline skin specimens submitted for histopathological examination from 1999 to 2000. Peter B. Hill has received honoraria and consulting fees from Pfizer/Zoetis and Elanco/Novartis. El GP preparó una revisión detallada de la literatura e hizo recomendaciones sobre temas seleccionados. Clinical efficacy with these products corresponds to multiple, systematic reports of low MICs in vitro with drugs of this class,329, 330, 334, 344 with the exception of fluconazole (see below). It is from these areas that Malassezia overgrowth commonly develops. Oral antifungal drugs might be given by an intermittent/ pulsed dosing schedule to try to prevent recurrent Malassezia dermatitis (and otitis) in dogs and cats, particularly where topical therapy is either ineffective or impractical. Nous comprenons parfaitement quIsabelle craque. Improved and agreed reference methods designed to overcome the specific growth requirements of Malassezia spp. No statistical analyses, 5 mg/kg once daily for two consecutive days/week, Transient vomiting [n = 2], inappetence [n = 1], 6/13 dogs: transient vomiting [n = 4], vomiting and soft stool [n = 1], diarrhoea [n = 1]. Weidman classified the yeast in the genus Pityrosporum, with the species name P. pachydermatis. These cells can take up whole M. furfur yeast cells and extracts, as well as recombinant M. furfur allergen 5 (Mal f 5)183 Mala f 1184 and M. furfur mannan. eye, ear, vagina) and four were isolated from blood. The perianal skin and anal mucosa is a frequent (~55% of 73 dogs) carriage site whereas nasal and oral carriage is less frequent. Traitement de l' otite externe du chien et du chat Dès lors, on comprend que plutôt que de changer maintes et maintes fois d'antibiotiques, et d’incriminer une éventuelle résistance bactérienne, il est préférable et nécessaire d'identifier à la fois un éventuel facteur prédisposant et surtout le ou les facteurs déclenchant à l'origine de l'otite. The most commonly affected body regions include the face, chin, neck, limbs, abdomen and ear canals (see below). Cutaneous responses to the application of viable and killed Malassezia have been assessed both clinically and histologically in laboratory animals (guinea pigs, mice, rabbits) and humans, primarily with “lipid‐dependent” Malassezia species isolated from humans (whose nomenclature pre‐dates current revised taxonomy) applied under occlusion.321-324 Lesions generally comprised focal areas of scaling that most often resolved without treatment upon discontinuation of inoculation and were characterised histologically by yeast cells or hyphae in the stratum corneum, variable epidermal hyperplasia and superficial dermal inflammation with granulocytes and lymphocytes. More recently, the spectrum of fungal species (“mycobiome”) in the human skin was investigated using next generation sequence techniques.121 In this study, 14 skin sites representing a range of physiological characteristics were sampled from 10 healthy adult volunteers. Frontiers in Cellular and Infection Microbiology, http://www.noahcompendium.co.uk/?xml:id=-449936, http://www.eucast.org/astoffungi/methodsinantifungalsusceptibilitytesting/susceptibility_testing_of_yeasts, https://ripehosting.blob.core.windows.net/anzcvs-prod-media/13334/ACVS%20Dermatology%20Chapter%20Proceedings%202010%20Complete.pdf, HS + LS (dogs, cats, many others, mostly canids), Based on consistent and good quality patient‐oriented evidence, Based on inconsistent or limited quality patient‐oriented evidence, Recommendation based on consensus, usual practice, disease‐oriented evidence or case series, High quality individual RCT, or meta‐analysis of consistent RCTs, Lower quality clinical trial, cohort study, case‐control study, In 10 mg/kg group: vomiting [n = 2], anorexia [n = 1], apathy [n = 1], Small group sizes; two KTZ doses compared.

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