Clinical features and treatment of Malassezia folliculitis with fluconazole in orthotopic heart transplant recipients

Orthotopic heart transplant recipients need immunosuppressive treatment and are at an increased risk for opportunistic infections such as Malassezia f olliculitis. During a 4-month period (July to October 1990), 11 such cases were identified and treated; all were male with mean age of 43 +/- 9 years and on standard triple immunosuppressive therapy. Skin scrapings in potassi um hydroxide (KOH) preparation with microscopy and/or culture identified ei ther Malassezia furfur or Malassezia pachydermatis as the etiologic agent. A treatment with topical preparation (clotrimazole 1% and selenium sulfide lotion) was effective in 6 patients, whereas the rest received systemic flu conazole treatment with satisfactory outcome; all lesions were resolved wit hin 3 weeks. Fluconazole appears to be an effective agent with excellent th erapeutic outcome when administered for 3 weeks.