Malassezia species exist as normal flora on human skin but can convert to a pathogenic state in response to a number of host and environmental factors ultimately resulting in tinea versicolor (TV). Biofilm formation represents one of the main mechanisms by which microorganisms maintain viability in hostile environments. We have shown that Malassezia furfur/ovale cultured from patients with active TV can produce biofilms in vitro and in vivo. Exposure of Malassezia to sweat in vivo is the likely trigger for biofilm formation (as it is in atopic dermatitis); we believe this biofilm formation is potentially responsible for both the pathogenesis and the chronicity of this infection. This gives rationale to biofilm-dispersing agents, such as selenium sulfide, as important components in the standard TV treatment regimen. Periodic use of such agents would conceivably prevent reinfection.
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