The lipophilic yeast Malassezia is an exacerbating factor in atopic dermatitis (AD) and colonizes the skin surface of patients with AD. With the goal of reducing the number of Malassezia cells, we investigated the antifungal activities of a therapeutic agent for AD, tacrolimus, and the azole agents itraconazole and ketoconazole against Malassezia species in vitro. We examined 125 strains of the 11 currently accepted Malassezia species by using the agar dilution method. All strains of the 11 Malassezia species were very susceptible to both azole agents, with MICs ranging from 0.016 to 0.25 g/ml. Tacrolimus had antifungal activities against half of the strains, with MICs ranging from 16 to 32 g/ml. Two of the major cutaneous floras, Malassezia globosa and Malassezia restricta, have several genotypes in the intergenic spacer region of the rRNA gene; the azole agents had slightly higher MICs for specific genotype strains of both microorganisms. A combination of azole agents and tacrolimus had a synergistic effect against Malassezia isolates, based on a fractional inhibitory index of 0.245 to 0.378. Our results provide the basis for testing these agents in future clinical trials to reduce the number of Malassezia cells colonizing the skin surface in patients with AD.Although lipophilic yeasts, Malassezia spp., colonize the skin surface of healthy individuals, they may also cause seborrheic dermatitis (SD), pityriasis (tinea) versicolor, and Malassezia folliculitis and may exacerbate atopic dermatitis (AD) (1). AD is a common chronic inflammatory skin disease. The standard treatment of AD is topical corticosteroids and topical immunomodulating agents, although some patients do not respond to these treatments. Cutaneous microorganisms are considered an exacerbating factor. Although large numbers of lipophilic Malassezia species organisms colonize the skin surfaces of both AD patients and healthy subjects, anti-Malassezia-specific immunoglobulin E antibody is detected only in AD patient sera (14,16,32). This is probably owing to the disrupted barrier function of the skin surface and the effects of scratching on sensitization to the organisms (30). The application of topical antifungal agents to AD patients decreases Malassezia colonization and the severity of eczematous lesions (2), suggesting that Malassezia species play a role in atopic dermatitis. In addition, several candidate Malassezia antigens have been implicated in the pathogenesis of AD (15,19,20,23,34).In 1996, the taxonomy of the genus Malassezia was revised by Guého et al. (8). The authors described seven species (Malassezia furfur, M. globosa, M. obtusa, M. restricta, M. slooffiae, M. sympodialis, and M. pachydermatis). Subsequently, Japanese researchers found another four new species: Malassezia dermatis (25), M. yamatoensis (28), M. japonica (27), and M. nana (11) were isolated from an AD patient, SD patients, a healthy individual, and an animal, respectively, between 2002 and 2004. At present, 11 species have been accepted in this genus. By use of the r...