Background: The impact of Malassezia yeasts on skin mycobiome and health has received considerable attention\nrecently. Pityriasis versicolor (PV), a common dermatosis caused by Malassezia genus worldwide, is a manifestation of\ndysbiosis. PV can be associated with hyper- and/or hypopigmented skin lesions. This disease entity is characterized\nby high percentage of relapses, which demands a proper antifungal therapy that is based on unambiguous species\nidentification and drug susceptibility testing.\nCase presentation: Comprehensive analysis of PV case in man presenting simultaneously hyper- and\nhypopigmented skin lesions was performed. Conventional and molecular diagnostic procedures revealed Malassezia\nfurfur and Malassezia sympodialis, respectively as etiological agents of skin lesions observed. Susceptibility tests\nshowed significantly lowered sensitivity of M. furfur cells to fluconazole. Based on susceptibility profiles local\nantifungal therapy with drugs characterized by entirely different mechanism of action was included.\nConclusions: Our study indicates that cases of PV represented by two types of skin lesions in one patient may be\nassociated with distinct Malassezia species. Moreover, as observed in this case, each of the isolated etiological\nagents of PV may differ significantly in susceptibility to antifungals. This can significantly complicate the treatment\nof dermatosis, which by definition is associated with a significant percentage of relapses. In the presented case\nlocalized topical treatment was sufficient and successful while allowing maintaining the physiological mycobiome.
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