The Veterinary Journal 304 (2024) 106084

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The Veterinary Journal

journal homepage: www.elsevier.com/locate/tvjl

Malassezia dermatitis in dogs and cats

Stefan Hobi a, *, Paweł M. Bęczkowski a, Ralf Mueller b, May Tse a, Vanessa R. Barrs a, c
a
Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
Administrative Region of China
b
LMU Small Animal Clinic, University of Munich, Munich, Germany
c
Centre for Animal Health and Welfare, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong
Administrative Region of China

A R T I C L E I N F O A B S T R A C T

Keywords: Malassezia are members of the mycobiome of dogs and cats. In the presence of an underlying disease, these yeasts
Malassezia can proliferate, attach to the skin or mucosa to induce a secondary Malassezia dermatitis, otitis externa or
Azoles paronychia. Since allergic dermatitis is one of the most common underlying causes, diagnostic investigation for
Dermatology
allergy is often indicated. Cats may suffer from various other underlying problems, especially where Malassezia
Small animals
Treatment
dermatitis is generalised. Malassezia dermatitis in dogs and cats is chronic, relapsing and pruritic. Direct cytology
from dermatological lesions and the ear canal, showing “peanut-shaped” budding yeasts, facilitates a rapid and
reliable diagnosis. Topical treatment includes antiseptic and antifungal azole-based products. Systemic treatment
with oral antifungals is indicated only in severe or refractory disease. Identification and treatment of the un­
derlying cause is essential for an optimal response. In this evidence-based narrative review, we discuss the
clinical presentation of Malassezia dermatitis in dogs and cats, underlying comorbidities, and diagnostic con­
siderations. Treatment is discussed in light of emerging evidence of antifungal resistance and the authors’ clinical
experience.

Introduction Malassezia can easily be identified on cytological preparations of skin

or otic discharge as small “peanuts” or “foot-prints” shaped organisms
Malassezia are lipophilic commensal yeasts of the skin and mucosa of with a diameter of 3–8 μm (Bond et al., 2020; Bajwa, 2023). Other
cats and dogs (Kennis et al., 1996; Sierra et al., 2000; Bond et al., 2020; diagnostic methods such as culture or DNA-based techniques, are typi­
Bajwa, 2023). These fungi can be found in many vertebrates and in cally reserved for research purposes (Bond et al., 2020). Although
environmental niches, making them one of the most widespread and antifungal susceptibility testing is not widely performed in veterinary
extremely adaptable fungal genera known (Breuer-Strosberg et al., practice, antifungal resistance of Malassezia isolates has been reported
1990; Chermette, 1998; Nakagaki et al., 2000; Crespo et al., 2002b; and resistance mechanisms involving efflux pumps, fungal wall sterol
Arenz et al., 2006; Tondello et al., 2012; Amend, 2014; Theelen et al., metabolism, and biofilm formation are recognized (Uchida et al., 1994;
2018; Amend et al., 2019; Pang et al., 2019; Hobi et al., 2022). Of the18 Figueredo et al., 2013; Cafarchia et al., 2015; Bumroongthai et al., 2016;
Malassezia species currently described, 11 have been detected in cats Iatta et al., 2017; Kim et al., 2018; Peano et al., 2020; Hobi et al., 2022).
and nine in dogs by culture or using molecular methods (Hobi et al., Treatment for Malassezia dermatitis includes application of a topical
2022). antiseptic and/or antifungal preparation. Systemic azole antifungal
Malassezia commonly causes dermatitis, otitis externa, and occa­ treatment is reserved for severe disease or for cases not responding to
sionally other clinical presentations such as paronychia and keratitis in topical treatment alone (Bond et al., 2020; Guillot and Bond, 2020; Hobi
dogs and cats (Morris, 1999; Machado et al., 2011; Ledbetter and Starr, et al., 2022; Bajwa, 2023). Treatment of any underlying diseases is
2015; Bajwa, 2017; Guillot and Bond, 2020; Spatz and Richard, 2020; critical to prevent relapse (Bond et al., 2020; Hobi et al., 2022; Bajwa,
Hobi et al., 2022). Septic fungaemia, an increasing and potentially fatal 2023).
complication in humans, has yet to be reported in animals (Hobi et al., In this review, we discuss pathophysiological aspects of Malassezia-
2022). associated disease as well as the clinical presentation of Malassezia

* Corresponding author.
E-mail address: [email protected] (S. Hobi).

https://doi.org/10.1016/j.tvjl.2024.106084
Accepted 18 February 2024
Available online 29 February 2024
1090-0233/© 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
S. Hobi et al. The Veterinary Journal 304 (2024) 106084

dermatitis in dogs and cats, comorbidities, and diagnostic as well as “neutral” commensal state (Il-10, TGF-β) or an inflammatory response
medical treatment considerations, in light of emerging evidence of (Il-1, Il-6, Il-8, TNFα) (Ruth Ashbee, 2006; Bond et al., 2020). Further­
resistance to antifungal drugs. more, epidermal Langerhans cells (and dermal dendritic cells if antigens
penetrate through the epidermis into the dermis) migrate to regional
Pathophysiologic aspects of Malassezia-associated disease lymph nodes, stimulating naïve T-helper cells to proliferate and differ­
entiate into Th1 cells and/or Th2 cells depending on the cytokine profile
Malassezia metabolism (Il-12, Il-4, Il-13). Activated B-lymphocytes differentiate into plasma
cells and produce different antibodies (IgG or IgE) depending on their
Due to the lack of a fatty acid synthetase gene, all Malassezia species, co-stimulatory factors. Il-2 and IFNγ induce IgG, while Il-4 and Il-13 lead
including M. pachydermatis, are lipophilic and an exogenous lipid source to an IgE antibody response (Bond et al., 2020). IgG may be protective,
is required for growth (Shifrine and Marr, 1963; Triana et al., 2015). while IgE may lead to sensitization and mast cell activation (Ashbee and
Consequently, Malassezia can especially be found in lipid-rich areas of Evans, 2002; Boekhout et al., 2010; Bond et al., 2020).
the skin (Park et al., 2021). M. pachydermatis is the only species that can
grow on Sabouraud’s dextrose agar due to its unique ability to use lipid Malassezia species
fractions within the peptone (Puig et al., 2017).
The major lipid sources on the skin are triglycerides and free fatty M. pachydermatis is the predominant species in the healthy skin of
acids produced by the sebaceous glands (Park et al., 2021). Cholesterol dogs and cats, although it is comparatively less frequently isolated from
and cholesterol esters are produced during the natural cell turnover and cats (Hajsig et al., 1990; Guillot et al., 1994; Bond et al., 2020). Other
degeneration of keratinocytes. These skin lipids positively influence species reported in dogs include M. sympodialis, M. furfur, M. obtusa,
yeast growth (Porro et al., 1977). Overall, lipid synthesis from Malas­ M. restricta, M. arunalokei, M. nana, M. slooffiae and M. globosa (Crespo
sezia-colonized sites, such as skin, is enabled by production of lipase, et al., 2002a; Nardoni et al., 2004; Cafarchia et al., 2005a; Cafarchia
phospholipase and sphingomyelinase (Triana et al., 2017; Bond et al., et al., 2005b; Eidi et al., 2011; Meason-Smith et al., 2020; Bajwa, 2023).
2020). In cats, M. furfur, M. yamatoensis, M. japonica, M. dermatis, M. nana,
Malassezia can also assimilate phospholipids and utilise organic and M. obtusa, M. slooffiae, M. sympodialis and M. restricta (ears) are reported
inorganic nitrogen (Riciputo et al., 1996; Boekhout et al., 2010). Ni­ (Nardoni et al., 2005; Åhman et al., 2007; Ahman and Bergstrom, 2009;
trogen sources can lead to the formation of indole alkaloids, which serve Bellis et al., 2010; Shokri et al., 2010; Castellá et al., 2011). Overall,
as ligands for the aryl hydrocarbon receptor (AhR) in humans, influ­ these other species tend to occur more often in cats than in dogs (Bond
encing the function of various cells expressing this receptor, and thereby et al., 2020). The Malassezia species detected in healthy and diseased
modulating different biological responses associated with inflammation, animals can be found in Table 1.
immune homeostasis, skin pathology, skin microflora and carcinogen­
esis (Magiatis et al., 2013; Mexia et al., 2015; Sparber and Clinical presentation of Malassezia dermatitis
LeibundGut-Landmann, 2017). In vitro growth of Malassezia can be
stimulated by addition of asparagine, pyridoxine or thiamine (Boekhout Breed predisposition
et al., 2010).
Malassezia cannot metabolize sugars but M. pachydermatis is able to Malassezia dermatitis is commonly seen in dogs, but is rare in cats
assimilate certain carbohydrates such as mannitol, glycerol and sorbitol (Morris, 1999; Ordeix et al., 2007; Negre et al., 2009; Machado et al.,
(Boekhout et al., 2010). 2011; Bajwa, 2017). There is no clear gender or age predisposition
(Bond et al., 2020; Hobi et al., 2022; Bajwa, 2023). In dogs, West
The adherence of Malassezia Highland White Terriers, American Cocker Spaniels, Dachshunds, Boxer,
Poodles, English Setters, Australian Silky Terriers, Shih Tzus and Basset
The interaction of Malassezia with keratinocytes is the fundamental Hounds are all breeds with an increased risk of Malassezia dermatitis
starting point for host invasion by the yeast (Boekhout et al., 2010). (Bond et al., 2020; Guillot and Bond, 2020; Hobi et al., 2022; Bajwa,
In-vitro adherence of M. furfur and M. pachydermatis to keratinocytes 2023). In cats, the Devon Rex and Sphynx have high burdens of colo­
peaks at approximately 2 hours (Faergemann et al., 1983; Bond and nizing Malassezia, predisposing them to oily seborrhoea and Malasse­
Lloyd, 1996; Boekhout et al., 2010). Trypsin-sensitive cell-surface pro­ zia-related skin diseases (Åhman et al., 2007; Ahman and Bergstrom,
teins/glycoproteins also play a role in canine keratinocyte adherence 2009).
(Boekhout et al., 2010). In addition, an in-vitro study showed that
Malassezia use glycosaminoglycans (GAGs) as surface receptors to bind Underlying diseases
to keratinocytes, but not to dermal fibroblasts (Ordiales et al., 2021).
How Malassezia interact with melanocytes is not completely under­ Malassezia typically cause superficial dermatitis, otitis externa and/
stood, although their metabolites including azelaic acid, lipoperoxides or paronychia (Bond et al., 2020; Guillot and Bond, 2020; Hobi et al.,
and malassezin have been shown to play a significant role due to their 2022; Bajwa, 2023). In dogs, this occurs secondary to ectoparasites,
cytotoxic and apoptotic potential (Boekhout et al., 2010). This could allergies (flea bite hypersensitivity, food-induced and environmentally
explain the de- to hypopigmented type of human pityriasis versicolor. induced atopic dermatitis), endocrinopathies (hyperadrenocorticism,
However, the number of melanocytes does not seem to be affected in hypothyroidism, diabetes mellitus), superficial pyoderma, keratiniza­
diseased skin, rather the melanin amount within the melanosomes and tion disorders or rarely autoimmune diseases. All these diseases alter the
the distribution of melanosomes within the skin differ (Boekhout et al., environment of the yeasts in a favourable way (Bond et al., 2020; Guillot
2010). and Bond, 2020; Hobi et al., 2022; Bajwa, 2023).
In cats, allergic dermatitis, feline leukaemia virus (FeLV) infection,
The immune response to Malassezia feline immunodeficiency virus (FIV) infection, thymoma-associated
exfoliative dermatitis, superficial necrolytic dermatitis and paraneo­
Malassezia can proliferate within the stratum corneum, the outer­ plastic alopecia are reported triggers for generalised Malassezia derma­
most layer of the epidermis, leading to the accumulation of various titis (Sierra et al., 2000; Crosaz et al., 2013; Guillot and Bond, 2020).
metabolites and allergens (Marsella, 2013). Epidermal Langerhans cells Other predisposing factors such as genetics, environmental humidi­
and keratinocytes recognize Malassezia antigens leading to the forma­ ty, anatomic confirmation (skin fold formation) and drug administration
tion of antimicrobial peptides and specific cytokines resulting in either a (e.g. immunomodulatory drugs) also contribute to the development of

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Table 1 Staphylococcus pseudintermedius are often found together. This is thought

Malassezia species and their distribution pattern in dogs and cats. to occur due to a symbiotic relationship between these organisms.
Species Host Healthy Skin Diseased Detected Staphylococci produce beneficial growth factors and change the envi­
Skin by ronment to favour yeast growth (Mauldin et al., 1997; Miller et al., 2012;
M. pachydermatis Dog Earsa, skin, conjunctiva, MD, OE C, P, Bajwa, 2017). In dogs with atopic dermatitis, Malassezia exacerbate
anus, nose, oral cavity, NGS clinical signs as an important flare factor of the disease (Bond et al.,
vulva 2020; Hobi et al., 2022).
Cat Earsa, skin, mucosa, anus, MD, OE C, P,
claws NGS
M. furfur Dog Skin MD, OE C, P,
Diagnosis and Malassezia identification
NGS
Cat Earsa, skin OE C, P, Malassezia can be identified by several methods, including direct
a
NGS cytologic evaluation, culture and molecular-based methods (Miller
M. sympodialis Dog Ears , skin, claws, faeces MD C, P,
et al., 2012; Bond et al., 2020; Bajwa, 2023).
NGS
Cat Skin, anus OE C, P,
NGS Direct evaluation and interpretation
M. globosa Dog Skin MD, OE C, P,
NGS A useful, practical and rapid method to diagnose Malassezia derma­
Cat Skin OE C, P,
NGS
titis is direct microscopy of tape strip, impression smear, cotton swab or
M. nana Dog NR MD, OE P skin scrape samples (Miller et al., 2012; Bond et al., 2020; Bajwa, 2023).
Cat Earsa, skin, claws, anus OE C, P, For better visualization of the fungal elements, potassium hydroxide or
NGS special dyes such as lactophenol blue, methylene blue, Gram stain or
M. slooffiae Dog NR MD P, NGS
fluorescence dyes can be added to the clinical sample (Miller et al.,
Cat Skin, claws, anus OE C, P,
NGS 2012; Bond et al., 2020; Bajwa, 2023). Malassezia are recognized by
M. yamatoensis Dog NR NR NR their typical uni-polar and often broad-based budding referred to as
Cat Skin NR C, P, “foot print”, “babushka” or “peanut” shapes (Miller et al., 2012; Bond
NGS et al., 2020; Bajwa, 2023) (Fig. 4.).
M. obtusa Dog Skin OE C, P,
NGS
Due to many influencing factors, there is no clear threshold for the
Cat Skin OE C, P, number of Malassezia organisms deemed to be pathological on cytology.
NGS Some investigators suggest that greater than two organisms per higher
M. restricta Dog Skin, oral cavity MD C, P NGS power field (hpf) may be considered abnormal (Plant et al., 1992;
Cat Skin OE C, P,
Mauldin et al., 1997). An increased number of Malassezia in the absence
NGS
M. japonica Dog NR NR NR of inflammatory cells is defined as “Malassezia overgrowth”, whilst the
Cat Skin NR C, P, presence of inflammatory cells indicates “Malassezia dermatitis”. The
NGS authors suggest not to interpret the number of organisms detected by
M. dermatis Dog NR NR NR cytology alone, but to consider alongside with history and clinical pre­
Cat Skin NR C, P,
NGS
sentation. For example, two Malassezia organisms per hpf found in a
M. arunalokei Dog Oral NR NGS patient with chronic, dry dermatitis with abundant keratosebaceous
Cat NR NR NR debris and a rancid odour might be more relevant than a higher number
MD, Malassezia dermatitis; OE, Otitis externa; NR, not reported; C, culture-
of Malassezia organisms in a relatively normal looking area of skin. Any
based; P, PCR (typically ITS, D1/D2); NGS, Next generation sequencing presence of clinical lesions or pruritus in association with even low
a
External ear canal and/or medial pinnae number of Malassezia on cytology should be an indication for topical
antiseptic therapy to evaluate, how much the yeast organisms contribute
Malassezia dermatitis in cats and dogs (Bond et al., 2020; Guillot and to the clinical signs present.
Bond, 2020; Hobi et al., 2022; Bajwa, 2023).
Isolation in culture

Affected body areas and clinical presentation The contact plate technique, where an agar surface is pressed against
the test surface, has been used in human and veterinary medicine; it is
Malassezia dermatitis can be localized or generalized (Bond et al., convenient, easy to perform, rapid and inexpensive (Åhman et al., 2007;
2020; Bajwa, 2023). Areas commonly involved in dogs include the Boekhout et al., 2010; Bond et al., 2020). Malassezia colonies can be
pinnae, external ear canals, muzzle, ventral neck, ventral body sites, cultured on different growth media. The commonly used modified
medial thighs and paws (Hobi et al., 2022; Bajwa, 2023). In most cats, Dixon’s or Sabouraud’s dextrose agar (SDA) can be analysed after
the pinnae, face, chin, neck, limbs and ventral abdomen are most 3–7 days of incubation at 32–34◦ C (Boekhout et al., 2010; Bond et al.,
frequently involved, while in Sphynx and Devon Rex breeds, the ventral 2020). The percentage of carbon dioxide can affect the isolation fre­
neck, axillae, inguinal areas and paws are predominantly affected (Hobi quency and colony count when SDA is used. Modified Dixon’s agar is the
et al., 2022). In addition, claw folds (in cats) and skin folds (for example preferred medium for Malassezia, since lipid supplementation renders it
in brachycephalic breeds) may be affected (Hobi et al., 2022; O’Neill suitable for lipophilic yeasts where species other than M. pachydermatis
et al., 2022). are involved (Bond et al., 2020). Other culture media such as
Pruritus is variable in both dogs and cats (Hobi et al., 2022; Bajwa, Leeming-Notman, Ushijima or chromogenic Candida agar, all supple­
2023). Dermatological signs include alopecia, erythema, scales, crusts, mented with lipid components, are also suitable (Ushijima et al., 1981;
greasiness and in more chronic cases, hyperpigmentation and lichen­ Leeming and Notman, 1987; Kaneko et al., 2007).
ification (Bond et al., 2020; Guillot and Bond, 2020; Hobi et al., 2022; Other techniques for culture of Malassezia, include collecting skin
Bajwa, 2023). Otitis externa and paronychia are often associated with a scrapings, dry or moist swabs, and tape strips (Boekhout et al., 2010;
brown to black dry to oily rancid material (Bond et al., 2020; Guillot and Miller et al., 2012; Bond et al., 2020; Hobi et al., 2022). In one canine
Bond, 2020; Hobi et al., 2022; Bajwa, 2023) (Figs. 1, 2 and 3). study comparing adhesive tape to dry swab sampling in dogs with
Interestingly, in dogs with pyoderma Malassezia pachydermatis and chronic dermatitis, adhesive tape was the superior method (Omodo-Eluk

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Fig. 1. Chronic Malassezia dermatitis in allergic dogs with severe pruritus showing different degrees of alopecia, erythema, lichenification, hyperpigmentation,
crusting and accumulation of keratosebaceous debris on the convex pinnae, facial folds, muzzle, ventral chest, distal limbs of a Bulldog (a); the lip fold (b), the tail (c),
ventral neck, chest and axilla (d) as well as the paw, ventral chest and abdomen of a Dachshund with Cushing’s disease (e).

Fig. 2. Allergic cats with Malassezia dermatitis indicated by alopecia, mild erythema, crusting and accumulation of black to brown debris on the preorbital area and
muzzle (a); alopecia, mild lichenification on the muzzle (b); alopecia, mild erythema and minimal debris on the convex pinnae, face and dorso-lateral neck (c);
accumulation of black to brown debris within the nail fold (paronychia, d).

et al., 2003). lymphocytic exocytosis, eosinophilic pustulosis and superficial peri­

vascular to interstitial lymphocyte-dominated dermatitis. If present,
unipolar budding yeasts may be found in the surface or infundibular
Skin biopsies and histopathology keratin (Mauldin et al., 1997; Gross et al., 2008; Bizikova et al., 2015)
(Fig. 5).
Since Malassezia can be easily detected in cytological samples, skin
biopsies are typically not performed to confirm a diagnosis of Malassezia Molecular-based identification methods
dermatitis. In histological preparations of skin biopsies from affected
patients, Malassezia may be absent due to skin preparation and/or For the rapid detection of Malassezia and species determination, DNA
sample processing or changes may be non-specific (Bond et al., 2020). sequence analysis of the ribosomal rRNA genes by PCR-based methods is
Histological changes associated with Malassezia dermatitis include typically performed (Boekhout et al., 2010; Cafarchia et al., 2011; Bond
pronounced irregular epidermal and infundibular hyperplasia, promi­ et al., 2020). These genes are highly conserved among different
nent parakeratotic hyperkeratosis, diffuse intercellular oedema and

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Fig. 3. Paraneoplastic alopecia in a cat with secondary, widespread Malassezia dermatitis leading to alopecia, mild crusting and hyperpigmentation on the face (a) as
well as prominent alopecia, mild erythema, crusting and accumulation of brown debris on the ventral body and distal limbs; note the shiny/glancy skin characteristic
for feline paraneoplastic alopecia (b).

(ITS1, ITS2) and 5.8 S regions. Other useful secondary target genes
include chitin synthetase 2 (CHS2), RNA polymerase 1 (RPB1), RNA
polymerase 2 (RPB2), β-tubulin, translation elongation factor 1 alpha
(EF1-alpha), mitochondrial cytochrome B (CYTB) and minichromosome
maintenance complex component 7 (MCM7) (Pryce et al., 2003;
Boekhout et al., 2010; Cafarchia et al., 2011; Lorch et al., 2018; Theelen
et al., 2018).

Treatment

General considerations for Malassezia dermatitis

The underlying primary cause should be identified and corrected, if

possible. Depending on the severity and distribution of the skin lesions,
topical treatment alone may be adequate, or a combination of topical
and systemic treatment may be required (Bajwa, 2017; Bond et al.,
2020; Guillot and Bond, 2020; Hobi et al., 2022; Bajwa, 2023).
Fig. 4. Cytological impression showing nuclear streaming (thin, purple lines),
multiple Malassezia yeasts (arrows) and a high number of coccoid bacteria
Topical treatments
(small, round, purple dots).

There is strong evidence from randomized control trials in dogs to

Malassezia species (Boekhout et al., 2010). Commonly analysed genes suggest that topical application of a shampoo containing 2% chlorhex­
within the rRNA gene cluster include the domain 1 (D1) and 2 (D2) of idine and 2% miconazole twice weekly is efficacious for treatment of
the 26 S subunit, small subunit 18 S and the internal transcribed spacer Malassezia dermatitis (Negre et al., 2009; Bond et al., 2020). Since this

Fig. 5. Malassezia dermatitis in a dog demonstrating prominent scalloping of epidermis and follicles, and prominent spongiosis. H&E 100x (a); mild superficial
dermal inflammation composed of mast cells, fewer lymphocytes and a few eosinophils. HE 400x (b); occasional yeast organism admixed with the keratin in the
follicular lumen. HE 1000x (c), PAS 1000x (d).

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shampoo is degreasing and can be irritating, rare side effects including randomized, single blinded clinical trials but further studies are needed
erythema and pruritus may occur (Bond et al., 2020). Consequently, the to inform treatment recommendations (Guillot et al., 2003; Bond et al.,
authors suggest to use a commercially available small-animal hair-coat 2020).
conditioner following the use of this shampoo treatment. Griseofulvin, an oral antifungal drug historically used for the treat­
In a European randomized control study including 67 dogs with ment of dermatophytosis is not effective against Malassezia yeasts and
pedal or generalized Malassezia overgrowth, more than 50% efficacy should be avoided (Miller et al., 2012; Bajwa, 2017; Bond et al., 2020).
was observed with a shampoo containing 3% chlorhexidine applied
three times to once weekly and evaluated for up to 6 weeks, but adverse Allergen-specific immunotherapy
effects including erythema and pruritus were common (Maynard et al.,
2011). This shampoo could be recommended as second choice for In a retrospective study from Sweden, the treatment success of 16
shampoo therapy. In a recent pilot study, the use of a 0.003% colloidal atopic dogs with Malassezia hypersensitivity, using at least 10 months of
silver nanoparticle-based shampoo showed beneficial effects in dogs subcutaneous immunotherapy with Malassezia extract only, indepen­
with Malassezia dermatitis, but prospective, double-blinded studies are dent of the application frequency, was evaluated. A good response,
needed to confirm this finding (Jones and Bloom, 2022). leading to a reduction of pruritus and medication use, was seen in nine
Other topical formulations including a shampoo containing 3% (56%) cases. No adverse effects were observed (Åberg et al., 2017). No
chlorhexidine and 0.5% climbazole, 1% and 2% miconazole condi­ similar studies have been performed in cats. Thus, there is insufficient
tioners, 2% climbazole shampoo, 0.2% enilconazole lotion, essential oil evidence to recommend Malassezia-specific immunotherapy as routine
mixtures, various products containing selenium sulphide, piroctone treatment modality (Nuttall, 2012; Bond et al., 2020).
olamine, benzalkonium chloride and triclosan could be used when the
recommended topical shampoos do not work, however there are no Treatment protocols
published prospective randomised clinical trials to demonstrate evi­
dence of efficacy (Bond et al., 2020). Topical antiseptic and/or antifungal mousses, wipes or sprays, con­
In cats, there are only anecdotal reports regarding the topical treat­ taining 2–3% chlorhexidine and/or azoles, can be applied once to twice
ment of Malassezia dermatitis. Based on a consensus panel, the World daily, while 2–3% chlorhexidine shampoos, with or without 2% mi­
Association of Veterinary Dermatologist’s WAVD guidelines state that conazole, can be used twice weekly (Miller et al., 2012; Bajwa, 2017;
products containing chlorhexidine, miconazole or climbazole should be Bond et al., 2020; Bajwa, 2023). Shampoo formulations containing >
beneficial (Bond et al., 2020). 2% chlorhexidine, with our without miconazole, should be followed by a
conditioner, as they can be drying and irritating (Maynard et al., 2011;
Alternative topical products Kloos et al., 2013). Topical shampoos and conditioners after a contact
time of at least five to ten minutes should be thoroughly rinsed off after
Plant-based products or peptides may be additional or prophylactic use to prevent ingestion. This is particularly important in cats. In addi­
options. Antifungal peptides are positively charged protein fragments tion, body orifices should be avoided (Miller et al., 2012).
such as defensins, cathelicidins, lactoferrin or lysozyme, interfering with In selected cases, where topical treatment is ineffective, or where
the permeability of the fungal cell membrane. Various plant components disease is severe (generalised, chronic or deep lesions), a systemic oral
including flavonoids, phenolic compounds, terpenes, sulfur-bases and antifungal drug is added to the topical treatment regime (Miller et al.,
saponin show in vitro activity against different Malassezia species (Rhimi 2012; Bond et al., 2020; Hobi et al., 2022; Bajwa, 2023). Itraconazole is
et al., 2021). Two in-vivo studies performed in Italy showed good usually used for first line therapy in cats and dogs. Ketoconazole can be
improvement of canine Malassezia dermatitis and otitis externa using used as an alternative in dogs, but is not recommended for the use in cats
different topical plant/herbal formulations (Nardoni et al., 2014; Nar­ due to toxicity. In many countries, ketoconazole has been withdrawn
doni et al., 2017). This was reflected by the significant reduction of from the market due to its high adverse effect profile in humans (Bond
clinical signs, reduction of frequency of yeasts occurrence and/or et al., 2020). In a clinical trial including 25 dogs with Malassezia
reduction of Malassezia numbers. Some dogs with otitis externa devel­ dermatitis, fluconazole was as effective as ketoconazole, but as cefalexin
oped local adverse effects (erythema, swelling) after contact to one of was part of the treatment regime, interpretation is difficult (Sickafoose
the mixtures. et al., 2010). Since itraconazole achieves high, prolonged concentrations
in the stratum corneum, oral pulse therapy with a dose of 5 mg/kg q24h
Systemic antifungal therapy in an alternate week protocol, is recommended for first line treatment
(Miller et al., 2012; Bond et al., 2020). Ideally, serum liver biomarkers
Antifungal azoles are characterized by an azole ring with two (im­ (alanine aminotransferase, aspartate aminotransferase, bilirubin)
idazoles) or three (triazoles) integrated nitrogen molecules. Azoles are should be measured before, and intermittently during the treatment, as
fungistatic and inhibit the enzyme 14-alpha demethylase thus prevent­ hepatotoxicity can occur (Wiebe and Karriker, 2005; Miller et al., 2012).
ing ergosterol synthesis of the fungal wall. This leads to the disruption of Compounded formulations of itraconazole should be avoided, since
the cell membrane, making the fungal cell more vulnerable. It also im­ their bioavailability is low resulting in poor absorption from the
pairs many membrane-associated enzymes. These agents have an effect gastrointestinal tract and treatment failure (Bond et al., 2020; Bajwa,
on the mammalian cytochrome P450 enzyme system thus interfering 2023).
with the steroid biosynthesis of the patient (Adams, 2001; Foy and At the same time, to correct any underlying cause of Malassezia
Trepanier, 2010; Miller et al., 2012). Overall, azoles are well tolerated, dermatitis, further diagnostic investigations should be carried out,
but interactions with other medications are common hepatotoxicity can depending on the clinical presentation (Miller et al., 2012; Bajwa, 2017;
be severe (Adams, 2001; Wiebe and Karriker, 2005). Bond et al., 2020; Guillot and Bond, 2020; Hobi et al., 2022; Bajwa,
Allylamines are a group of antifungals with a high selectivity for 2023). Since allergy is a common trigger in both dogs and cats, effective
squalene epoxidase, an enzyme being responsible for the synthesis of flea/parasite prevention, a strict elimination diet over 4–8 weeks, and an
lanosterol. This specific, reversible, and noncovalent inhibition affects allergen-specific immunotherapy in case of atopic disease, are indicated
both the fungal membrane structure and function. Allylamines show in many patients (Miller et al., 2012; Gedon and Mueller, 2018; Nuttall
broad-spectrum activity and can be fungicidal as well as fungistatic. et al., 2019; Bond et al., 2020; Hobi et al., 2022; Bajwa, 2023).
Terbinafine, an oral allylamine, is well tolerated overall (Adams, 2001; Recheck examination to evaluate treatment success, is recommended
Foy and Trepanier, 2010; Miller et al., 2012). Its use for treatment of 2–4 weeks after the initial topical and/or systemic treatment (Miller
Malassezia dermatitis has been described in single reports and et al., 2012; Bajwa, 2023). A dermatological examination is combined

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S. Hobi et al. The Veterinary Journal 304 (2024) 106084

with a cytological evaluation to determine the remaining Malassezia et al., 2022). A study in atopic dogs from East Asia, using the E-test
burden (Miller et al., 2012; Bajwa, 2023). It is important to treat patients (Sabouraud dextrose agar with 0.5% Tween 40), found higher MIC
7–10 days beyond clinical remission (Miller et al., 2012). Uncompli­ values for ketoconazole and itraconazole, while in another study from
cated cases easily take 3–4 weeks until clinical remission. Italy, implementing the CLSI reference broth microdilution, clinical
isolates of diseased dogs showed intermediate to high MIC values of
Treatment failure and considerations fluconazole, ketoconazole, itraconazole, voriconazole, miconazole and
posaconazole, demonstrating that cross-resistance to multiple azole
It is fundamental to take a detailed history of each patient, since antifungals can occur (Cafarchia et al., 2012b; Watanabe et al., 2014).
treatment failure is common, and the reasons are multifactorial. The One report using the M27-A3 protocol indicated less susceptibility (high
following situations are commonly encountered on recheck examina­ MICs) towards amphotericin B, clotrimazole, miconazole, fluconazole,
tions after treatment has been initiated: and nystatin, associated with M. pachydermatis strains of diseased dogs
(Weiler et al., 2013).
(1) The Malassezia dermatitis has completely resolved, but relapses There are some reports in dogs, where treatment failure due to
occur several weeks or months later. In this scenario, it is likely, resistance was suspected clinically and later confirmed in vitro via
that the underlying trigger has not yet been identified or cor­ antifungal susceptibility testing. Resistance was encountered to
rected and further diagnostic investigations are warranted (e.g. commonly used systemic and topical agents including itraconazole,
allergy work up, endocrinological testing, imaging, skin ketoconazole and clotrimazole (several-fold increase of MIC) (Angileri
biopsies). et al., 2019; Kano et al., 2019; Kano et al., 2020).
(2) The Malassezia dermatitis is unchanged compared to pre-
treatment. In this scenario, treatment might not have been Conclusions
adequate (e.g. only topical therapy alone, incorrect or insufficient
treatment), wrong drug formulation (e.g. compound itracona­ Malassezia dermatitis is commonly encountered in dogs, while less
zole), incorrect dosages were used (e.g. itraconazole) or the frequent in cats. In both species there are breed predispositions.
Malassezia isolate may be resistant to the antifungal drug). M. pachydermatis is most commonly isolated from diseased dogs and
(3) The Malassezia dermatitis has resolved, but relapses occur some cats. Skin lesions include alopecia, erythema, crusts, scales, lichen­
days after clinical remission. In this scenario, most likely micro­ ification and accumulation of keratosebaceous debris, while the ears or
biological cure was not achieved despite remission of clinical nails often show a brown to black, malodorous exudate. Pruritus is
signs and treatment duration was likely not long enough. variable. Malassezia dermatitis is usually triggered by a primary un­
derlying disease. A definitive diagnosis is easily achieved via direct
Antifungal susceptibility testing cytology and microscopy. There is a need for a standardized, commer­
cially available culture and susceptibility methodology to inform treat­
Despite the regular use of oral antifungal medications in general ment decisions in case of refractory disease. The focus in patients with
practice, antifungal susceptibility testing of Malassezia isolates is rarely Malassezia dermatitis should be on topical treatment and identification
performed in veterinary practice and there is no standardization of the underlying illness. Systemic antifungal treatment should be
regarding the method, culture medium, inoculum size, incubation time reserved for severe or refractory disease only, due to the risk of azole
and MIC endpoint criteria, making data interpretation and recommen­ resistance.
dation difficult (Boekhout et al., 2010; Bond et al., 2020; Hobi et al.,
2022). CRediT authorship contribution statement
A research group from Italy assessed the antifungal susceptibility of
M. pachydermatis in various media and concluded that culture in Sabo­ Stefan Hobi: Writing – review & editing, Writing – original draft,
uraud dextrose broth with 1% tween 80, a stock inoculum suspension of Methodology, Investigation, Formal analysis, Data curation, Conceptu­
1–5 ×106 CFU/ml, and an incubation time of 48 hours is optimal alization. Pawel M. Bęczkowski: Visualization, Validation. Vanessa R.
(Cafarchia et al., 2012a; Cafarchia et al., 2012c). Another method using Barrs: Validation, Supervision, Formal analysis, Conceptualization.
Christensen’s broth with 0.1% Tween 80 and 0.5% Tween 40, an inoc­ May Tse: Visualization, Resources, Investigation. Ralf Mueller: Visu­
ulum size of approximately 1–5 ×105 yeast cells/ml and an incubation alization, Validation, Formal analysis.
time of 48 hours can be considered as a suitable alternative (Rincón
et al., 2006; Peano et al., 2012; Chiavassa et al., 2014). Declaration of Competing Interest
International standardised guidelines for susceptibility testing of
Malassezia are urgently needed so that antifungal susceptibility testing Ralf Mueller has been a consultant, lectured for or received support
can be widely offered to veterinary practitioners. This would facilitate for research from the following companies manufacturing or selling
detection of Malassezia isolates with increased minimum inhibitory antifungal medications: Ceva (topical chlorhexidine), Elanco (Malaseb
concentrations of antifungals and would inform the selection of appro­ shampoo, itraconazole), Selectavet (enilconazole) and Virbac (topical
pariate antifungal drugs for therapy. chlorhexidine). None of the other authors of this paper has a financial or
personal relationship with other people or organizations that could
Antifungal susceptibility inappropriately influence or bias the content of the paper.

M. pachydermatis, the main species causing Malassezia dermatitis Acknowledgements

and/or otitis externa in small animals, can show azole resistance as
demonstrated in two studies using clinical isolates (Angileri et al., 2019; This study was supported by the UGC block grant from City Uni­
Kano et al., 2019). Reduced azole susceptibility in Malassezia may be versity of Hong Kong. The authors would like to thank Dr. Chris Klinger
caused by missense mutations, amino acid alterations, tandem quadru­ and Dr. Teresa Boehm for the image contribution.
plication, increased expression of ERG11, efflux pump alterations caused
by overexpression of genes encoding membrane transporters of the ABC
transporter family (CDR1/CDR2) or the major facilitator (MDR1) family
and also by biofilm formation (Bumroongthai et al., 2016; Kim et al.,
2018; Angileri et al., 2019; Kano et al., 2019; Peano et al., 2020; Hobi

7
S. Hobi et al. The Veterinary Journal 304 (2024) 106084

References Eidi, S., Khosravi, A.R., Jamshidi, S., 2011. A comparison of different kinds of Malassezia
species in healthy dogs and dogs with otitis externa and skin lesions. Turkish Journal
of Veterinary and Animal Sciences 35, 345–350.
Åberg, L., Varjonen, K., Åhman, S., 2017. Results of allergen-specific immunotherapy in
Faergemann, J., Aly, R., Maibach, H., 1983. Adherence of Pityrosporum orbiculare to
atopic dogs with Malassezia hypersensitivity: a retrospective study of 16 cases.
human stratum corneum cells. Archives of Dermatological Research 275, 246–250.
Veterinary Dermatology 28, 633–e157.
Figueredo, L.A., Cafarchia, C., Otranto, D., 2013. Antifungal susceptibility of Malassezia
Adams, H.R., 2001. Veterinary Pharmacology and Therapeutics. Iowa State University
pachydermatis biofilm. Medical Mycology 51, 863–867.
Press,.
Foy, D.S., Trepanier, L.A., 2010. Antifungal treatment of small animal veterinary
Åhman, S., Perrins, N., Bond, R., 2007. Carriage of Malassezia spp. yeasts in healthy and
patients. Veterinary Clinics: Small Animal Practice 40, 1171–1188.
seborrhoeic Devon Rex cats. Sabouraudia 45, 449–455.
Gedon, N.K.Y., Mueller, R.S., 2018. Atopic dermatitis in cats and dogs: a difficult disease
Ahman, S.E., Bergstrom, K.E., 2009. Cutaneous carriage of Malassezia species in healthy
for animals and owners. Clinical and Translational Allergy 8 (1), 12.
and seborrhoeic Sphynx cats and a comparison to carriage in Devon Rex cats.
Gross, T.L., Ihrke, P.J., Walder, E.J., Affolter, V.K., 2008. Skin diseases of the dog and cat:
Journal Feline Medicine Surgery 11, 970–976.
clinical and histopathologic diagnosis. John Wiley & Sons,.
Amend, A., 2014. From dandruff to deep-sea vents: Malassezia-like fungi are ecologically
Guillot, J., Bensignor, E., Jankowski, F., Seewald, W., Chermette, R., Steffan, J., 2003.
hyper-diverse. PLoS Pathogens 10, e1004277.
Comparative efficacies of oral ketoconazole and terbinafine for reducing Malassezia
Amend, A., Burgaud, G., Cunliffe, M., Edgcomb, V.P., Ettinger, C.L., Gutiérrez, M.,
population sizes on the skin of Basset Hounds. Veterinary Dermatology 14, 153–157.
Heitman, J., Hom, E.F., Ianiri, G., Jones, A.C., 2019. Fungi in the marine
Guillot, J., Bond, R., 2020. Malassezia yeasts in veterinary dermatology: an updated
environment: Open questions and unsolved problems. MBio 10 e01189-01118.
overview. Frontiers in Cellular and Infection Microbiology 79.
Angileri, M., Pasquetti, M., De Lucia, M., Peano, A., 2019. Azole resistance of Malassezia
Guillot, J., Chermette, R., Guého, E., 1994. Prevalence of the genus Malassezia in the
pachydermatis causing treatment failure in a dog. Medical Mycology Case Reports 23,
Mammalia. Journal Délelő tt Mycologie Medicale 4, 72–79.
58–61.
Hajsig, D., Hajsig, M., Svoboda-Vuković, D., 1990. Malassezia pachydermatis in healthy
Arenz, B.E., Held, B.W., Jurgens, J.A., Farrell, R.L., Blanchette, R.A., 2006. Fungal
cats. Veterinarski Arhiv 60, 69–73.
diversity in soils and historic wood from the Ross Sea Region of Antarctica. Soil
Hobi, S., Cafarchia, C., Romano, V., Barrs, V.R., 2022. Malassezia: Zoonotic Implications,
Biology and Biochemistry 38, 3057–3064.
Parallels and Differences in Colonization and Disease in Humans and Animals.
Ashbee, H.R., Evans, E.G., 2002. Immunology of diseases associated with Malassezia
Journal of Fungi 8, 708.
species. Clinical Microbiology Reviews 15, 21–57.
Iatta, R., Puttilli, M.R., Immediato, D., Otranto, D., Cafarchia, C., 2017. The role of drug
Bajwa, J., 2017. Canine Malassezia dermatitis. Canadian Veterinary Journal 58,
efflux pumps in Malassezia pachydermatis and Malassezia furfur defence against
1119–1121.
azoles. Mycoses 60, 178–182.
Bajwa, J., 2023. Malassezia species and its significance in canine skin disease. Canadian
Jones, S., Bloom, P., 2022. Efficacy of a Silver-Based Shampoo for Treatment of Canine
Veterinary Journal 64, 87–90.
Malassezia: A Pilot Study. Journal of the American Animal Hospital Association 59,
Bellis, Fd, Castellá, G., Cabañes, F.J., Bond, R., 2010. Absence of DNA sequence diversity
7–11.
of the intergenic spacer 1 region in Malassezia nana isolates from cats. Medical
Kaneko, T., Makimura, K., Abe, M., Shiota, R., Nakamura, Y., Kano, R., Hasegawa, A.,
Mycology 48, 427–429.
Sugita, T., Shibuya, S., Watanabe, S., 2007. Revised culture-based system for
Bizikova, P., Santoro, D., Marsella, R., Nuttall, T., Eisenschenk, M.N., Pucheu-Haston, C.
identification of Malassezia species. Journal of Clinical Microbiology 45, 3737–3742.
M., 2015. Clinical and histological manifestations of canine atopic dermatitis.
Kano, R., Aramaki, C., Murayama, N., Mori, Y., Yamagishi, K., Yokoi, S., Kamata, H.,
Veterinary Dermatology 26, 79–e24.
2020. High multi-azole-resistant Malassezia pachydermatis clinical isolates from
Boekhout, T., Guého-Kellermann, E., Mayser, P., Velegraki, A., 2010. Malassezia and the
canine Malassezia dermatitis. Medical Mycology 58, 197–200.
skin: science and clinical practice. Springer Science & Business Media,.
Kano, R., Yokoi, S., Kariya, N., Oshimo, K., Kamata, H., 2019. Multi-azole-resistant strain
Bond, R., Lloyd, D., 1996. Factors affecting the adherence of Malassezia pachydermatis to
of Malassezia pachydermatis isolated from a canine Malassezia dermatitis. Medical
canine corneocytes in vitro. Veterinary Dermatology 7, 49–56.
Mycology 57, 346–350.
Bond, R., Morris, D.O., Guillot, J., Bensignor, E.J., Robson, D., Mason, K.V., Kano, R.,
Kennis, R., Rosser Jr, E., Olivier, N., Walker, R., 1996. Quantity and distribution of
Hill, P.B., 2020. Biology, diagnosis and treatment of Malassezia dermatitis in dogs
Malassezia organisms on the skin of clinically normal dogs. Journal of the American
and cats Clinical Consensus Guidelines of the World Association for Veterinary
Veterinary Medical Association 208, 1048–1051.
Dermatology. Veterinary Dermatology 31, 27–e24.
Kim, M., Cho, Y.-J., Park, M., Choi, Y., Hwang, S.Y., Jung, W.H., 2018. Genomic tandem
Breuer-Strosberg, R., Hochleithner, M., Kuttin, E., 1990. Malassezia pachydermatis
quadruplication is associated with ketoconazole resistance in Malassezia
isolation from a scarlet macaw. Mycoses 33, 247–250.
pachydermatis.
Bumroongthai, K., Chetanachan, P., Niyomtham, W., Yurayart, C., Prapasarakul, N.,
Kloos, I., Straubinger, R.K., Werckenthin, C., Mueller, R.S., 2013. Residual antibacterial
2016. Biofilm production and antifungal susceptibility of co-cultured Malassezia
activity of dog hairs after therapy with antimicrobial shampoos. Veterinary
pachydermatis and Candida parapsilosis isolated from canine seborrheic dermatitis.
Dermatology 24, 250–e254.
Sabouraudia 54, 544–549.
Ledbetter, E.C., Starr, J.K., 2015. Malassezia pachydermatis keratomycosis in a dog.
Cafarchia, C., Figueredo, L.A., Favuzzi, V., Surico, M.R., Colao, V., Iatta, R.,
Medical Mycology Case Reports 10, 24–26.
Montagna, M.T., Otranto, D., 2012a. Assessment of the antifungal susceptibility of
Leeming, J.P., Notman, F.H., 1987. Improved methods for isolation and enumeration of
Malassezia pachydermatis in various media using a CLSI protocol. Veterinary
Malassezia furfur from human skin. Journal of Clinical Microbiology 25, 2017–2019.
Microbiology 159, 536–540.
Lorch, J., Palmer, J., Vanderwolf, K., Schmidt, K., Verant, M., Weller, T., Blehert, D.,
Cafarchia, C., Figueredo, L.A., Iatta, R., Colao, V., Montagna, M.T., Otranto, D., 2012b. In
2018. Malassezia vespertilionis sp. nov.: a new cold-tolerant species of yeast isolated
vitro evaluation of Malassezia pachydermatis susceptibility to azole compounds using
from bats. Persoonia-Molecular Phylogeny and Evolution of Fungi 41, 56–70.
E-test and CLSI microdilution methods. Medical Mycology 50, 795–801.
Machado, M.L., Ferreiro, L., Ferreira, R.R., Corbellini, L.G., Deville, M., Berthelemy, M.,
Cafarchia, C., Figueredo, L.A., Iatta, R., Montagna, M.T., Otranto, D., 2012c. In vitro
Guillot, J., 2011. Malassezia dermatitis in dogs in Brazil: diagnosis, evaluation of
antifungal susceptibility of Malassezia pachydermatis from dogs with and without
clinical signs and molecular identification. Veterinary Dermatology 22, 46–52.
skin lesions. Veterinary Microbiology 155, 395–398.
Magiatis, P., Pappas, P., Gaitanis, G., Mexia, N., Melliou, E., Galanou, M., Vlachos, C.,
Cafarchia, C., Gallo, S., Capelli, G., Otranto, D., 2005a. Occurrence and population size of
Stathopoulou, K., Skaltsounis, A.L., Marselos, M., 2013. Malassezia yeasts produce a
Malassezia spp. in the external ear canal of dogs and cats both healthy and with
collection of exceptionally potent activators of the Ah (dioxin) receptor detected in
otitis. Mycopathologia 160, 143–149.
diseased human skin. Journal of Investigative Dermatology 133, 2023–2030.
Cafarchia, C., Gallo, S., Romito, D., Capelli, G., Chermette, R., Guillot, J., Otranto, D.,
Marsella, R., 2013. Fixing the skin barrier: past, present and future–man and dog
2005b. Frequency, body distribution, and population size of Malassezia species in
compared. Veterinary Dermatology 24, 73–e18.
healthy dogs and in dogs with localized cutaneous lesions. Journal of Veterinary
Mauldin, E.A., Scott, D.W., Miller, W.H., Smith, C.A., 1997. Malassezia dermatitis in the
Diagnostic Investigation 17, 316–322.
dog: a retrospective histopathological and immunopathological study of 86 cases
Cafarchia, C., Gasser, R.B., Figueredo, L.A., Latrofa, M.S., Otranto, D., 2011. Advances in
(1990–95). Veterinary Dermatology 8, 191–202.
the identification of Malassezia. Molecular and Cellular Probes 25, 1–7.
Maynard, L., Rème, C., Viaud, S., 2011. Comparison of two shampoos for the treatment
Cafarchia, C., Iatta, R., Immediato, D., Puttilli, M.R., Otranto, D., 2015. Azole
of canine Malassezia dermatitis: a randomised controlled trial. Journal of Small
susceptibility of Malassezia pachydermatis and Malassezia furfur and tentative
Animal Practice 52, 566–572.
epidemiological cut-off values. Medical Mycology 53, 743–748.
Meason-Smith, C., Olivry, T., Lawhon, S.D., Hoffmann, A.R., 2020. Malassezia species
Castellá, G., De Bellis, F., Bond, R., Cabañes, F.J., 2011. Molecular characterization of
dysbiosis in natural and allergen-induced atopic dermatitis in dogs. Medical
Malassezia nana isolates from cats. Veterinary Microbiology 148, 363–367.
Mycology 58, 756–765.
Chermette, R., 1998. Dermatitis caused by Malassezia pachydermatis in a California sea
Mexia, N., Gaitanis, G., Velegraki, A., Soshilov, A., Denison, M.S., Magiatis, P., 2015.
lion (Zalophus californianus). The Veterinary Record 142, 311–312.
Pityriazepin and other potent AhR ligands isolated from Malassezia furfur yeast.
Chiavassa, E., Tizzani, P., Peano, A., 2014. In vitro antifungal susceptibility of Malassezia
Archives of Biochemistry and Biophysics 571, 16–20.
pachydermatis strains isolated from dogs with chronic and acute otitis externa.
Miller, W.H., Griffin, C.E., Campbell, K.L., 2012. Muller and Kirk’s small animal
Mycopathologia 178, 315–319.
dermatology. Elsevier Health Sciences.
Crespo, M., Abarca, M., Cabañes, F.J., 2002a. Occurrence of Malassezia spp. in the
Morris, D.O., 1999. Malassezia dermatitis and otitis. Veterinary Clinics of North America:
external ear canals of dogs and cats with and without otitis externa. Medical
Small Animal Practice 29, 1303–1310.
Mycology 40, 115–121.
Nakagaki, K., Hata, K., Iwata, E., Takeo, K., 2000. Malassezia pachydermatis isolated from
Crespo, M.J., Abarca, M.L., Cabañes, F.J., 2002b. Occurrence of Malassezia spp. in horses
a South American sea lion (Otaria byronia) with dermatitis. Journal of Veterinary
and domestic ruminants. Mycoses 45, 333–337.
Medical Science 62, 901–903.
Crosaz, O., Legras, A., Vilaplana-Grosso, F., Debeaupuits, J., Chermette, R., Hubert, B.,
Nardoni, S., Mancianti, F., Corazza, M., Rum, A., 2004. Occurrence of Malassezia species
Guillot, J., 2013. Generalized dermatitis associated with Malassezia overgrowth in
in healthy and dermatologically diseased dogs. Mycopathologia 157, 383–388.
cats: A report of six cases in France. Medical Mycology Case Reports 2, 59–62.

8
S. Hobi et al. The Veterinary Journal 304 (2024) 106084

Nardoni, S., Mancianti, F., Rum, A., Corazza, M., 2005. Isolation of Malassezia species Rhimi, W., Theelen, B., Boekhout, T., Aneke, C.I., Otranto, D., Cafarchia, C., 2021.
from healthy cats and cats with otitis. Journal of Feline Medicine Surgery 7, Conventional therapy and new antifungal drugs against Malassezia infections.
141–145. Medical Mycology 59, 215–234.
Nardoni, S., Mugnaini, L., Pistelli, L., Leonardi, M., Sanna, V., Perrucci, S., Pisseri, F., Riciputo, R., Oliveri, S., Micali, G., Sapuppo, A., 1996. Phospholipase activity in
Mancianti, F., 2014. Clinical and mycological evaluation of an herbal antifungal Malassezia furfur pathogenic strains: phospholipase-Aktivität an patientenisolaten
formulation in canine Malassezia dermatitis. Journal Délelő tt Mycologie von Malassezia furfur. Mycoses 39, 233–235.
Megyeédicale 24, 234–240. Rincón, S., Cepero de García, M., Espinel-Ingroff, A., 2006. A modified Christensen’s urea
Nardoni, S., Pistelli, L., Baronti, I., Najar, B., Pisseri, F., Bandeira Reidel, R.V., Papini, R., and CLSI broth microdilution method for testing susceptibilities of six Malassezia
Perrucci, S., Mancianti, F., 2017. Traditional Mediterranean plants: Characterization species to voriconazole, itraconazole, and ketoconazole. Journal of Clinical
and use of an essential oils mixture to treat Malassezia otitis externa in atopic dogs. Microbiology 44, 3429–3431.
Natural Product Research 31, 1891–1894. Ruth Ashbee, H., 2006. Recent developments in the immunology and biology of
Negre, A., Bensignor, E., Guillot, J., 2009. Evidence-based veterinary dermatology: a Malassezia species. FEMS Immunology Medical Microbiology 47, 14–23.
systematic review of interventions for Malassezia dermatitis in dogs. Veterinary Shifrine, M., Marr, A., 1963. The requirement of fatty acids by Pityrosporum ovale.
Dermatology 20, 1–12. Microbiology 32, 263–270.
Nuttall, T., 2012. Malassezia dermatitis. BSAVA manual of canine and feline Shokri, H., Khosravi, A., Rad, M., Jamshidi, S., 2010. Occurrence of Malassezia species in
dermatology. BSAVA Library,, pp. 198–205. Persian and domestic short hair cats with and without otitis externa. Journal of
Nuttall, T.J., Marsella, R., Rosenbaum, M.R., Gonzales, A.J., Fadok, V.A., 2019. Update Veterinary Medical Science 72, 293–296.
on pathogenesis, diagnosis, and treatment of atopic dermatitis in dogs. Journal of the Sickafoose, L., Hosgood, G., Snook, T., Westermeyer, R., Merchant, S., 2010.
American Veterinary Medical Association 254, 1291–1300. A noninferiority clinical trial comparing fluconazole and ketoconazole in
O’Neill, I.D., Rowe, D., Brodbelt, D.C., Pegram, C., Hendricks, A., 2022. Ironing out the combination with cephalexin for the treatment of dogs with Malassezia dermatitis.
wrinkles and folds in the epidemiology of skin fold dermatitis in dog breeds in the Veterinary Therapeutics: Research in Applied. Veterinary Medicine 11, E1–E13.
UK. Science Reports 12, 10553. Sierra, P., Guillot, J., Jacob, H., Bussiéras, S., Chermette, R., 2000. Fungal flora on
Omodo-Eluk, A., Baker, K., Fuller, H., 2003. Comparison of two sampling techniques for cutaneous and mucosal surfaces of cats infected with feline immunodeficiency virus
the detection of Malassezia pachydermatis on the skin of dogs with chronic dermatitis. or feline leukemia virus. American Journal of Veterinary Research 61, 158–161.
The Veterinary Journal 165, 119–124. Sparber, F., LeibundGut-Landmann, S., 2017. Host responses to Malassezia spp. in the
Ordeix, L., Galeotti, F., Scarampella, F., Dedola, C., Bardagi, M., Romano, E., Fondati, A., mammalian skin. Frontiers in Immunology 8, 1614.
2007. Malassezia spp. overgrowth in allergic cats. Veterinary Dermatology 18, Spatz, M., Richard, M.L., 2020. Overview of the potential role of Malassezia in gut health
316–323. and disease. Frontiers in Cellular and Infection Microbiology 10, 201.
Ordiales, H., Vázquez-López, F., Pevida, M., Vázquez-Losada, B., Vázquez, F., Quirós, L., Theelen, B., Cafarchia, C., Gaitanis, G., Bassukas, I.D., Boekhout, T., Dawson Jr, T.L.,
Martín, C., 2021. Glycosaminoglycans are involved in the adhesion of Candida 2018. Malassezia ecology, pathophysiology, and treatment. Medical Mycology 56,
albicans and Malassezia species to keratinocytes but not to dermal fibroblasts. Actas S10–S25.
Dermo-Sifiliográficas (English Edition) 112, 619–624. Tondello, A., Vendramin, E., Villani, M., Baldan, B., Squartini, A., 2012. Fungi associated
Pang, K.-L., Guo, S.-Y., Chen, I.-A., Burgaud, G., Luo, Z.-H., Dahms, H.U., Hwang, J.-S., with the southern Eurasian orchid Spiranthes spiralis (L.) Chevall. Fungal Biology
Lin, Y.-L., Huang, J.-S., Ho, T.-W., 2019. Insights into fungal diversity of a shallow- 116, 543–549.
water hydrothermal vent field at Kueishan Island, Taiwan by culture-based and Triana, S., de Cock, H., Ohm, R.A., Danies, G., Wösten, H.A., Restrepo, S., González
metabarcoding analyses. PLoS One 14, e0226616. Barrios, A.F., Celis, A., 2017. Lipid metabolic versatility in Malassezia spp. yeasts
Park, M., Park, S., Jung, W.H., 2021. Skin Commensal Fungus Malassezia and Its Lipases. studied through metabolic modeling. Frontiers in Microbiology 8, 1772.
Journal of Microbiology Biotechnology 31, 637–644. Triana, S., González, A., Ohm, R., Wösten, H., de Cock, H., Restrepo, S., Celis, A., 2015.
Peano, A., Beccati, M., Chiavassa, E., Pasquetti, M., 2012. Evaluation of the antifungal Draft genome sequence of the animal and human pathogen Malassezia pachydermatis
susceptibility of Malassezia pachydermatis to clotrimazole, miconazole and strain CBS 1879. Genome Announc 3, e01197-15.
thiabendazole using a modified CLSI M27-A3 microdilution method. Veterinary Uchida, Y., Onodera, S., Nakade, T., Otomo, K., 1994. Sterol composition in polyene
Dermatology 23, 131–e129. antibiotic-sensitive and resistant strains of Malassezia pachydermatis. Veterinary
Peano, A., Johnson, E., Chiavassa, E., Tizzani, P., Guillot, J., Pasquetti, M., 2020. Research Communications 18, 183–187.
Antifungal resistance regarding Malassezia pachydermatis: where are we now? Ushijima, T., Takahashi, M., Ozaki, Y., 1981. Selective and differential media for
Journal of Fungi 6, 93. isolation and tentative identification of each species of Pityrosporum residing on
Plant, J., Rosenkrantz, W., Griffin, C., 1992. Factors associated with and prevalence of normal or diseased human skin. Microbiology and Immunology 25, 1109–1118.
high Malassezia pachydermatis numbers on dog skin. Journal of the American Watanabe, S., Koike, A., Kano, R., Nagata, M., Chen, C., Hwang, C.-Y., Hasegawa, A.,
Veterinary Medical Association 201, 879–882. Kamata, H., 2014. In vitro susceptibility of Malassezia pachydermatis isolates from
Porro, M.N., Passi, S., Caprilli, F., Mercantini, R., 1977. Induction of hyphae in cultures canine skin with atopic dermatitis to ketoconazole and itraconazole in East Asia.
of Pityrosporum by cholesterol and cholesterol esters. Journal of Investigative Journal of Veterinary Medical Science 76, 579–581.
Dermatology 69, 531–534. Weiler, C.B., Jesus, F.P.Kd, Nardi, G.H., Loreto, É.S., Santurio, J.M., Coutinho, S.D.A.,
Pryce, T.M., Palladino, S., Kay, I., Coombs, G., 2003. Rapid identification of fungi by Alves, S.H., 2013. Susceptibility variation of Malassezia pachydermatis to antifungal
sequencing the ITS1 and ITS2 regions using an automated capillary electrophoresis agents according to isolate source. Brazilian Journal of Microbiology 44, 175–178.
system. Medical Mycology 41, 369–381. Wiebe, V., Karriker, M., 2005. Therapy of systemic fungal infections: a pharmacologic
Puig, L., Bragulat, M.R., Castella, G., Cabanes, F.J., 2017. Characterization of the species perspective. Clinical Techniques in Small Animal Practice 20, 250–257.
Malassezia pachydermatis and re-evaluation of its lipid dependence using a synthetic
agar medium. PLoS One 12, e0179148.