Malassezia Folliculitis following Triple Therapy for Cystic Fibrosis

Triple-combination therapy with elexacaftor, tezacaftor and ivacaftor has been recently approved for cystic fibrosis patients with at least one F508del mutation in the transmembrane conductance regulator of the cystic fibrosis gene. Among the adverse events of elexacaftor, tezacaftor and ivacaftor,...

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Published in:Medicina (Kaunas, Lithuania) Lithuania), 2022-09, Vol.58 (9), p.1204
Main Authors: Li Pomi, Federica, Di Bartolomeo, Luca, Vaccaro, Mario, Lentini, Maria, Cristadoro, Simona, Lucanto, Maria Cristina, Lombardo, Mariangela, Costa, Stefano, Borgia, Francesco
Format: Article
Language:English
Subjects:
Acne
adverse drug reaction
Analysis
Antibiotics
Biopsy
Care and treatment
Case Report
Cystic fibrosis
Diagnosis
Disease
Drug therapy, Combination
elexacaftor/tezacaftor/ivacaftor
Erythema
Exocrine glands
folliculitis
Health aspects
Malassezia
Membrane proteins
Mutation
Patient outcomes
Patients
Pulmonary function tests
Quality of life
skin
Stains & staining
White people
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Summary:Triple-combination therapy with elexacaftor, tezacaftor and ivacaftor has been recently approved for cystic fibrosis patients with at least one F508del mutation in the transmembrane conductance regulator of the cystic fibrosis gene. Among the adverse events of elexacaftor, tezacaftor and ivacaftor, the cutaneous ones have been rarely reported, mainly dealing with urticarial-like rashes. On this topic, we report two cases of Malassezia folliculitis following triple therapy administration in two young females. In the first patient, a papulopustular rush appeared before the folliculitis while in the second patient it was not preceded by other skin manifestations. The diagnosis was confirmed both by dermoscopy and histology. The prompt response to systemic antimycotic drugs provided further evidence for the causative role of Malassezia, requiring no discontinuation of cystic fibrosis therapy. We could hypothesize that the triple regimen treatment may induce changes in the skin microbiome, potentially able to favor colonization and proliferation of Malassezia species. Physicians should be aware of such associations to allow prompt diagnosis and early interventions, avoiding useless drug removal.
ISSN:1648-9144
1010-660X
1648-9144
DOI:10.3390/medicina58091204