The Prevalence of Candida in Skin and Acne Lesions of Patients in Sari, Iran

Candida is a member of normal flora of human skin and mucosa which cause a wide range of skin infections as cutaneous candidiasis. Considering the pathogenesis of acne, predisposing factors and microbial agents which involve in acne, and the pathogenicity of Candida in causing skin diseases, this study evaluated the prevalence of Candida in skin and acne lesions of patients to analyze its probable role in acne. A total number of 125 patients (70 females and 55 males) enrolled in this study. The samples were collected from inside and surface of acne lesions. Direct microscopic examination was performed with 20% potassium hydroxide (KOH) + calcofluor white (CFW). The collected samples were also cultured on Sabouraud's dextrose agar with chloramphenicol (SC). The isolated species were identified by morphologic and physiologic methods such as culture on chrome agar Candida media, germ tube test, chlamydospore forming test on cornmeal agar media, growth in 45˚c, and sugar assimilation test with HiCandida identification kit (HiMedia, Mumbai, India). Among all collected samples from inside of acne lesions, 45.6% were positive for yeast cells in direct microscopic examination. Moreover, 45 samples (36.0%), 11 cases (24.4%) from inside of acne lesions and 34 cases (75.6%) from skin surface, were positive for Candida colony growth in culture. Candida parapsilosis and Candida krusei were the most frequent isolated species from inside of acne lesions and skin surface, respectively. In 5 cases (11.1%), Candida was simultaneously found in both inside of acne lesions and skin surface samples. According to the results of our study, Candida is a normal flora of skin which can be considered in the etiology of acne. We also recommend further studies with a larger sample size and specific aims in the future.