Non-synonymous ERG11 mutations in <i>M. restricta</i> and <i>M. arunalokei</i> : impact on azole susceptibility

<i>Malassezia</i> over colonization is associated with conditions such as dandruff and seborrheic dermatitis, which give rise to unpleasant itching and swelling on the skin. Azole antifungals such as ketoconazole, clotrimazole, and miconazole are the primary treatments of choice available as over-the-counter creams or shampoos. However, the emergence of antifungal resistance leads to a loss of treatment efficacy and persistent fungal infection. To understand the mechanisms underlying antifungal resistance, we profiled the susceptibility profiles of commensal <i>Malassezia</i> isolates from the skin and identified novel ERG11 mutations. Our results indicate that antifungal susceptibility is determined by a combination of factors (mutations, efflux pump activity, gene expression, copy number) and suggest that the healthy skin microbiome serves as a reference for the emergence of new mutations and strain phenotypes.