Letter: Some Caveats in Skin Bank Practices from the Perspectives of Fungal Skin Flora

Editor I read the review by Linford et al.1 regarding the use of allograft skin and its microbiological safety. In the retrospective findings, Linford et al. has provided only a grim overview of the fungal agents. As described by authors, among the yeast the genus Candida are encountered frequently as skin colonisers. However, the role of diverse fungal skin flora other than Candida and potential safety issues owing to their presence need to be highlighted. A wider spectrum of fungal skin flora needs to be screened as part of the skin bank microbiology evaluation practices. The role of potentially pathogenic fungi like Malassezia, Rhodotorula, Trichosporon, Dermatophytes seems to be undermined and not documented in the review. In Table 2, culture results ‘candida’ is misspelt as ‘Candica’. Recently, novel fungal agents like Coniosporium epidermidis have been recovered from human skin which emphasise the concern in this regard 2. The processing of allograft skin described in the article using 85% glycerol and antibiotics like G-Penicillin and Streptomycin is inadequate to completely eradicate the fungal agents. Moreover, it can be speculated that the glycerolisation process might potentially favour the growth of lipid-dependent Malassezia found on humans jeopardizing the skin grafting. The resident skin fungal flora can initiate degradation process damaging the integrity of the allograft skin. Thus, there is a need for thorough screening for fungal skin flora and development of robust processing protocols to ensure increased success rate in skin grafting. Prakash Yegneswaran Peralam 1