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Furthermore, a potential association with Malassezia furfur has been described, either because fungal colonization induces keratinization abnormalities or due to an atypical host immune response.[1-3] This theory is supported by the characteristic distribution of the lesions

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IEGs are a collection of genes that are induced within minutes to hours by various triggers as these do not require de novo protein synthesis, and many are transcription factors or other DNA-binding proteins involved in transcription of genes involved in later responses [13, 14]

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Ideally, for policy and mitigation purposes, this would be a substance unique to THS that is not present in significant amounts in SHS, one that is formed during the aging process as SHS is transformed into THS