What is malassezia folliculitis?
Malassezia folliculitis (previously called ‘pityrosporum folliculitis’) is due to proliferation of a yeast, called malassezia, within the hair follicles. It presents as an itchy, acne-like eruption and most often affects the trunk.
What does it look like?
Tiny dome-shaped pink papules and small superficial pustules arise in crops on the upper back, shoulders and chest. It can occasionally affect other areas including the neck, face and upper arms. It tends to be quite itchy. The spots may appear more prominent when scratched.
Acne may accompany malassezia folliculitis, because of oily skin.
What provokes malassezia folliculitis?
The causes of malassezia folliculitis are not fully understood but the following are believed to be important:
- The yeast tends to overgrow in hot, humid, sweaty environments.
- Sweating is encouraged by wearing occlusive clothing.
- Sunscreens and greasy emollients may occlude the follicles.
- Oily skin (provoked by hormonal influences)
- Stress or fatigue
- Systemic illness, including:
- Diabetes mellitus
- Immune deficiency
- Medications, such as:
Diagnosis of malassezia folliculitis
The diagnosis of malassezia folliculitis may be made clinically, when a patient presents with a monomorphic, acne-like eruption on the chest and upper back. It may also be suspected by finding organisms within the hair follicles on histopathological examination of a skin biopsy.
Treatment of malassezia folliculitis
Treatment must deal with both the yeast overgrowth and predisposing factors, otherwise the condition will recur. Malassezia folliculitis has a tendency to recur.
The first step in management is to correct as far as possible any of the predisposing factors listed above.
Specific treatment can be divided into:
- Antidandruff shampoo as a cleanser
- Topical antifungal agents, especially ketoconazole or ciclopirox creams or econazole foaming solution