Malassezia folliculitis

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.

Malassezia can be found on the skin of most adults; it only causes folliculitis when conditions are right. Malassezia can also cause pityriasis versicolor and seborrhoeic dermatitis

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.

Malassezia folliculitis

What provokes malassezia folliculitis?

The causes of malassezia folliculitis are not fully understood but the following are believed to be important:

External factors

• 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.

Host factors

• Oily skin (provoked by hormonal influences)
• Obesity
• Pregnancy
• Stress or fatigue
• Systemic illness, including:
  • Diabetes mellitus
  • Immune deficiency
• Medications, such as:
  • Broad spectrum oral antibiotics (often prescribed for acne), which suppress skin bacteria allowing yeasts to proliferate.
  • Oral steroids such as prednisone (steroid acne)
  • Oral contraceptive pill

Treatment

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:

Topical treatment

• Antidandruff shampoo as a cleanser
• Topical antifungal agents, especially ketoconazole or ciclopirox creams or econazole foaming solution

Oral treatment

• Azole antifungal agents including:
  • Ketoconazole
  • Itraconazole
• Isotretinoin to reduce seborrhoea