Malassezia folliculitis

Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand,1997.

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 malassezia folliculitis 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:

External factors

Host factors

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:

Topical treatment

Oral treatment

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