Malassezia folliculitis

Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand,1997. Updated by Dr Thomas Stewart, General Practitioner, Sydney, Australia, November 2017.


What is malassezia folliculitis?

Malassezia folliculitis, previously known as pityrosporum folliculitis, is an infection of hair follicles caused by lipophilic malassezia yeasts. There are multiple malassezia species, including furfur, globosa, sympodialis and restricta [1]. The yeast is a normal inhabitant of human skin and only causes disease under specific conditions [2].

Malassezia have been linked to a number of skin diseases including seborrhoeic dermatitis, folliculitis, confluent and reticulated papillomatosis and pityriasis versicolor [3].

Malassezia folliculitis

Who gets malassezia folliculitis?

Malassezia folliculitis is most commonly seen in adolescent and young adult males living in humid climates [3,4]. Other risk factors include:

How does malassezia folliculitis present?

Malassezia folliculitis presents as small uniform itchy papules and pustules on the forehead, chin, neck, trunk and extensor aspect of the upper limbs. They may be itchy.

How is malassezia folliculitis diagnosed?

Clinical examination is usually sufficient for diagnosis. Laboratory investigations may be performed.

  • Potassium hydroxide preparation of skin scrapings may reveal budding spores and hyphae [7].
  • Other stains, including the May-Grunwald-Giema stain may also be helpful, but are less commonly used [1].
  • Cultures are not routinely done, as malassezia species typically require special media for growth.

Malassezia folliculitis may also be suspected by finding organisms within the hair follicles on histopathological examination of a skin biopsy.

Treatment of malassezia folliculitis

It is important to address any predisposing factors at the outset, as malassezia folliculitis has a tendency to recur.

Oral treatment is recommended, as it has proven much more effective than topical agent. Fluconazole is used more commonly than itraconazole due to its superior side effect profile [8].

Topical agents (eg, selenium sulfide shampoo, econazole solution) may also be used but should be reserved for those unable to tolerate oral treatment  [9,10].

Isotretinoin and photodynamic therapy (PDT) have been used with some success in small case series [8, 11,12].

Prevention of malassezia folliculitis

Recurrence is common, even after successful treatment [10].

Long-term prophylaxis with topical agents may be considered in those at high-risk or with multiple recurrences.

Periodic re-evaluation of predisposing factors is recommended. 

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Related information

 

References 

  1. Durdu M, Güran M, Ilkit M. Epidemiological characteristics of Malassezia folliculitis and use of the May-Grünwald-Giemsa stain to diagnose the infection. Diagn Microbiol Infect Dis. 2013 Aug;76(4):450-7. doi: 10.1016/j.diagmicrobio.2013.04.011. Epub 2013 May 22. PubMed PMID: 23706503. PubMed.
  2. Akaza N, Akamatsu H, Sasaki Y, Kishi M, Mizutani H, Sano A, Hirokawa K, Nakata S, Nishijima S, Matsunaga K. Malassezia folliculitis is caused by cutaneous resident Malassezia species. Med Mycol. 2009;47(6):618-24. doi: 10.1080/13693780802398026. PubMed PMID: 18949624. PubMed.
  3. Gaitanis G, Velegraki A, Mayser P, Bassukas ID. Skin diseases associated with Malassezia yeasts: facts and controversies. Clin Dermatol. 2013 Jul-Aug;31(4):455-463. doi: 10.1016/j.clindermatol.2013.01.012. Review. PubMed PMID: 23806162. PubMed
  4. Rubenstein RM, Malerich SA. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. 2014 Mar;7(3):37-41. Review. PubMed PMID: 24688625; PubMed. Central PMCID: PMC3970831.PubMed.
  5. Weary PE, Russell CM, Butler HK, Hsu YT. Acneform eruption resulting from antibiotic administration.  Arch Dermatol 1969;100179- 183. Journal.
  6. Rhie S, Turcios R, Buckley H, Suh B. Clinical features and treatment of Malassezia folliculitis with fluconazole in orthotopic heart transplant recipients. J Heart Lung Transplant. 2000 Feb;19(2):215-9. PubMed PMID: 10703699. PubMed.
  7. Thayikkannu AM, Kindo AJ, Veeraraghavan M. Malassezia – Can it be ignored? Indian J Dermatol. 2015;60(4):332-339. Journal.
  8. Hald M, Arendrup MC, Svejgaard EL, Lindskov R, Foged EK, Saunte DM; Danish Society of Dermatology. Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases. Acta Derm Venereol. 2015 Jan;95(1):12-9. doi:10.2340/00015555-1825. Review. PubMed PMID: 24556907. PubMed.
  9. Bäck O, Faergemann J, Hörnqvist R. Pityrosporum folliculitis: a common disease of the young and middle-aged. J Am Acad Dermatol. 1985 Jan;12(1 Pt 1):56-61. PubMed PMID: 3980804. PubMed.
  10. Abdel-Razek M, Fadaly G, Abdel-Raheim M, al-Morsy F. Pityrosporum (Malassezia) folliculitis in Saudi Arabia--diagnosis and therapeutic trials. Clin Exp Dermatol. 1995 Sep;20(5):406-9. PubMed PMID: 8593718. PubMed.
  11. Lee JW, Kim BJ, Kim MN. Photodynamic therapy: new treatment for recalcitrant Malassezia folliculitis. Lasers Surg Med. 2010 Feb;42(2):192-6. doi: 10.1002/lsm.20857. PubMed PMID: 20166153. PubMed.

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