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].

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.

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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