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A 20-year-old college student presents with a rash on her arms and chest that has been present for the past 2 months. The condition initially responded to oral minocycline but after 4 weeks of therapy, the rash worsened. Additional topical clindamycin and a benzoyl peroxide wash did not improve the condition. The patient reports several areas have begun to itch. She is in good health and takes an oral contraceptive. Examination reveals multiple pustules and inflammatory papules of the affected areas.
Pityrosporum folliculitis (PF) is a fungal eruption caused by Malassezia, a fungal infection often mistaken for acne vulgaris.1 Primary occlusion of hair follicles leads to yeast overgrowth leading to an inflammatory cytokine cascade.2 Malassezia contains both lipase and phospholipase enzymes that work to damage skin...
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Pityrosporum folliculitis (PF) is a fungal eruption caused by Malassezia, a fungal infection often mistaken for acne vulgaris.1 Primary occlusion of hair follicles leads to yeast overgrowth leading to an inflammatory cytokine cascade.2 Malassezia contains both lipase and phospholipase enzymes that work to damage skin barrier function inducing irritation and itch in patients.3
The condition is more common in immunocompromised individuals including post-transplant patients and those with HIV/AIDS.4 Conditions that may mimic PF include acne vulgaris, follicular eczema, bacterial folliculitis, eosinophilic folliculitis, tinea incognito, and steroidal acne.5
The majority of PF patients are males in their mid-twenties. Eruptions are usually localized to the chest, back, and shoulders and present as monomorphic papulopustular skin lesions that lack comedones. Commonly misdiagnosed, potassium hydroxide preparations of skin lesions are used to identify budding yeast cells under the microscope. Extensive cases warrant oral antifungals such as fuconazole. Topical therapies include selenium sulfide and ketoconazole shampoos.6
Sidney Lampert is a medical student at the Drexel University College of Medicine, in Philadelphia. Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
References
- Rubenstein RM, Malerich SA. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. 2014;7(3):37-41.
- Corzo-León DE, MacCallum DM, Munro CA. Host responses in an ex vivo human skin model challenged with Malassezia sympodialis. Front Cell Infect Microbiol. 2021:10:561382. doi:10.3389/fcimb.2020.561382.
- Paichitrojjana A, Chalermchai T. The prevalence, associated factors, and clinical characterization of Malassezia folliculitis in patients clinically diagnosed with acne vulgaris. Clin Cosmet Investig Dermatol. 2022;15:2647-2654. doi:10.2147/CCID.S395654
- Green M, Feschuk AM, Kashetsky N, Maibach HI. Clinical characteristics and treatment outcomes of Pityrosporum folliculitis in immunocompetent patients. Arch Dermatol Res. 2023;315(6):1497-1509. doi:10.1007/s00403-022-02506-0
- Malgotra V, Singh H. Malassezia (Pityrosporum) folliculitis masquerading as recalcitrant acne. Cureus. 2023;15(1):e33641. doi:10.7759/cureus.33641
- Vest BE, Krauland K. Malassezia Furfur. In: StatPearls [Internet]. StatPearls Publishing; Updated 2023 May 22.
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