What is "pityrosporum folliculitis"?

Pityrosporum folliculitis

This is a an itchy condition whereby hair follicles becomes inflamed due to overgrowth of Malassezia yeast. The condition typically occurs in areas that can support the growth and proliferation of Mallassezia - especially the upper trunk, shoulders and rarely the head and neck area. Although 92 % of the world is covered in Malassezia, most people do not develop any problems from them. Predisposing factors to develop Pityrosporum folliculitis include hot humid environments, age (rarely happens before puberty), cancer, immunocompromised states and previous use of antibiotics.

The patient develops tiny 1-3 mm inflammatory papules and pustules. These reveal the classic budding yeast when examined under the microscope with a drop of potassium hydroxide (KOH).

What conditions can look similar?

One needs to consider many other diagnoses as well before reaching the conclusion that the patient has pityrosporum folliculitis. Steroid acne, acne vulgaris, bacterial folliculitis, eosinophilic pustular folliculitis and insect bites can sometimes look similar.

How is pityrosporum folliculitis treated?

Treatment includes topical antifungal creams including ketonconazole and ciclopirox. Antifungal (antidandruff) shampoos are also frequently used with the creams. Rarely, oral antifungal agents like fluconazole and itraconazole or oral isotretinoin (to shrink the sebaceous glands altogether) are needed.