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What Is Pityrosporum Folliculitis?

Medically Reviewed by Melinda Ratini, DO, MS on May 27, 2021

Your skin is home to many yeasts that coexist peacefully with you. One of these is pityrosporum, a yeast that could be the reason your acne doesn’t go away. If you’ve been using acne medicine or other remedies, but it doesn’t seem to get better, talk to your doctor about getting tested for pityrosporum folliculitis.

Pityrosporum is responsible for fungal acne, a kind of acne that is identifiable by pinhead-sized pimples on your upper chest or upper back. Although commonly mistaken for acne vulgaris, the acne that’s caused by excess skin oil, fungal acne is different and can be made worse by normal acne treatments.

What Causes It?

‌Pityrosporum folliculitis is caused by a yeast called pityrosporum or malassezia. Pityrosporum is found on everyone’s skin. The yeast forms part of the skin flora, also known as the microbiome, and it’s completely normal.

However, when it gets down into the hair follicles and multiplies, an itchy, acne-like eruption follows, called folliculitis. It’s important to note that folliculitis is not contagious, infectious, or an indicator of poor skin hygiene.

Since yeast grows in warm, moist environments, it tends to multiply in conditions that have plenty of humidity, perspiration, and heat. People who have systemic diseases like diabetes are also at risk.

Risk factors include:

Symptoms of Pityrosporum Folliculitis

‌Although it affects people of all sexes, young and middle-aged males are more at risk of fungal acne than other people. Breakouts appear as small, red bumps appearing to rise uniformly from your hair follicles. They often appear in symmetric rows on the forehead or scattered on the cheeks. It can also develop on your upper back or upper chest.

In acute cases, fungal acne appears as 1 mm-wide papulopustules, pustules, or vesicles. In persistent cases, the outer layer of the skin tends to thicken. Fungal acne is exacerbated by sweating, and it gets worse in hot and humid weather.

Diagnosis of Pityrosporum Folliculitis

You should have your acne checked by a doctor or dermatologist. Misdiagnosis may lead to the development of pityrosporum folliculitis that persists for years.

Your doctor may be able to diagnose fungal acne by its appearance or the failure of medications used to treat acne, or they may be able to see the yeast within your hair follicles upon examination. Your dermatologist may perform a number of other tests, like:

  • Tape stripping
  • Skin scraping
  • Swabs
  • Contact plates
  • Direct microscopy
  • Dermoscopy

‌Your doctor may use potassium hydroxide with some skin scrapings to see if there are any budding yeasts. 

How To Treat Pityrosporum Folliculitis

‌To treat the condition, your doctor will typically prescribe oral antifungal medication. Sometimes topical antifungal medicines may be used instead. If there is any inflammation, then you may be advised to add anti-inflammatory therapy as a supplement. For treatment to work, it must deal with the yeast in the follicles and any factors that predisposed your body to folliculitis in the first place. It is also essential to remember that the condition may recur even after you’ve been treated successfully.

You may also use medicated shampoo if the fungal acne is on the hairline or scalp. If your folliculitis is being caused by immunosuppression from a different condition, your treatment regimen for the other condition will help ease symptoms of fungal acne.

For treatment to work, it must deal with the yeast in the follicles and any factors that predisposed your body to folliculitis in the first place. It is also essential to remember that the condition may recur even after you’ve been treated successfully.

As a preventative measure, always keep your skin clean, especially the affected area. Do not use any skin products that can irritate the acne before it is fully healed. 

Some forms of folliculitis can go away after using home remedies, so talk to your doctor or dermatologist to weigh your options. You might, for example, ease the itchiness that accompanies fungal acne by soaking a towel in warm water, wringing out the excess, and placing the warm towel on the affected place.

WebMD Medical Reference

Sources

SOURCES:

American Journal of Clinical Dermatology: “Folliculitis: recognition and management.”

‌American Osteopathic College of Dermatology: “PITYROSPORUM FOLLICULITIS.”

Diagnostic Microbiology and Infectious Disease: “Epidemiological characteristics of Malassezia folliculitis and use of the May-Grünwald-Giemsa stain to diagnose the infection.”

The Ohio State University Wexner Medical Center. “What is fungal acne, or pityrosporum folliculitis?”

Frontiers: “Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment.”

The Journal of Clinical and Aesthetic Dermatology: “Malassezia (Pityrosporum) Folliculitis.”

Mayo Clinic: “Folliculitis.”

Journal of the American Academy of Dermatology. “Pityrosporum folliculitis: A retrospective review of 110 cases.”

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