The basics about Pityrosporum Folliculitis. In other words, the who, what, where, when, why, and how! Grab a cup of coffee or tea, a light snack, and make yourself comfortable.

What’s Pityrosporum Folliculitis?

 

 

What exactly is Pityrosporum folliculitis?  Pityrosporum folliculitis is also known as Malassezia folliculitis.  Malassezia is a yeast commonly found on skin and is generally harmless.  Generally.  The problem occurs when the environment is ripe causing these yeast to overgrow and invade hair follicles thus causing a fungal infection of the skin.  Often times the result is an acne-like eruption.  In fact, this condition looks so much like acne it’s often misdiagnosed as such!

 

 

Image of Pityrosporum Folliculitis

15 year-old girl with Pityrosporum Folliculitis – Arch Pediatr Adolesc Med.2005;159(1):64-67. doi:10.1001/archpedi.159.1.64 (Image Credit)

 

 

The key difference between Malassezia or Pityrosporum folliculitis and acne is the itch that some say they experience with this condition.  Itchiness, as you might know, is a common symptom of fungal infections.

 

One other notable difference between Pityrosporum folliculitis and acne is the lack of response to acne treatment.  Frankly, acne medications won’t work on Pityrosporum folliculitis for the same reason why they won’t work on Athlete’s Foot.  Two entirely different skin conditions.

 

Aside from acne products being completely ineffective against this skin condition, here’s another reason why you may want to avoid using them.  Many acne medications work by killing bacteria but this only allows for yeasts like Malassezia to flourish. In the absence of bacteria, yeasts have the ability to consume all of the resources and nutrients they would’ve normally had to compete for.  Kill the bacteria and you aren’t just helping yeast live; you’re helping them thrive.

 

Now, here’s where things get a little tricky: acne can still be present along with Pityrosporum folliculitis.  Yes, you read that correctly.  This means you could have acne and an overgrowth of this yeast at the same time.  How?  Well, oily skin is a risk factor for both of these conditions.  The same oil that clogs your pores and causes acne is the same oil this yeast feeds off of.

 

If you think you’re experiencing acne and Pityrosporum folliculitis, try to tackle one condition at a time to avoid complicating matters.  In case you’re wondering which should you try to resolve first, the answer is folliculitis.  Since we know acne treatments may worsen Pityrosporum folliculitis, it’s best to use them only after you have successfully treated the folliculitis.

 

Still, just like other fungal infections of the skin, there’s a possibility of recurrence;  so, even after successful treatment, Pityrosporum folliculitis can come back.  Again, think Athlete’s Foot.  Just because you got rid of it once doesn’t mean it can’t come back again.  Therefore, it’s important to know what the risk factors are and how to prevent it in the first place.

 

DERMAdoctor

The risk factors for Pityrosporum folliculitis include, but are not limited to:

 

  • Obesity
  • Pregnancy
  • Diabetes
  • Stress
  • Taking broad-spectrum antibiotics
  • Taking steroid medication
  • Using oral contraceptives
  • Having a systemic illness
  • Having a weakened immune system
  • Excessive heat and/or sweating
  • Oily, greasy, sebum-rich environment/skin
  • Tight, restrictive clothing

Studies have shown this condition has also been found in healthy individuals, as well.

 

Here are the top ways to prevent Pityrosporum folliculitis or reduce the likelihood of recurrence:

 

  • Spend less time in hot, humid and sweaty environments
  • Keep yourself cool and dry
  • Shower after sweating
  • Wear loose, breathable clothing and especially if exercising or engaging in strenuous activity
  • Avoid applying greasy and oil-based products to the skin and hair
  • Limit usage of broad-spectrum antibiotics and steroid medications unless necessary
  • Boost immune system and maintain a healthy diet
  • Take a daily probiotic like this one or this one.
  • Reduce stress

 

Dr Brandt Skincare

 

Finally, Pityrosporum folliculitis can occur wherever hair follicles are located, but typically appears on the face, back, neck, chest, and shoulders.  It can affect young to middle-aged people, males and females and, unfortunately, is a lot more common than we might think.

 

Nevertheless, this condition is usually only discovered after months and sometimes years of unsuccessfully trying to resolve what is thought to be acne.

 

If you suspect you have Pityrosporum folliculitis, it’s always a good idea to get confirmation from a licensed dermatologist.  If you suspect you might have both acne and Pityrosporum folliculitis, well, a licensed dermatologist can help with confirming that, too.

 

And, here’s the good news: just like acne, depending on the severity, you may be able to treat this condition effectively at home.  Click here to read what might help.

 

 

 

 

References:
  1. Ayers K, Sweeney SM, Wiss K. Pityrosporum Folliculitis Diagnosis and Management in 6 Female Adolescents with Acne Vulgaris. Arch Pediatr Adolesc Med.2005;159(1):64-67. doi:10.1001/archpedi.159.1.64
  2. Ayers K, Sweeney SM, Wiss K. Pityrosporum Folliculitis Diagnosis and Management in 6 Female Adolescents with Acne Vulgaris. Arch Pediatr Adolesc Med.2005;159(1):64-67. doi:10.1001/archpedi.159.1.64 (Image Credit)
  3. Dermatology Online Journal 19(8). 2013. De Andrade, V., Dias, A.C. Pityrosporum Folliculitis in an immunocompetent individual: clinical case description. http://escholarship.org/uc/item/94d335b1
  4. American Osteopathic College of Dermatology [Internet]. Kirksville (MO).; 2017. Pityrosporum Folliculitis; [ cited 2017 Feb 5]; [about 2 p.]. Available from: http://aocd.site-ym.com/?page=PityrosporumFollicu

Treatment Options for Pityrosporum Folliculitis

 

If you have Pityrosporum folliculitis, you may be able to skip the dermatologist and treat this pesky condition right at home.  But it depends.

 

In some research studies, topical treatments like creams and ointments were extremely beneficial against Pityrosporum folliculitis.  In other studies, the most effective treatment occurred when oral medication and topical treatments were used simultaneously.  The varying degrees of treatment may depend on how severe your condition is.

 

Nevertheless, the following treatment options are worth looking into and, in many instances, you may be able to try them right in the comfort of your home.

 

Pityrosporum Folliculitis Treatment Options:

 

  • One of the most common anti-fungal medications used to treat Pityrosporum folliculitis is ketoconazole.  Ketoconazole comes in two forms – oral and topical.  However, as of May 2016, the Food and Drug Administration advised against using oral ketoconazole tablets to treat fungal infections of the skin due to several serious side effects.  Topical ketoconazole, however, has not been associated with these effects and is still a viable option.  Nizoral A-D 1% Shampoo is a dandruff shampoo that contains 1% ketoconazole as the active ingredient.  This topical, over-the-counter product is available at most grocery stores and Amazon.  Be sure to read about my personal experience using Nizoral to treat this condition.

 

  • Shampoos containing selenium sulfide such as Head & Shoulders or Selsun Blue have also been reported to provide some relief.  These products can be found at most grocery stores and Amazon.

 

  • ID Monolaurin Gel Face and Body Acne/Sweat Acne Treatment is advertised as offering anti-yeast, anti-bacterial, anti-viral, and anti-protozoal properties.  This product, in clinical studies, had a 100% successful rate in treating Pityrosporum folliculitis, according to their website.

 

 

 

  • Bentonite clay is worth mentioning simply because of its ability to deeply cleanse pores!  It may not be associated with treating this condition, but it’s widely known for removing buildup of excess oil and sebum.

 

The following options listed below may require a prescription or consult with a licensed dermatologist or healthcare professional.

 

  • Additional members of the Azole family include anti-fungal agents clotrimazole, fluconazole, and itraconazole.  Similar to ketoconazole, they have also been used to treat certain yeasts with varying degrees of effectiveness.  These drugs more often than not require a prescription from a doctor.

 

  • Brand name products such as Xolegel 2% Gel (for seborrheic dermatitis), Nizoral 2% Shampoo (for tinea versicolor), Ketoderm 2% Cream (for dermatophytes and candidiasis of the skin), and Extina 2% Foam (for seborrheic dermatitis) all contain prescription-strength levels of ketoconazole.

 

  • Photodynamic therapy and salicylic acid peels may also help but, it seems, more research is needed in these areas.

 

As noted above, there are several options that could help in treating or reducing the symptoms associated with Pityrosporum folliculitis.  Since this condition can return, be sure to also spend some time learning about the risk factors and how to prevent it to reduce the possibility of recurrence.

 

Can you think of any other products that might be helpful? Please share! The more comprehensive this list is the better!

 

How To Prepare for Summer If You Have Pityrosporum Folliculitis

 

Summer is here and if you haven’t already, it’s time to get out those khaki shorts, sunglasses, open-toe sandals, and whatever else summer designates!  This, by far, is my favorite season of the year until about late July – around the time I start complaining about the humidity.  As much as I hate being cold, when you feel sticky after being outdoors for only a few minutes, that’s when I begin rethinking my outdoor life.  I mean, seriously, I rethink it.  I plan everything around how much time I’ll be spending out in the sun.  From the clothing I wear to how much makeup I apply, I think about everything.

 

So, why am I sharing this with you? To simply prepare you for Summer if you have or have had Pityrosporum folliculitis.

 

One of the risk factors for Pityrosporum folliculitis is excessive sweating and heat.  Meaning this condition could peak or flare up as the weather gets warmer.  In fact, this video I posted had nearly 68,000 views in August 2016 alone, the most views out of any other month of the year (typically this number is between 30-40,000 views).  Coincidence?  Maybe.  Or, perhaps as it warms up and people sweat more, it increases the chance of a flare up (whether on the forehead or somewhere else on your skin).

 

But by no means does that mean you should refrain from enjoying outdoor activities.  Please don’t let that deter you.  After all, it’s summer!  It just means if you’ve had or currently have Pityrosporum folliculitis, you’ll need to take some precaution and plan ahead much like I do.

 

Here are some ways I keep Pityrosporum folliculitis at bay during the warmer months:

 

  • Consider taking a lukewarm or cool shower more than once a day if you’re prone to sweating.
  • Limit the amount of time you spend in direct sunlight.
  • Don’t wear heavy or greasy lotions and sunscreens.
  • Keep makeup to a minimum if you wear any.
  • Consider wearing a powder foundation instead of a liquid foundation.
  • Keep your hair and scalp free of greasy/oily products and thick pomades.
  • Keep hair off and away from your face.
  • Lower the windows or turn on the air conditioner in the car several minutes before getting in.
  • Consider parking in a shaded area or parking garage if you park outdoors.
  • Wear loose, breathable clothing. Don’t wear anything that clings to the skin.
  • Refrain from wearing baseball caps, headwraps or sweatbands that can trap sweat and moisture against the skin.
  • Keep the temperature inside your home within a reasonable range.

 

Some of these tips can be applied year-round and not necessarily only during the warm weather months.

 

Personal side note: Around the time when I first began experiencing this condition I didn’t have a fully-functioning air conditioner in my apartment for at least two consecutive summers.  I did have a very old window unit in my bedroom, but unfortunately it wasn’t nearly as powerful as it sounded. Needless to say, on most Summer days, my 600 sq./ft. apartment always felt like a furnace!  The crazy thing is, it didn’t bother me too much (I used inexpensive window fans and, again, I enjoy being warm), but I had no idea my toasty apartment was actually making matters worse for my skin.

 

If you’re looking for other ways to stay cooler this summer, you have several options:

 

  • Portable units are perfect if you live in an apartment without A/C or one that isn’t functioning properly.  They can also be used in homes where certain rooms don’t seem to get cool enough.
  • Air conditioning window units and powerful tower fans are other options to consider to keep the temperature in your home within a reasonable and normal range.

 

Unfortunately, the season most people love sometimes causes the most misery for your skin.  But don’t let that stop you!  With some thoughtful modifications and a few simple precautions, flare ups that are common during these warmer months can, at worst, be minimized or, at best, all together eliminated.

 

 

Do you love summer? How do you stay cool and dry?  

 

How and Why Ketoconazole Works

 

The term “drug class” refers to a set of drugs that share similar characteristics. For instance, they might have a similar chemical structure, behave the same way by binding to the same target, or treat the same disease.

 

Ketoconazole belongs to the azole drug class. Other members of this class include, but are not limited to clotrimazole, econazole, miconazole, fluconazole, and itraconazole. Azoles are famous for targeting a variety of fungi, including dermatophytes like tinea and yeasts like candida and malassezia. For now, we’ll focus on ketoconazole because it’s the most widely used topical antifungal for the treatment of Malassezia yeast infections.

 

Ketoconazole, basically, works to stop fungal growth.

 

But how does it work exactly? Well think of a cell and a cell membrane. Unlike animal cells, ergosterols can be found in the cell membranes of most fungi and protozoans (for now we’ll focus on fungi cell membranes).

 

Why is ergosterol important? It helps to regulate membrane fluidity. They’re basically membrane reinforcers.

 

Antifungal drugs, like ketoconazole, work by targeting ergosterol. In fact, while ergosterol is being synthesized or made, ketoconazole inhibits it. For many fungi, this interference can lead to an increase in cell permeability, leakage of cell components and, ultimately, cell death.

 

Simply put, ketoconazole is effective because it targets ergosterol, making an otherwise impermeable cell membrane permeable. Once the membrane is permeable, cell death is almost inevitable.

 

Ketoconazole comes in two forms – oral and topical. But as of May 2016, the Food and Drug Administration advised against using oral ketoconazole tablets to treat fungal infections of the skin due to several serious side effects like toxicity, liver damage and adrenal gland problems to name a few. Yikes! You can read more about it here. For similar reasons, it has been discontinued in many other countries, as well.

 

Topical ketoconazole, however, has not been associated with these effects and is still a valuable drug for some superficial fungal infections of the skin. Nizoral A-D 1% Shampoo is an over-the-counter anti-dandruff shampoo that contains 1% ketoconazole as the active ingredient. This product can be found in some local grocery stores and on Amazon. You can read more about my personal experience with Nizoral A-D 1% Shampoo here.

 

Brand name products such as Xolegel 2% Gel (for seborrheic dermatitis), Nizoral 2% Shampoo (for tinea versicolor), Ketoderm 2% Cream (for dermatophytes and candidiasis of the skin), and Extina 2% Foam (for seborrheic dermatitis) contain prescription-strength levels of ketoconazole and, therefore, are not available over-the-counter.

 

While ketoconazole has not yet been clinically proven to treat or stop the growth of Pityrosporum (Malassezia) folliculitis specifically, it has been shown to inhibit the growth of other common fungi in the laboratory. Be sure to discuss with your doctor the possible risks and benefits of using this particular drug.

 

 

 

 

 

  1. Dufourc, E. J. (2008). Sterols and membrane dynamics.Journal of Chemical Biology,1(1-4), 63–77. http://doi.org/10.1007/s12154-008-0010-6
  2. Food and Drug Administration [Internet]. Drug Safety Communication on Nizoral (Ketoconazole) Oral Tablets; [cited 2017 Apr 8]; [about 2 p.]. http://www.fda.gov/downloads/Drugs/DrugSafety/UCM501983.pdf
  3. Food and Drug Administration [Internet]. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2004/076419.pdf
  4. Rosenthal, L., Burchum, J. Feb. 2017. Lehne’s Pharmacotherapeutics for Advanced Practice Providers.