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Malassezia Folliculitis – Everything You Need to Know

 

 

This is the most comprehensive article on the blog to date!  It’s literally everything you need to know about Malassezia folliculitis!  Or, Pityrosporum folliculitis.  Did you know Malassezia folliculitis and Pityrosporum folliculitis actually refer to the same condition?  We’ll discuss this more later.

 

For those of you who simply want treatment options, a list of them have been provided below.  Want the cliff notes?  The section titled, “Important Points about Malassezia Folliculitis” may be what you are looking for.  The Frequently Asked Questions (FAQ) segment also has answers to common questions.  Just scroll all the way down to view them. I’ll continuously add to this list as the most common questions are raised.

 

And for those of you who are interested in the complete picture, this lengthy, but interesting article definitely paints it for you from beginning to end.  So, let’s dive in.

 

Do you have malassezia folliculitis?

 

 

Well, yes.  More than likely you do have Malassezia; allow me to explain.  Normal skin consists of a variety of Malassezia yeasts among other things.  That’s right.  Yeasts normally live on skin.  Healthy skin, at that.  In fact, these yeasts make up to 80% of the total skin fungal population.  And they’re generally harmless.  The operative word here is generally.  In some circumstances, they can cause certain skin disorders.

 

Malassezia yeasts have been associated with the following skin conditions: pityriasis versicolor, psoriasis, atopic dermatitis/eczema, seborrheic dermatitis, and folliculitis.  There are several different types of folliculitis, but the primary focus of this post will be Malassezia folliculitis.

 

Folliculitis, in simpler terms, is basically inflammation of the hair follicle.  Malassezia folliculitis simply refers to inflammation of the hair follicle by Malassezia yeasts. Get it?

 

Malassezia yeasts acquired their name from Malassez who first discovered and implicated them as the causative agent in dandruff in the late 1800’s.  These yeasts were also named Pityrosporum and Pityrosporum malassez.  One-hundred years later, though, the name Masassezia was reclaimed again!  Malassezia folliculitis and Pityrosporum folliculitis are, often, still used interchangeably today.  And, just for the record, Malassezia folliculitis and Pityrosporum folliculitis refer to the same condition.   For consistency, I’ll use Malassezia folliculitis throughout this post.

 

Malassezia folliculitis

 

Malassezia folliculitis looks a lot like acne, actually.  In fact, this condition usually isn’t discovered until months and sometimes years of unsuccessfully trying to resolve what was thought to be acne.  Heck, even experienced dermatologists mistakenly misdiagnose it!  Ask me how I know.

 

Essentially, Malassezia folliculitis presents as an inflammatory rash or breakout consisting of papules and pustules.  A mild itching sensation may also be experienced.  It can be found on the scalp, face, neck, shoulders, arms, chest or back, and can even occur in different age groups. However, one study found it detected highest in teenagers and those in their twenties and thirties.

 

Malassezia folliculitis on the face

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Here’s where it gets a little tricky.  As previously mentioned, Malassezia folliculitis is often mistaken for acne.  However, it isn’t just misdiagnosed, it’s also frequently under-diagnosed in patients who already have acne.  In other words, acne and Malassezia folliculitis can coexist.

 

Acne or folliculitis

 

To paint a clearer picture, here are several possible scenarios you could be experiencing:

 

  1. You could have acne.
  2. You could have Malassezia folliculitis.
  3. You could have both acne and Malassezia folliculitis.
  4. Or, you could have none of the above (just sayin’).

 

That makes four.  At least four possible scenarios!  So, how do you determine which scenario you fall into?  Figuring this out may not be as daunting as you might think.  Essentially, there are two fairly straight-forward ways to test for Malassezia folliculitis.

Testing for Malassezia Folliculitis

 

1. At Home

Many suspect the presence of a fungal infection after traditional acne treatment has failed to improve this skin condition.  Likewise, a positive response to topical antifungals could also strongly suggest the presence of yeast.  Several over-the-counter topical antifungals are readily available without a prescription for safe use at home. Continue reading to find out more.

 

2. At the Doctor’s Office

Another way to test for Malassezia folliculitis is to visit your doctor.  Malassezia folliculitis can be diagnosed on the basis of both clinical features and direct microscopic findings.

A potassium hydroxide preparation is another very common technique used for confirming Malassezia folliculitis.

And, although rare, a skin biopsy may also be necessary to differentiate between Malassezia folliculitis and other skin conditions and for treatment-resistant cases.

A positive response to oral or topical antifungal therapy could also suggest this diagnosis.

 

Malassezia Folliculitis Treatment Options

 

Studies have shown Malassezia folliculitis can improve with the use of topical and oral antifungals.  In other studies, beneficial results were safely obtained with topical antifungals alone.  Currently, there are no internationally approved guidelines for treating Malassezia folliculitis, however, the following treatments are frequently used to resolve this skin condition.

 

Treatment Option #1: Topical Antifungal Treatment for Malassezia Folliculitis

Topical shampoos are generally applied to the affected area and left on for up to 20 minutes and then rinsed off.  After successfully treating the area, ongoing maintenance may still be necessary.

 

Malassezia Folliculitis

 

 

1. Ketoconazole Shampoo (1% or 2%)

Ketoconazole shampoo is one of the most common treatments for Malassezia folliculitis.  This may be due to its antifungal properties or its ability to reverse blockage of the hair follicles.

Check out this detailed blog post for a step-by-step account of how Nizoral, a ketoconazole 1% shampoo, was used on the forehead as a treatment for Malassezia folliculitis.

 

2. Zinc Pyrithione Soap or Shampoo (1% or 2%)

Zinc Pyrithione also has antifungal effects and is another common ingredient used in the treatment of Malassezia yeasts.  In fact, in one study, researchers discovered reservoirs of zinc pyrithione particles were found residing in the same scalp follicular compartments Malassezia yeasts are primarily found in for up to ten days!  No wonder it can be effective!  Noble Formula Shampoo 2%, Noble Formula Soap 2%, and DermaHarmony 2% (ZnP) Zinc Therapy Bar Soap contain Zinc Pyrithione as the active ingredient.

 

3. Selenium Sulfide Shampoo (1%)

Shampoos that contain the active ingredient, selenium sulfide, have also been used to treat Malassezia-related dandruff and other skin conditions.  Products such as Head & Shoulders and Selsun Blue contain this ingredient.

 

4. Antifungal Lotions & Creams

2% Ketoconazole Cream, Econazole Cream, and Clotrimazole Lotion are antifungal lotions and creams that may be available with or without a prescription.

Treatment Option #2: Combination Oral & Topical Antifungal Treatment for Malassezia Folliculitis

 

Malassezia Folliculitis

 

While the majority of cases can be treated with topical antifungal agents, some cases require prescription oral antifungal medication along with topical aids.  As with any prescription, compliance is very important.  Adhering to treatment regimens exactly as they have been prescribed could make a difference in whether this condition completely resolves and/or you experience any adverse side effects.  Common examples of treatment regimens used to treat Malassezia folliculitis include, but are not limited to:

 

Itraconazole (Sporanox) 200 mg for 5-7 days
• Fluconazole 100-200 mg a day for 1-2 weeks
• Itraconazole (Sporanox) 200mg once a day for 7 days and Clotrimazole Lotion or Econazole Cream
• Itraconazole (Sporanox) 200mg for 5 days and Ketoconazole Shampoo

 

Alternative therapies have also been considered in treating Malassezia folliculitis.  For example, some promise has been shown in the use of photodynamic therapy.  Likewise, research shows light-emitting diode (LED) irradiation may also have an antifungal effect on Malassezia species.

Treatment and regimen will often depend on a variety of factors including personal preference, access to medication, and cost.

Malassezia Folliculitis Risk Factors

 

How did you get folliculitis

 

Remember, under normal conditions, Malassezia yeasts live on healthy skin and do not pose a problem.  However, there are risk factors that can cause these yeasts to overgrow.

 

The blockage of hair follicles, an increase in temperature, sweating, and having oily skin are some of the factors that could cause or aggravate a flare.

 

Diabetes, chemotherapeutic agents, corticosteroids, antibiotics, oral contraceptives, and bone marrow transplantation may also increase risk for Malassezia folliculitis.

 

It is also common for this skin condition to occur in those with a suppressed or compromised immune system.  On the contrary, one study discovered Malassezia folliculitis in a healthy immunocompetent individual, as well.

 

Still, some of these risk factors allow for Malassezia yeasts to thrive, ultimately, causing folliculitis to occur.  Thoroughly understanding these risks will not only help in resolving this condition, but will also minimize the possibility of it returning, and/or reduce further aggravation to an existing condition.

 

Let’s discuss the risk factors for Malassezia folliculitis in greater detail.

 

Risk Factor #1: Blocked hair follicles

 

Folliculitis and blocked hair follicles

Interestingly enough, Malassezia yeasts may not be the only agent responsible for invading and infecting hair follicles.  Some test results have shown hair follicles impacted by keratinous material, debris, oil, sebum, and mucin.  In fact, follicular occlusion or blocked follicles are often thought of as the primary issue followed by an overgrowth of Malassezia as the secondary issue.  This problem can be further compounded if the pores of those hair follicles are also blocked.

 

Prevention: The blockage of hair follicles and pores can be remedied to an extent.  Eliminate or reduce the amount of greasy hair styling products and thick cosmetics used.  Be wary of the accumulation of dead skin cells, as well.  Thoroughly and regularly washing skin twice a day with gentle and effective cleansers could also help reduce or prevent blockages of pores and follicles.

 

Risk Factor #2: Oily/Greasy/Sebum-Rich Skin

Folliculitis and Greasy Oily Skin

Researchers discovered in order for Malassezia to grow, lipids are required.  In fact, the same lipids found on normal human scalps are often sufficient to meet those same lipid requirements of Malassezia yeasts.  High levels of sebum and greasy skin are main culprits when dealing with an overgrowth of Malassezia yeasts.  Sebum is the skin’s natural, protective oil produced by the sebaceous glands.  Sebaceous glands are found all over the body except on the palms of hands and the soles of the feet.  Not surprisingly, Malassezia folliculitis tends to affect those areas where there is an increased activity of sebaceous glands.  The chest, back and head regions are some of the most sebaceous-rich areas of the skin.  When too much sebum is produced by the sebaceous glands, the pores on the skin surface can become blocked.

 

Prevention: The amount of sebum and oil you experience has a lot to do with genetics and your hormones.  Twice a day thoroughly wash the skin with gentle and effective cleansers to reduce oil, grease, and sebum found on the surface of the skin.  Reducing the amount of oil or greasy products topically applied to the skin or scalp can also improve conditions.  Instead, opt for oil-free products to reduce the sources of nutrients for Malassezia yeasts.

 

Risk Factor #3: Hot/Humid Environments & Increased Sweating

Folliculitis and hot and humid and sweating

Malassezia folliculitis has been found in more than half of acne patients in the Philippines which experiences a tropical climate year-round. The increased sweating that often comes with a hot/humid environment is a major risk factor. Similarly, those who experience increased sweating are also more prone to this condition.

 

Prevention: Keep cool! Try as much as possible to reduce the time spent in warm and humid environments (i.e. sunbathing, saunas, steam baths, etc.).  Fans, air conditioners, lukewarm or cool showers, and breathable clothing are all must-haves, and especially in warmer environments.

 

Risk Factor #4: Those with Suppressed or Compromised Immune Systems

Folliculitis and compromised immune system

Those with suppressed or compromised immune systems may have a reduced ability to fight off illness and, therefore, may be more susceptible to a skin condition such as Malassezia folliculitis.

 

Prevention: Boosting the immune system naturally by eating plenty of colorful fruits and vegetables is one way to jump start your body’s immunity.  Taking a daily multivitamin is another way to help ensure your body is receiving all the essential vitamins and minerals it needs on a daily basis.  Probiotics also help as they work to balance out both the good and bad bacteria in the body.  If you are not sure if your immune system is low or needs boosting, consuming healthy foods and taking multivitamins and probiotics can help ensure your body is always running in optimal condition.

 

Risk Factor #5: Those Who Take Oral Contraceptives, Corticosteroids, and Antibiotics

 

Folliculitis and oral contraceptives and medication

Individuals who currently take or recently stopped taking oral contraceptives may be at risk for Malassezia folliculitis.  Likewise, those on or recently off corticosteroid medication and antibiotics are also at risk.

 

Prevention: If you have folliculitis and are currently taking oral contraceptives, steroids or antibiotics, it is always best that you speak with your doctor regarding any concerns and before discontinuing any medication.

Managing these common predisposing risk factors could be your first break in getting rid of Malassezia folliculitis.  If possible, rectify any risk factors you might have to shorten the recovery time and reduce the chances of recurrence.

While new information is always emerging, there is still a lot that is unknown about Malassezia folliculitis.  But, one thing is for certain: Malassezia folliculitis has recently been receiving more attention and that, my friend, is a good thing.

Important Points About Malassezia Folliculitis

 

Ok, let’s go over things really quickly. Malassezia yeasts are harmless yeasts that live on skin.  In some instances, overgrowth can cause Malassezia folliculitis.  This occasionally itchy skin condition, which consists of papules and pustules, is frequently mistaken for acne.  Ironically, however, this condition is often underdiagnosed in those with acne, as well.  In other words, it is possible to have both acne and Malassezia folliculitis at the same time.

 

Visually assessing the skin may not be enough to determine whether, in fact, Malassezia folliculitis is present.  However, diagnosing this condition can be as easy as visiting a doctor’s office.  Microscopic examination, a potassium hydroxide preparation, or a skin biopsy are various techniques and procedures used to diagnose Malassezia folliculitis.  Often times, however, Malassezia folliculitis isn’t suspected until a topical antifungal treatment successfully resolves a persistent rash.

 

With that being said, depending on the severity and extent, topical antifungal treatment may help in treating Malassezia folliculitis.  There are widely available topical antifungal shampoos, lotions, and creams with active ingredients that can help treat this skin condition.  For instance, ketoconazole, has been shown to be a promising option, and products containing pyrithione-zinc and selenium sulfide have also shown success.  Treatment regimens consisting of topical and oral antifungal drugs have also been helpful. Unfortunately, however, even after treatment, recurrence is still a possibility.

 

Recovery time can be lengthened and symptoms can reappear or worsen depending on a variety of risk factors.  These risk factors include blockage of pores and hair follicles, increased sweating, and time spent in hot or humid environments.  Those individuals with compromised immune systems, who take oral contraceptives, corticosteroids, or antibiotics are also at risk.  These factors can increase the chances of Malasezzia folliculitis, further aggravate it, or affect its ability to completely resolve.

 

It is best to eliminate or reduce any greasy or thick cosmetics or styling aids that could potentially block pores and follicles, and thoroughly cleanse skin twice a day.  Keep your body cool, boost your immune system, and talk with your doctor concerning any prescriptions you are currently taking.

Frequently Asked Questions About Malassezia Folliculitis

 

I think I have Malassezia folliculitis. Should I see a doctor?

A more comprehensive treatment plan is often needed to resolve resistant, persistent or severe cases.  Doctors can prescribe certain medications after performing the appropriate procedures and examinations to determine the proper course of treatment specific to the severity and extent of the condition.  In many instances, however, this condition can also be resolved right at home through the use of over-the-counter topical antifungal agents.

 

How do I know if I have Malassezia folliculitis?

Often times, Malassezia folliculitis is only suspected after symptoms improve following antifungal treatment.  Malassezia folliculitis may also worsen, be unresponsive, or partially responsive to traditional acne treatment.  However, a doctor or health care provider can perform various tests and procedures to definitely confirm Malassezia folliculitis.

 

I don’t experience an itchy sensation.  Can this still be Malassezia folliculitis?

While an itchy sensation at the site of infection can be an accompanying symptom, it is not always the case.

 

Can I have Malassezia folliculitis and acne at the same time?

It is not uncommon for Malassezia folliculitis to be present in patients who also have acne, but this is not always the case.

 

If I have Malassezia folliculitis and acne, which should I treat first?

It is best to treat Malassezia folliculitis before treating acne.  Once the folliculitis has cleared, any residual acne can be treated.  If antibiotics are needed to resolve the acne, it would not aggravate an existing folliculitis condition.  Although, be wary, it may cause Malassezia folliculitis to flare.

 

Is Malassezia folliculitis contagious?

Malassezia folliculitis can be persistent, but it is not infectious.

 

What are the treatment options for Malassezia folliculitis?

There are various treatment options for Malassezia folliculitis listed in the ‘Malassezia Folliculitis Treatment Options’ section of this post or check out this detailed post.

 

 

Be honest. Did you just scroll to the end of this post? I’m not mad at you. 

 

Last updated: April 4, 2019

 

 

 

 

References:

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