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 traditional 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!


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 traditional 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 traditional acne.
  2. You could have Malassezia folliculitis.
  3. You could have both traditional 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 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.  However, one study discovered Malassezia folliculitis in a healthy immunocompetent individual, as well.


Nevertheless, some of the previously mentioned risk factors allow for Malassezia yeasts to thrive, ultimately, causing folliculitis.  Thoroughly understanding these risks will not only help to resolve this condition, but it will also minimize the possibility of it returning.


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 the 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.  See risk factor #1, again.


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 source 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 been receiving more and more attention.


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.


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 traditional 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.




Last updated: October 20, 2019






  1. Gaitanis,G., Magiatis, P. 2012. The Malassezia Genus in Skin and Systemic Diseases.
  2. Bäck O, Faergemann J, Hörnqvist R. 1985. Pityrosporum folliculitis: a common disease of the young and middle-aged. J. Am. Acad. Dermatol. 12:56 –61.
  3. Jacinto-Jamora S, Tamesis J, Katigbak ML. 1991. Pityrosporum folliculitis in the Philippines: diagnosis, prevalence, and management. J. Am. Acad. Dermatol. 24:693–696.
  4. Ayers K, Sweeney SM, Wiss K. 2005. Pityrosporum folliculitis: diagnosis and management in 6 female adolescents with acne vulgaris. Arch. Pediatr. Adolesc. Med. 15
  5. Jagielski T, Rup E, Ziółkowska A, Roeske K, Macura AB, Bielecki J. Distribution of Malassezia species on the skin of patients with atopic dermatitis, psoriasis, and healthy volunteers assessed by conventional and molecular identification methods. BMC Dermatology. 2014;14:3. doi:10.1186/1471-5945-14-3.
  6. Singapore Med J 2018, 1–3 Published ahead of print: 21 June 2018 Online version can be found at Malassezia: a case of coexisting pityriasis versicolor and Malassezia folliculitis
  7. Pityrosporum folliculitis: A retrospective review of 110 cases Prindaville, Brea et al. Journal of the American Academy of Dermatology, Volume 78 , Issue 3 , 511 – 514
  1. Treatment Outcomes for Malassezia Folliculitis in the Dermatology Department of a University Hospital in Japan. 2016. Chikako Suzuki,  Midori Hase ,  Harunari Shimoyama ,  Yoshihiro Sei
  2. Kim SY, Lee YW, Choe YB, Ahn KJ. Progress in Malassezia Research in Korea. Annals of Dermatology. 2015;27(6):647-657. doi:10.5021/ad.2015.27.6.647.
  3. Harada, K., Saito, M., Sugita, T. and Tsuboi, R. (2015), Malassezias pecies and their associated skin diseases. J Dermatol, 42: 250-257. doi:10.1111/1346-8138.12700
  4. Skin Disease Book 4th Edition.
  5. Viana de Andrade A, Pithon M, Oiticica O. Pityrosporum folliculitis in an immunocompetent patient: clinical case description. Dermatology Online Journal[serial online]. August 15, 2013;19(8):19273. Available from: MEDLINE, Ipswich, MA. Accessed August 22, 2018.
  6. Virgili A, Zampino M, Mantovani L. Fungal skin infections in organ transplant recipients. American Journal Of Clinical Dermatology[serial online]. 2002;3(1):19-35. Available from: MEDLINE, Ipswich, MA. Accessed August 22, 2018.
  7. Kim YR, Kim J-H, Shin H-J, Choe YB, Ahn KJ, Lee YW. Clinical Evaluation of a New-Formula Shampoo for Scalp Seborrheic Dermatitis Containing Extract of Rosa centifolia Petals and Epigallocatechin Gallate: A Randomized, Double-Blind, Controlled Study. Annals of Dermatology. 2014;26(6):733-738. doi:10.5021/ad.2014.26.6.733.
  8. Ashbee HR, Evans EGV. Immunology of Diseases Associated with Malassezia Species. Clinical Microbiology Reviews. 2002;15(1):21-57. doi:10.1128/CMR.15.1.21-57.2002.
  9. Sentamilselvi G, Janaki C, Murugusundram S. Trichomycoses. International Journal of Trichology. 2009;1(2):100-107. doi:10.4103/0974-7753.58552.
  10. Ko JH, Lee YW, Choe YB, Ahn KJ. Epidemiologic Study of Malassezia Yeasts in Patients with Malassezia Folliculitis by 26S rDNA PCR-RFLP Analysis. Annals of Dermatology. 2011;23(2):177-184. doi:10.5021/ad.2011.23.2.177.
  11. Encyclopedia of Health, Fourth Edition. Volume 15. 2010. New York. Marshall Cavendish Corporation.

Summer 2018 Skin Care Routine


The dog days of summer are finally here and I wanted to share exactly what I’ve been using to continue keeping Pityrosporum folliculitis at bay during these hot and sweaty months.

And, for those of you who are cost-conscious, don’t fret! I tend to keep things pretty conservative when it comes to my skin and my wallet.

So, here is my Summer 2018 Skin Care Routine:


Skin Care Routine (Mornings)


In the mornings, depending on personal preference and how my skin looks, I either:

My final rinse is always with cool water.  Then, I pat my skin dry with a clean towel.

And, viola!  That’s it!  I like to go au-natural as much as I can so I skip the makeup during most summer days.



Skin Care Routine (Evenings)

In the evenings, again, depending on personal preference and how my skin looks, I either:

My final rinse is always with cool water.  Then, I pat my skin dry with a clean towel.

I rinse my face a few more times with cool water and pat my skin dry with a clean towel.

For my evening moisturizer, I either use:



Skin Care Routine (Evenings) – After Wearing Makeup

  • I used to slather either Cerave or any old moisturizer I had lying around to remove my makeup, but nowadays Mario Badescu’s Enzyme Cleansing Gel works not only as a great cleanser, but also an excellent makeup remover.  My skin never feels stripped or dry afterwards and it does a pretty good job at removing makeup, including mascara!
  • After rinsing, often times I follow up with an exfoliant like Burt’s Bees Deep Pore Scrub.

I rinse my face a few times with cool water and pat my skin dry with a clean towel.

For my moisturizer, I either use:



If you’ve read how to prepare for summer if you have Pityrosporum folliculitis then you can understand how apprehensive I was about introducing a sunscreen AND an oil into my regimen!  Just thinking about it makes me really nervous.  But, it’s been a few months and so far, so good.  In fact, I haven’t had any bouts of PF in almost a year!  I do, occasionally, get blemishes and pimples, but no more than one or two at a time.  Still, diligence during these months makes for a worthwhile payoff year round.


So, that’s it!  These five products last all summer long and maybe even into the Fall if I’m not too heavy-handed!



Pityrosporum Folliculitis Summer Skin Care Routine

Oh, hi there big, beautiful dark circles of mine – July 2018.



*If you’re interested in trying a similar routine and are currently experiencing a bout of PF, skip the argan oil and the Yes to Carrots Moisturizer SP15.  Instead, opt for something much lighter and safer like Cerave Daily Moisturizing Lotion.  This and several of my all-time favorite Pityrosporum folliculitis products can be read about right here!




What’s your routine?  Share below how you keep your skin bump-free during the summer months!


Using Nizoral Shampoo to Treat Pityrosporum Folliculitis



Let’s just go ahead and address the biggest elephant in the room, shall we?!  The thought of using shampoo on anything other than your hair is ridiculous, right?  Well, hear me out…


Discovering Nizoral Shampoo


I first heard about using Nizoral Shampoo for Pityrosporum folliculitis while surfing through an online forum several years ago.  That’s right – shampoo for your hair or your skin!  I couldn’t believe it really, but that didn’t stop me from heading to my local grocery store to grab a bottle of the shampoo.  What stopped me was the fact that I couldn’t find it so I moved on.

Fast forward yet another year and I was still looking online for a solution to the itchy bumps on my forehead that wouldn’t go away.  While visiting multiple websites, Nizoral Shampoo resurfaced yet again in the discussion.  Many said this particular shampoo quickly treated those acne-like bumps.  So I ventured out again and this time I found it!  And that, my friend, is when everything changed.

After a couple of years of trying to get rid of those tiny bumps on my forehead, they were gone within days of using Nizoral Shampoo. Just like that – gone!  I was speechless.

Now I should say I had already started making progress with my skin prior to using Nizoral.  With a consistent skin care regimen, my forehead was beginning to show signs of progress in comparison to previous years.  But, I’ll also be the first to tell you, there was still room for improvement.  And that’s exactly what this product did – it improved things considerably.


Nizoral Shampoo for Pityrosporum Folliculitis:


Nizoral Shampoo

Here’s exactly how I used Nizoral Shampoo as a treatment for Pityrosporum Folliculitis:


Preparation: A day before I conducted a skin patch test in an inconspicuous area (i.e. the inside of the arm) to check for any adverse skin reactions.  Also, prior to using this product, I did not wash my face.  My skin was dry (not wet) and sans any product (no makeup, moisturizer, etc.). 

Duration: Morning and night for 10-15 minutes for 10 consecutive days.


 STEP 1 :

  I applied a thin layer of the shampoo directly onto my skin.

Nizoral Shampoo for Pityrosporum Folliculitis

Nizoral Shampoo for Pityrosporum Folliculitis

Nizoral Shampoo for Pityrosporum Folliculitis


STEP 2: 

After 10-15 minutes, I wet my fingertips and gently lathered the area.

Nizoral Shampoo for Pityrosporum Folliculitis

Nizoral Shampoo for Pityrosporum Folliculitis


STEP 3: 

I removed all traces of the product with water.

Nizoral Shampoo for Pityrosporum Folliculitis

Nizoral Shampoo for Pityrosporum Folliculitis

Nizoral Shampoo for Pityrosporum Folliculitis


STEP 4: 

I used a clean towel to gently pat dry.

Nizoral Shampoo for Pityrosporum Folliculitis

Nizoral Shampoo for Pityrosporum Folliculitis


*The images shown above are for demonstration purposes and do not show an actual rash or infection.  To see actual images of Malassezia (Pityrosporum) Folliculitis, please visit the Homepage.


So, I essentially used Nizoral Shampoo as a forehead mask for 10 days morning and night.  The remainder of my face (everything but my forehead), I washed with a facial cleanser.  No additional products were applied to my forehead afterwards.  In fact, at no point throughout those 10 days did I apply anything but Nizoral to my forehead.  Personally, I thought it was best if I allowed the product to work “its magic”, if you will, without any external influences like moisturizer or makeup.

By day two or three, I could clearly see a big difference in the texture of my skin.  Some of the bumps were either already gone or soon-to-be-gone.  And by the final day, my forehead wasn’t just clear, it was baby smooth!

I posted two videos on my YouTube channel and discussed how to get rid of forehead bumps with Nizoral Shampoo as well as how I used Nizoral Shampoo to treat Pityrosporum (Malassezia) Folliculitis.  By the way, my video How To Get Rid of Tiny Forehead Bumps, has reached nearly a million views!  In other words, you’re not alone.





Potential Side Effects

Some potential side effects of using Nizoral Shampoo on the skin include, but are not limited to, dryness, peeling, and redness at the site of application.  Reducing the amount used or the frequency in application could combat this.  Additionally, conducting a skin patch test in an inconspicuous area beforehand may help in determining other potential adverse reactions prior to using this product.

Why Nizoral Works

The active ingredient in Nizoral 1% Shampoo is ketoconazole.  I discuss ketoconazole in-depth in this blog post.  It’s actually really interesting and worth reading if you ask me.  But, in short, ketoconazole is commonly used to treat fungal infections of the skin.  You might be wondering what in the world is an antifungal agent doing in an anti-dandruff shampoo.  Well, one of the causes of dandruff is an overgrowth of a yeast-like fungus.  Sound familiar?  So ketoconazole works to treat the dandruff by targeting this yeast-like fungus.  And, interestingly enough, the fungus species responsible for dandruff is the same species responsible for Pityrosporum folliculitis and other skin-related conditions like seborrheic/atopic dermatitis, pityriasis versicolor and others.  So, that’s why Nizoral works – its key ingredient isn’t simply antidandruff, it’s also antifungal!

Prescription-Strength Nizoral

If you’ve received a prescription for Nizoral from your doctor, then chances are the Nizoral you’ve been prescribed contains 2% ketoconazole verses the over-the-counter 1% ketoconazole found in Nizoral 1% Shampoo.  It’s typically prescribed to treat tinea (pityriasis) versicolor and other fungal infections of the skin.

Nizoral Has Not Been Approved to Treat Pityrosporum Folliculitis  

It is important to mention Nizoral Shampoo is not FDA approved to treat Pityrosporum folliculitis.  Hence, it has neither been tested for the usage described above nor do the directions specify it should be used to treat anything other than dandruff. Please don’t rely solely on the information presented here and always read labels, warnings, and directions before using any product.  And, as always, be sure to talk with your doctor about any questions and concerns you might have.  And, again, before using a new product, a skin patch test is always a good idea prior to applying over a larger area of skin.

Contacting Johnson & Johnson

I reached out to the Consumer Care Center at Johnson & Johnson, the makers of Nizoral Shampoo, and informed them of my positive experience with using this product.  I’m not the first person nor am I the last person to use this product quite like this, so I wanted to share my experience.  After all, I consider Nizoral Shampoo to be a game-changer for Pityrosporum folliculitis!  Furthermore, if for some reason, it’s ever discontinued, we’re all screwed.  Royally.

Anyways, I ended up speaking with a representative several days after filling out an online form where I mentioned I’d love to see a similar product formulated specifically to treat or help treat Pityrosporum folliculitis.  I even inquired about any research and development opportunities. I’d be lying if I said I hadn’t done my own research into having a product like this formulated.  There’s no way my entrepreneur spirit would’ve allowed me to pass that up.  Aside from the clinical studies and so forth, there’s a lot involved to formulate a product containing a drug.  And, by “a lot involved,” I mean a lot of money. Like a lot, a lot.

In the end, I answered a lot of questions about my experience with the product and provided some demographic information that I’m assuming they’ll use for research.  No response from them regarding the R&D opportunities, though.  The love was not lost.  I just hope my feedback was helpful.

Was Nizoral a One-Time Use?

Unfortunately, the positive results I experienced did not last forever.  I had to dust out my secret weapon approximately two months later, which is why I always have a bottle on hand just in case.  I would imagine I’d need to use it a lot more frequently if my skin care regimen weren’t as solid as it is.  Check out my skin care regimen here to find out how I keep my skin clear and under control.

Did I get the same baby smooth results after every application of this product?  Yes!  No flukes here!  Still not convinced?  Don’t forget about all those YouTube comments from people all over the world who have had success, too!

And that’s it!  For other products that could possibly help in treating PF, check out these blog posts:  Treatment Options for Pityrosporum Folliculitis and My Favorite Products for Pityrosporum Folliculitis!



Have you ever used Nizoral Shampoo for Pityrosporum folliculitis? What were your results? Please share in the comments below!


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.



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.





  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.
  4. American Osteopathic College of Dermatology [Internet]. Kirksville (MO).; 2017. Pityrosporum Folliculitis; [ cited 2017 Feb 5]; [about 2 p.]. Available from:

The Video That Went Viral



When I created this YouTube video in 2016 I had no idea it would receive nearly as many views as it has.  A year later, this video has been viewed over half a million times and has approximately 700 comments, and growing.  On average, it receives anywhere from 30,000 to 65,000 views each month, and by far is the most watched video on my channel!  Whether it’s related to Pityrosporum folliculitis or not, it’s evident there are people all over the world who are dealing and searching for a solution to the small, persistent, and stubborn bumps like the ones I had.


While this video is only a small synopsis of Pityrosporum folliculitis, based upon the numerous comments I’ve received and the follow-up emails, this video may have offered people who are dealing with this condition a glimpse of hope.  In case you haven’t seen it, you can click the video to view it or you can read the transcript provided below.


*Please Note: In this video, I mention one treatment option and a few risk factors, however, there are several other treatment options and additional risk factors to consider.  Check out this comprehensive blog post What is Pityrosporum Folliculitis to learn more about them.



Hi guys, welcome back to my channel.  I wanted to talk about these tiny, annoying, pesky little bumps on your forehead.  You have tried salicylic acid.  You have tried benzoyl peroxide.  You have tried almost every single acne product on the market and they do not seem to work.  What is going on?


Pityrosporum folliculitis or Malassezia folliculitis is caused by proliferation of a yeast within the hair follicles.  What?  So, basically it is a yeast.  On the surface of the skin, it looks like it is acne except it isn’t.  One distinguishable difference between acne and this yeast is the itchiness it causes.  If the bumps you’re experiencing are accompanied by an occasional itch, chances are you may have this yeast present.  However, ironically, acne may be present, too; due to the fact that skin oiliness is one of the factors that can lead to this condition, and also, as you know, acne. More on that later.


Surprisingly, malassezia or pityrosporum can actually be found on the skin of most adults;  the thing is an over-proliferation of this yeast is usually what causes this acne-like breakout to occur, and like any yeast or fungus an over-proliferation occurs only when the conditions are ripe. Then things go crazy!


One more important point to make.  While the title of this video is tiny bumps on forehead, this condition can actually be present on the upper back, the chest, the shoulders, and the neck.  It can really be found in quite a few different place.  But I have found when we are talking about acne and when we are talking about skin care, a lot of people have mentioned this tiny bump-like eruption on the forehead.


How did you get Pityrosporum folliculitis?  Or how did you get malassezia folliculitis?  Going back to what I said earlier, it can occur from oily skin.  Other factors include obesity, stress, fatigue, or pregnancy.  Even a systemic illness that can cause a weakening in your immune system or taking certain broad spectrum antibiotics and medications can also be factors.


How can you tell if you have Pityrosporum folliculitis?  A clinical diagnosis can be determined by either visually observing the area or microscopically having a skin biopsy done.  Sounds intense, I know.


The good news is treatment is entirely way more straight-forward.  If you don’t have the time or, let’s face it, the money to go see a doctor, determining whether or not you have acne or a yeast present can be as simple as applying a topical treatment to treat yeast, and seeing if it works.


Nizoral AD Shampoo is a commonly used product used to treat this type of yeast.  Its active ingredient is Ketoconazole.  Ketoconazole is an anti-dandruff, anti-fungal agent.  Basically, it treats dandruff, it kills yeast and kills fungus.


Apply a thin layer of this product over the affected areas twice a day – morning and night – for ten days.  It is recommended that you leave it on the skin for ten to fifteen minutes before washing off.


If you notice a significant improvement after the ten day application, more than likely an over-growth of this yeast was present and the cause of the bumps you saw on your forehead.


If you notice mild improvement, both acne and an overgrowth of this yeast may have been present and may still be present.  After a ten day treatment of this product, try treating the remainder of the bumps you have with acne remedies and acne solutions to see if you notice a difference.


Lastly, if you did not notice any improvement, more than likely an overgrowth of this yeast is not present.  It could simply be acne that is causing the bumps on your forehead.


For more information on how to treat acne and acne skin care, please check out my other videos.  Please make sure you like, comment and subscribe and please let me know what other videos you would like to see in the future.  Talk to you guys later.  Bye.


*June 2017 Update: There are several other treatment options and risk factors for this condition.  Check out these blog posts What is Pityrosporum Folliculitis and Treatment Options for Pityrosporum Folliculitis to learn more!