From the Research
Pityrosporum folliculitis is a fungal skin infection caused by an overgrowth of Malassezia yeast, characterized by pruritic papules and pustules on the upper body and face, and is often mistaken for acne vulgaris. The condition is typically triggered by factors such as heat, humidity, sweating, occlusive clothing, immunosuppression, or antibiotic use that disrupts the skin's normal microbial balance 1.
Clinical Characteristics
The clinical characteristics of Pityrosporum folliculitis include:
- Pruritic follicular papules and pustules located primarily on the upper trunk, neck, and upper arms
- Small, uniform, itchy pink or red bumps and pustules typically on the upper back, chest, shoulders, and sometimes face
- Majority of patients are young males with an average age of presentation of 24.26 years 1
- Pruritus is reported by the majority of patients (71.7%) 1
Treatment
Treatment typically involves topical antifungal medications like ketoconazole 2% cream or shampoo applied to affected areas daily for 2-4 weeks, with oral antifungal medications such as fluconazole or itraconazole reserved for more widespread or resistant cases. According to a recent study, treatment was most successful with an oral antifungal (92%), followed by a topical antifungal (81.6%) 1.
Prevention of Recurrence
To prevent recurrence, it is recommended to use antifungal shampoo containing ketoconazole, selenium sulfide, or pyrithione zinc as a body wash 1-2 times weekly, especially in hot, humid weather. Additionally, avoiding tight clothing, excessive sweating without showering, and oil-based skin products that can feed the yeast can help prevent recurrence 2, 3.
Diagnosis
Diagnosis of Pityrosporum folliculitis can be confirmed by routine histology with haemotoxylineosin staining and Periodic acid-Schiff staining, as well as scrapings of the lesions mounted in KOH/Parker blue ink and examined under the microscope 2. However, biopsy is usually not necessary, and the diagnosis can be made based on clinical presentation and response to treatment 2.