Treatment of Yeast Folliculitis
For yeast folliculitis (Malassezia folliculitis), oral itraconazole 100-200 mg daily is the most effective first-line treatment, though topical ketoconazole 2% cream is a safe and effective alternative for patients who prefer to avoid systemic therapy. 1
Treatment Approach
First-Line Systemic Therapy
- Oral itraconazole 100-200 mg daily until papules flatten (typically 14 days) is the preferred treatment for moderate to severe disease 1, 2
- This achieves clinical improvement in approximately 14 days on average 1
- All patients in clinical studies showed improvement with this regimen, with no adverse reactions reported 1
Alternative Topical Therapy
For patients preferring topical treatment or with mild disease:
- Ketoconazole 2% cream applied to affected areas until papules flatten (typically 27 days on average) 1
- This achieves equivalent clinical outcomes to oral therapy, though requires longer treatment duration 1
- Selenium sulfide shampoo applied to affected areas for 3-4 weeks is also effective 3
- Propylene glycol 50% in water applied twice daily for 2-3 weeks is another validated option 4, 3
Clinical Considerations
Typical Presentation
- Monomorphic follicular papules and pustules, often pruritic 3, 2
- Most commonly affects upper trunk (chest in 60% of cases), upper arms, and face 1, 3
- Predominantly affects young to middle-aged adults, with female predominance 3
Diagnostic Confirmation
- Direct microscopy should reveal 10 or more yeast-like fungi per follicle to confirm diagnosis 1
- Round budding yeast cells and occasionally hyphae are characteristic findings 3
Important Pitfalls
- This condition is commonly misdiagnosed as acne vulgaris and may persist for years if treated only with acne medications 2
- Predisposing factors include occlusion, greasy skin, immunosuppression, and antibiotic use 4, 3, 2
- Intermittent maintenance therapy is often necessary as symptoms and lesions frequently recur after treatment discontinuation 3
- When yeast folliculitis coexists with acne vulgaris, combination therapy with both antifungal and acne medications may be required 2