From the FDA Drug Label
Ketoconazole Cream 2% is indicated for the topical treatment of ... in the treatment of tinea (pityriasis) versicolor caused by Malassezia furfur (Pityrosporum orbiculare); Microbiology: ... yeasts: ... Malassezia ovale (Pityrosporum ovale) and ... Malassezia furfur (Pityrosporum orbiculare).
Pityrosporum folliculitis treatment may involve the use of ketoconazole, as it is effective against Malassezia species, which are responsible for this condition.
- The mode of action of ketoconazole is the impairment of ergosterol synthesis, a vital component of fungal cell membranes.
- Ketoconazole has been shown to be effective in treating tinea versicolor, which is caused by Malassezia furfur (Pityrosporum orbiculare) 1, 1.
From the Research
Pityrosporum folliculitis is best treated with oral antifungal medications, with a success rate of 92%, as reported in the most recent study 2. The treatment of pityrosporum folliculitis involves targeting the Malassezia yeast that thrives in hair follicles, causing characteristic itchy, monomorphic papules and pustules typically seen on the upper back, chest, and shoulders. Some key points to consider in the treatment of pityrosporum folliculitis include:
- Oral antifungal medications, such as itraconazole (200mg daily for 1-2 weeks) or fluconazole (150mg once weekly for 2-4 weeks), are effective in treating the condition, with itraconazole showing a distinct and statistically significant improvement over placebo in a study 3.
- Topical antifungal medications, such as ketoconazole 2% shampoo, can be used in conjunction with oral antifungals, and should be applied to affected areas for 5-10 minutes daily, then rinsed off, for 2-4 weeks.
- Avoiding oils, heavy moisturizers, and occlusive skincare products, which can feed the yeast, is also important.
- Wearing loose-fitting, breathable clothing and showering promptly after sweating can help prevent the growth of Malassezia yeast.
- Maintenance therapy with weekly use of antifungal shampoo may be necessary to prevent recurrence, as reported in a study 4.
- If symptoms do not improve after 4 weeks of treatment, consulting a dermatologist to reconsider the diagnosis is recommended, as pityrosporum folliculitis can be mistaken for acne vulgaris, and may require a combination of antifungal and acne medications, as noted in a study 5. It is also worth noting that pityrosporum folliculitis can be associated with conditions that alter the normal cutaneous flora, such as immunosuppression and antibiotic use, and may persist for years without complete resolution with typical acne medications, as reported in a study 6.