What Does Pityrosporum Folliculitis Look Like?

Pityrosporum folliculitis—also known as fungal acne or Malassezia folliculitis—is an inflammatory skin disease affecting your face, trunk, and neck. Though it looks like acne vulgaris (common acne), this condition is linked to a yeast called Malassezia or Pityrosporum. This yeast lives naturally on your skin.

This article describes Pityrosporum folliculitis symptoms, growth, and treatment.

How Do You Recognize Pityrosporum Folliculitis?

Symptoms of Pityrosporum folliculitis are similar to the effects of traditional acne. As a result, it is often confused with and misdiagnosed as acne. However, unlike acne, Pityrosporum folliculitis causes itchy lesions in 80% of cases.

The following symptoms also define this type of yeast:

• Small, uniform red bumps emerging from hair follicles
• Symmetric rows of bumps commonly found in the following locations: forehead, chin, cheeks (Malasezzia face), back, elbows, chest, neck, scalp (Malassezia scalp)
• Itchiness but no pain at the site of the bumps
• Absence of blackheads and whiteheads, pustules (pus-filled blisters), painful nodules (bumps deep within the skin), or cysts (a saclike pocket of tissue that contains fluid pus or air) commonly found in traditional acne
• Persistent bumps that worsen with sweating and flare in hot and humid temperatures

The diagnosis of Pityrosporum folliculitis can also be complicated because it can occur at the same time as traditional acne and the following skin conditions:

• Seborrheic dermatitis
• Atopic dermatitis (a form of eczema)
• Psoriasis
• Confluent and reticulated papillomatosis
• Onychomycosis (toenail fungus)
• Transient acantholytic dermatosis
• Tinea versicolor 
  

How Does Pityrosporum Yeast Turn Into Folliculitis?

Pityrosporurm yeast is a normal inhabitant of your skin within the hair follicles. This makes it different from the yeast that causes an infection like thrush (a yeast infection in your mouth) or vaginal candidiasis (a vaginal yeast infection.

Pityrosporum yeast turns into folliculitis when Pityrosporum yeast overgrows and clogs hair follicles. While it's not known exactly why this overgrowth happens, research indicates that certain factors may contribute to the formation of fungal folliculitis.

Taking systemic antibiotics can increase your risk for Pityrosporum folliculitis because these medications kill normal skin-inhabiting bacteria that compete with skin-inhabiting yeast for space on your skin. When antibiotics suppress bacteria, it creates the perfect environment for Pityrosporum to flourish and overgrow.

Other factors can also support the yeast overgrowth type leading to Pityrosporum folliculitis. Having one of the following characteristics can increase your risk of this condition forming:

• Persistent sweating due to hot, humid, sweaty environments or clothing that doesn't breathe
• Use of greasy sunscreens and oily emollients like coconut oil
• Diabetes
• Human immunodeficiency virus (HIV)
• Treatment with prednisone (a corticosteroid) or other immunosuppressant drugs
• Being overweight, which can result in wearing tight clothing and sweating more
• Stress or fatigue
  

When to See a Dermatologist for Pityrosporum Folliculitis

It can be difficult to identify Pityrosporum folliculitis on your own. Consult with a dermatologist (a medical doctor who specializes in treating conditions of the skin, hair, and nails) if you have any of the following symptoms that may indicate a case of Pityrosporum folliculitis:

• Itchy but painless acne
• Episodes of itchiness at the affected sites after sweating during exercise or taking a hot shower
• Skin that shows a hive-like reaction with a surrounding red flare after being scratched
• Persistent acne that does not improve with traditional acne treatments
• Acne-like breakouts that worsen with sweating
• Breakouts that flare in hot and humid temperatures

A dermatologist can accurately diagnose Pityrosporum folliculitis so you can begin the right treatment. A skin scraping for yeast may be used to confirm the diagnosis.

Pityrosporum Folliculitis Treatment

Pityrosporum folliculitis treatment must be directed at the overgrowth of yeast as well as any predisposing factors to prevent the problem from recurring. Since it can be hard to know all the factors that make you susceptible to Pityrosporum folliculitis, it is common for the problem to recur after you finish a course of treatment.

Treatment for Pityrosporum folliculitis can involve oral and topical treatments, home remedies, and lifestyle changes.

Oral Treatment

Oral treatment is regarded as the most effective option for Pityrosporum folliculitis. It works by directly killing or preventing the growth of fungal cells. This can be especially effective when symptoms begin since the yeast starts forming deep within the hair follicle, which can be difficult for topicals to reach. A drastic improvement in symptoms usually occurs with the use of antifungal medication.

The most commonly used oral treatments are the following prescription oral antifungal medications:

• Sporanox (itraconazole)
• Nizoral (ketoconazole)

The length of treatment varies based on the extent of symptoms and how you respond to medication. Oral treatment is usually prescribed daily for one to three weeks.

For severe cases of Pityrosporum folliculitis, treatment with oral Accutane (isotretinoin) may be appropriate.

Topical Treatments

Topical antifungal medication may be appropriate for mild cases of Pityrosporum folliculitis. These treatments can provide an effective option for people who can't take oral antifungals due to side effects or other medication problems.

Topical treatments can be used in combination with oral treatment. They can also be used to maintain results and prevent recurrence, which is common.

Common topical treatments include the following treatments:

• Nizoral (shampoo with ketoconazole) or Selsun (selenium sulfide) ( anti-dandruff shampoos applied for 10 minutes and washed off in the shower once a week
• 50% propylene glycol in water applied twice daily with a gauze pad for three weeks, then twice a week
• Lamisil (terbinafine) solution sprayed on the skin surface for 14 days then weekly
• Application of Loprox (ciclopirox) gel or Nizoral (ketoconazole) cream twice daily for two to three weeks

Topical antifungals and shampoos are often important to maintenance therapy. After the initial treatment, therapy usually continues two to three times weekly for one to two months.

Home Remedies

The following home remedies can help relieve symptoms of itching and inflammation in pityrosporum folliculitis:

• Apply warm compresses on the affected areas three to four times daily
• Leave the compress on your skin for 15 to 20 minutes during each session

The following natural ingredients can be used to make a paste to relieve symptoms of pityrosporum folliculitis:

• Aloe vera
• Apple cider vinegar
• Coconut oil
  
• Garlic
• Honey
• Lemongrass oil
  
• Neem leaves
• Tea tree oil
• Turmeric
  

Lifestyle Changes

You may help reduce symptoms and the risk of Pityrosporum folliculitis recurrence by making lifestyle changes. Since the condition often recurs, you can reduce your risk of having chronic Pityrosporum folliculitis by changing diet and other factors.

Change your diet to decrease the intake of foods that promote yeast growth:

• Reduce your intake of white flour and refined sugar.
• Increase your intake of whole foods like fruits, vegetables, grains, and lean meats.

Change factors that could be contributing to the cause of damage, such as the following:

• Lose weight.
• Wear loose clothing.
• Discontinue oily topical products such as make-up, lotion, or sunscreen.
• Avoid circumstances in which you sweat.
• Change out of your clothes and shower immediately after working out.
• Don't shave, pluck, or wax the affected areas for at least 30 days during treatment.
  

Reducing Pityrosporum Folliculitis Symptoms on Antibiotics

Treating Pityrosporum folliculitis with acne treatments, especially antibacterial medications, will not improve your condition. These treatments may even worsen your condition by killing bacteria and allowing the yeast to flourish.

If you are taking Pityrosporum folliculitis with some form of antibiotics, discontinuation of antibiotics may result in improvement of the folliculitis without treatment. However, you may need to use antibiotics for another reason while you have Pityrosporum folliculitis.

Research indicates that taking probiotics alongside antibiotics can lessen or prevent some antibiotic-induced side effects. Probiotics may help to preserve the diversity and composition of the bacteria. They may even help protect some "friendly" bacteria that reduce inflammation.

Summary

Pityrosporum folliculitis is a skin disease that occurs when yeast in your hair follicle overgrows. Though often confused with common acne, this disease is set apart from acne and other problems because it causes itching.

This problem causes pimples on your forehead, cheeks, trunk, and neck. It can't be treated with common acne treatments. Instead, these treatments may support the spread of this disease rather than heal it.

Oral or topical anti-fungal drugs provide the best results. Treatment often continues after the problem clears to avoid recurrence. Making lifestyle changes can help promote healing and lower your risk of having the problem return after symptoms clear.