Your skin is home to many yeasts that coexist peacefully with you. One of these is pityrosporum, a yeast that could be the reason your acne doesn’t go away. If your acne treatments, such as medicines or other remedies, aren’t working, talk to your doctor about getting tested for pityrosporum folliculitis.
Pityrosporum is responsible for fungal acne, a kind of acne that shows up as pinhead-sized pimples on your upper chest or upper back. Although commonly mistaken for acne vulgaris (the acne caused by excess skin oil), fungal acne is different and can be worsened by normal acne treatments.
“I’ve seen people attempt acne medications for months with no result, because it wasn’t acne,” says David Johnson, MD, a board-certified dermatologist based in Texas and co-founder of RedliteX, a company that makes red light therapy devices for home use. “When I put them on antifungal medication, it cleared up fast.”
What Causes Pityrosporum (Malassezia) Folliculitis?
Pityrosporum folliculitis, also called malassezia folliculitis, is caused by a yeast called pityrosporum or malassezia. Pityrosporum is found on everyone’s skin. It forms part of the skin flora, also known as the microbiome, and it’s completely normal.
However, when it gets down into the hair follicles and multiplies, it can cause an itchy, acne-like eruption, called folliculitis. It’s important to note that folliculitis is not contagious, infectious, or an indicator of poor skin hygiene.
Since yeast grows in warm, moist environments, it tends to multiply in conditions that have plenty of humidity, sweating, and heat. People who have systemic diseases like diabetes are also at risk.
Risk factors include:
- Adolescence
- Immunosuppression (a weakened immune system)
- Diabetes
- Steroid or antibiotic use
- Excessive sweating
- Being male
What Are the Symptoms of Pityrosporum (Malassezia) Folliculitis?
Although it affects people of all sexes, young and middle-aged males are more at risk of fungal acne than other people. Breakouts show up as small, red bumps that appear to rise uniformly from your hair follicles — often in even rows on the forehead or scattered on the cheeks. It can also develop on your upper back or upper chest.
In acute cases, fungal acne appears as 1 millimeter-wide papulopustules, pustules, or vesicles. In persistent cases, the outer layer of the skin tends to thicken. Hot, humid weather and sweating can worsen fungal acne.
“It looks like acne but isn’t,” Johnson notes.
How Is Pityrosporum (Malassezia) Folliculitis Diagnosed?
You should have your acne checked by a doctor or dermatologist. A misdiagnosis may lead to pityrosporum folliculitis that persists for years.
Your doctor may be able to diagnose fungal acne by its appearance or the failure of medications used to treat acne, or they may be able to see the yeast within your hair follicles upon examination. Your dermatologist may perform several other tests, such as:
- Tape stripping
- Skin scraping
- Swabs
- Contact plates
- Direct microscopy
- Dermoscopy
Your doctor may use potassium hydroxide with some skin scrapings to see if there are any budding yeasts.
How Do You Treat Pityrosporum (Malassezia) Folliculitis?
To treat the condition, your doctor will typically prescribe oral antifungal medication. Sometimes, topical antifungal medicines may be used instead. If there is any inflammation, you may be advised to add anti-inflammatory therapy as a supplement.
You may also use medicated shampoo if the fungal acne is on the hairline or scalp. If your folliculitis is being caused by immunosuppression from a different condition, your treatment regimen for the other condition will help ease symptoms of fungal acne.
For any treatment to work, it must deal with the yeast in the follicles and any factors that led to folliculitis in the first place. Remember that the condition may return even after you’ve been treated successfully.
As a preventive measure, always keep your skin clean, especially the affected area. Do not use any skin products that can irritate the acne before it is fully healed.
Some forms of folliculitis can go away after using home remedies, so talk to your doctor or dermatologist to weigh your options. You might, for example, ease the itchiness that comes with fungal acne by soaking a towel in warm water, wringing out the excess, and placing the warm towel on the affected area.
If you want to give DIY a shot, “try ketoconazole or selenium sulfide shampoo as an antifungal,” and use it on your body as well as your hair, Johnson says. “But if it spreads or keeps coming back, it’s off to the dermatologist. I treat it with oral antifungal medications. They work fast and get at the root of the problem.”
When Should You See a Doctor About Pityrosporum (Malassezia) Folliculitis?
If you think you have acne but the treatments you try don’t work, see your doctor to check if you have a fungal infection.
How Is Pityrosporum (Malassezia) Folliculitis Different From Acne?
Pityrosporum (malassezia) folliculitis is caused by yeast, not bacteria. “The yeast resides in the hair follicles and, if it overgrows, forms itchy little lumps,” says Johnson. “Acne usually contains blackheads, whiteheads, and is caused by oil and bacteria.”
Can You Prevent Pityrosporum (Malassezia) Folliculitis?
You can try to stave off a fungal infection by trying to keep your skin from getting too hot, moist, or sweaty. For example:
- Wear breathable clothing.
- Keep your skin clean.
- Don’t use greasy skincare products.
- Opt for “dry touch” or nonoily sunscreens.
Takeaways
Pityrosporum (malassezia) folliculitis is a fungal infection that happens when your body makes too much of a type of yeast called pityrosporum. It’s common for people who sweat a lot, live in hotter climates, or have other risk factors. Because it can look like acne, many people try to treat it as such. See a doctor if acne treatments are not working or worsening the condition.
Pityrosporum (Malassezia) Folliculitis FAQs
What is pityrosporum (malassezia) folliculitis, and how is it different from acne?
It’s caused by a type of yeast called pityrosporum, aka malassezia. It’s normal to have it on your skin, but too much of it can build up and get in your body hair follicles. This can cause small red bumps that might look like acne. Acne is a different skin condition and is caused by bacteria and oils.
What causes pityrosporum (malassezia) folliculitis to flare up?
Sweating, heat, tight-fitting clothing, and oily skin can all play a role. “It’s common in individuals with very strenuous exercise programs or those in warm climates,” Johnson says. Other risk factors include being an adolescent or having diabetes.
Can pityrosporum (malassezia) folliculitis be prevented or cured permanently?
Since it’s normal to have this type of yeast on your skin, you mainly want to keep its growth in check. Keeping your skin clean and avoiding greasy skin products are two good ways.
