Abstract

Malassezia (Pityrosporum) folliculitis is a fungiform condition normally misdiagnosed as acne vulgaris. Though often associated with common acne, this may persist for years without complete resolution with typical acne medications. Malassezia folliculitis results from overgrowth of yeast present in the normal cutaneous flora. The most common presentation is monomorphic papules and pustules, often on the chest, back, posterior arms, and face. Oral antifungals are the most effective treatment and result in rapid improvement. The association with acne vulgaris may require combinations of both antifungal and acne medications

Case 

A 15-year-old girl came with complaints of pimples on her face, which would not go away even after taking multiple treatments for the last three months. She did not report any itching or burning sensation over the lesions and the rest of her body, including the trunk, was not involved. On evaluation, she was found to have multiple erythematous papules with few pustules limited to the face involving both cheeks and sparing the skin around the nose, mouth, and over the forehead  

Small red papules noticed on the face with residual hyperpigmentation.

She was started on oral antibiotics, and a formulation containing topical tretinoin.

She was then started on topical antifungal lotion in addition to the therapy for acne vulgaris. One week later, she reported fractional improvement. She was asked to repeat the same for 2 weeks and topical antifungals were continued, and oral antibiotics discontinued. 

After completing the recommended treatment for two weeks, the girl reports significant improvement and resolution of nearly 90% of her skin lesions.

Conclusion

Malassezia folliculitis is a clinical condition that requires accurate timely diagnosis and management. This significantly reduce the patient discomfort and cost of treatment. The condition requires a high index of clinical suspicion on initial presentation, especially if there is intense itching and monomorphic skin lesions are present over the trunk, extremities, and face. Alternate clinical diagnoses should also be considered if inadequate clinical improvement or worsening of the disease occurs with a properly planned treatment regimen for acne. Administration of antifungal medications results in a dramatic improvement of the disease.

Suggested Reading

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