The patient is a 21-year-old college athlete who presents for evaluation of dermatitis affecting his chest and back. The eruption began approximately 3 weeks ago during baseball season and worsened while he was receiving therapy with doxycycline. Due to increased pruritus, oral prednisone was added to his treatment regimen 1 week ago. Examination revealed multiple erythematous papules and occasional pustules of the affected areas.
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Pityrosporum or Malassezia folliculitis is a yeast infection characterized by an acneiform presentation. The condition may arise secondary to antibiotic use or ongoing immunosuppression. Due to its clinical similarity to acne, pityrosporum folliculitis may go unrecognized for months.1 Incidence is highest in adolescents, male individuals, and those living in warmer climates.2 It is important to differentiate yeast infection from bacterial folliculitis as antibiotic treatment can cause exacerbation of the disease. Pityrosporum folliculitis may also be seen in conjunction with seborrheic dermatitis and tinea versicolor as both are associated with colonization by the Malassezia species.3
Patients with pityrosporum folliculitis often present with pruritic follicular papules and pustules measuring 1mm to 2mm; these are most commonly found on the neck, back, chest, and extensor surfaces of the arms. The absence of comedones, presence of pruritic lesions, and failure to improve with use of oral and topical antibiotics may help distinguish this condition from acne.3
Diagnosis of pityrosporum folliculitis is usually based on clinical presentation. Potassium hydroxide preparation of skin scrapings may reveal budding yeasts. Clearing can be accomplished with oral and/or topical anti-yeast medications.4
Kevin Anderson is a physician assistant student at Arcadia University. Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.
- 1. Ljubojević S, Skerlev M, Lipozencić J, Basta-Juzbasić A. The role of Malassezia furfur in dermatology. Clin Dermatol. 2002;20:179-182.
- 2. Ayers K, Sweeney SM, Wiss K. Pityrosporum folliculitis: diagnosis and management in 6 female adolescents with acne vulgaris. Arch Pediatr Adolesc Med. 2005;159(1):64-67.
- 3. Rubenstein RM, Malerich SA. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. 2014;7(3):37-41.
- 4. Hald M, Arendrup MC, Svejgaard EL, Lindskov R, Foged EK, Saunte DM; Danish Society of Dermatology. Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases. Acta Derm Venereol. 2015;95(1):12-19.