Malassezia (Pityrosporum) Folliculitis Clinical Presentation

  • Author: Siobahn M Bower, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 23, 2012
 

History

  • The Pityrosporum folliculitis patient's history is that of a chronic, often extremely pruritic, papular and pustular eruption with perifollicular erythema most commonly on the back, upper arms, and chest.
  • The main differential diagnoses of Pityrosporum folliculitis are acne vulgaris and staphylococcal folliculitis. Often, patients have been treated with medication appropriate for acne vulgaris, resulting in no improvement or worsening of their condition.[10]
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Physical

  • Multiple, discrete, 2- to 4-mm erythematous monomorphic, papules and, later, pustules are observed.
  • Lesions have a definite follicular pattern.
  • Material expressed from pustules is white to yellow.
  • Pityrosporum folliculitis is present on body locations in which Malassezia organisms are most abundant: back and chest, neck, shoulders, scalp,[11] upper arms (occasional), and face (rare).
  • Under a Wood light, bright blue or white fluorescence is observed in clinically uninvolved follicles in the location of the lesions.
  • Pityrosporum folliculitis often is mistaken for acne vulgaris; however, no comedones or cysts are associated with Pityrosporum folliculitis.[12]
  • Many patients have coexisting seborrheic dermatitis.[7]
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Causes

Pityrosporum folliculitis is caused by Malassezia yeasts, which are lipophilic. Several factors can lead to changes in immunity, sebum production, and the growth of skin flora. These factors help to produce favorable conditions for growth of these yeasts.

  • Systemic diseases and pharmacologic agents that encourage the growth of yeast, possibly because of alterations in immunity, include the following:
    • Diabetes mellitus
    • Cushing disease
    • Hodgkin disease[13]
    • Cancer treated with cetuximab (IMC-C225; marketed under the name Erbitux), a chimeric (mouse/human) monoclonal antibody epidermal growth factor receptor (EGFR) inhibitor for the treatment of metastatic colorectal cancer and head and neck cancer[14]
    • HIV infection
    • Corticosteroids and/or immunosuppressant therapy following organ transplantation[15, 16, 17]
    • Crohn disease treated with infliximab a monoclonal antibody against tumor necrosis factor alpha.[18]
  • An increase in sebum production, such as that in pregnancy,[19, 20] and high levels of androgens may potentiate the development of Pityrosporum folliculitis.
  • Antibiotics can alter normal skin flora, allowing the yeast to proliferate.
  • Pityrosporum folliculitis more frequently occurs in environments of high heat and humidity.
  • Occlusion of the skin and hair follicles with cosmetics, lotions, sunscreens, emollients, olive oil, or clothing creates favorable conditions for Pityrosporum folliculitis.
  • Anticonvulsant therapy and Down syndrome[21] are other conditions that are associated with Pityrosporum folliculitis.
  • Other related and coexisting conditions may include the following:
    • Seborrheic dermatitis
    • Confluent and reticulated papillomatosis
    • Systemic candidiasis[22]
  • Some individuals seem to have an innate propensity for Pityrosporum folliculitis.
    • In one experiment, Malassezia yeasts were applied to occluded forearm skin in patients with Pityrosporum folliculitis. Flares of Pityrosporum folliculitis occurred at the application site.
    • In the same experiment, Pityrosporum folliculitis did not develop in patients with no prior diagnosis of the condition.
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Contributor Information and Disclosures
Author

Siobahn M Bower, MD  Internal Medicine Physician, Boys Town National Research Hospital

Siobahn M Bower, MD is a member of the following medical societies: American College of Physicians and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel J Hogan, MD  Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association

Disclosure: Nothing to disclose.

Stephen H Mason  MD

Stephen H Mason is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Society for Dermatologic Surgery, Skin Cancer Foundation, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Jean-Hilaire Saurat, MD  Chair, Professor, Department of Dermatology, University of Geneva, Switzerland

Jean-Hilaire Saurat, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, and previous author, Brittany J. Oswald, MD, to the development and writing of this article.

References

  1. Potter BS, Burgoon CF Jr, Johnson WC. Pityrosporum folliculitis. Report of seven cases and review of the Pityrosporum organism relative to cutaneous disease. Arch Dermatol. Mar 1973;107(3):388-91. [Medline].

  2. Levin NA. Beyond spaghetti and meatballs: skin diseases associated with the Malassezia yeasts. Dermatol Nurs. Jan-Feb 2009;21(1):7-13, 51; quiz 14. [Medline].

  3. Gaitanis G, Magiatis P, Hantschke M, Bassukas ID, Velegraki A. The malassezia genus in skin and systemic diseases. Clin Microbiol Rev. Jan 2012;25(1):106-41. [Medline].

  4. Akaza N, Akamatsu H, Sasaki Y, et al. Malassezia folliculitis is caused by cutaneous resident Malassezia species. Med Mycol. 2009;47(6):618-24. [Medline].

  5. Jacinto-Jamora S, Tamesis J, Katigbak ML. Pityrosporum folliculitis in the Philippines: diagnosis, prevalence, and management. J Am Acad Dermatol. May 1991;24(5 Pt 1):693-6. [Medline].

  6. Bulmer GS, Pu XM, Yi LX. Malassezia folliculitis in China. Mycopathologia. Jun 2008;165(6):411-2. [Medline].

  7. Gupta AK, Batra R, Bluhm R, Boekhout T, Dawson TL Jr. Skin diseases associated with Malassezia species. J Am Acad Dermatol. Nov 2004;51(5):785-98. [Medline].

  8. Back O, Faergemann J, Hornqvist R. Pityrosporum folliculitis: a common disease of the young and middle-aged. J Am Acad Dermatol. Jan 1985;12(1 Pt 1):56-61. [Medline].

  9. Archer-Dubon C, Icaza-Chivez ME, Orozco-Topete R, Reyes E, Baez-Martinez R, Ponce de Leon S. An epidemic outbreak of Malassezia folliculitis in three adult patients in an intensive care unit: a previously unrecognized nosocomial infection. Int J Dermatol. Jun 1999;38(6):453-6. [Medline].

  10. Levy A, Feuilhade de Chauvin M, Dubertret L, Morel P, Flageul B. [Malassezia folliculitis: characteristics and therapeutic response in 26 patients]. Ann Dermatol Venereol. Nov 2007;134(11):823-8. [Medline].

  11. Aytimur D, Sengöz V. Malassezia folliculitis on the scalp of a 12-year-old healthy child. J Dermatol. Nov 2004;31(11):936-8. [Medline].

  12. Ayers K, Sweeney SM, Wiss K. Pityrosporum folliculitis: diagnosis and management in 6 female adolescents with acne vulgaris. Arch Pediatr Adolesc Med. Jan 2005;159(1):64-7. [Medline].

  13. Helm KF, Lookingbill DP. Pityrosporum folliculitis and severe pruritus in two patients with Hodgkin's disease. Arch Dermatol. Mar 1993;129(3):380-1. [Medline].

  14. Cholongitas E, Pipili C, Ioannidou D. Malassezia folliculitis presented as acneiform eruption after cetuximab administration. J Drugs Dermatol. Mar 2009;8(3):274-5. [Medline].

  15. Alves EV, Martins JE, Ribeiro EB, Sotto MN. Pityrosporum folliculitis: renal transplantation case report. J Dermatol. Jan 2000;27(1):49-51. [Medline].

  16. Bufill JA, Lum LG, Caya JG, et al. Pityrosporum folliculitis after bone marrow transplantation. Clinical observations in five patients. Ann Intern Med. Apr 1988;108(4):560-3. [Medline].

  17. Blaes AH, Cavert WP, Morrison VA. Malassezia: is it a pulmonary pathogen in the stem cell transplant population?. Transpl Infect Dis. Aug 2009;11(4):313-7. [Medline].

  18. Nasir A, El Bahesh E, Whitten C, Lawson A, Udall JN Jr. Pityrosporum folliculitis in a Crohn's disease patient receiving infliximab. Inflamm Bowel Dis. Jan 2010;16(1):7-8. [Medline].

  19. Heymann WR, Wolf DJ. Malassezia (Pityrosporon) folliculitis occurring during pregnancy. Int J Dermatol. Jan-Feb 1986;25(1):49-51. [Medline].

  20. Parlak AH, Boran C, Topcuoglu MA. Pityrosporum folliculitis during pregnancy: a possible cause of pruritic folliculitis of pregnancy. J Am Acad Dermatol. Mar 2005;52(3 Pt 1):528-9. [Medline].

  21. Kavanagh GM, Leeming JP, Marshman GM, Reynolds NJ, Burton JL. Folliculitis in Down's syndrome. Br J Dermatol. Dec 1993;129(6):696-9. [Medline].

  22. Klotz SA, Drutz DJ, Huppert M, Johnson JE. Pityrosporum folliculitis. Its potential for confusion with skin lesions of systemic candidiasis. Arch Intern Med. Nov 1982;142(12):2126-9. [Medline].

  23. Yu HJ, Lee SK, Son SJ, Kim YS, Yang HY, Kim JH. Steroid acne vs. Pityrosporum folliculitis: the incidence of Pityrosporum ovale and the effect of antifungal drugs in steroid acne. Int J Dermatol. Oct 1998;37(10):772-7. [Medline].

  24. Shibata N, Saitoh T, Tadokoro Y, Okawa Y. The cell wall galactomannan antigen from Malassezia furfur and Malassezia pachydermatis contains beta-1,6-linked linear galactofuranosyl residues and its detection has diagnostic potential. Microbiology. Oct 2009;155:3420-9. [Medline].

  25. Faergemann J, Bergbrant IM, Dohse M, Scott A, Westgate G. Seborrhoeic dermatitis and Pityrosporum (Malassezia) folliculitis: characterization of inflammatory cells and mediators in the skin by immunohistochemistry. Br J Dermatol. Mar 2001;144(3):549-56. [Medline].

  26. Elmets CA. Management of common superficial fungal infections in patients with AIDS. J Am Acad Dermatol. Sep 1994;31(3 Pt 2):S60-3. [Medline].

  27. Ferrandiz C, Ribera M, Barranco JC, Clotet B, Lorenzo JC. Eosinophilic pustular folliculitis in patients with acquired immunodeficiency syndrome. Int J Dermatol. Mar 1992;31(3):193-5. [Medline].

  28. Hill MK, Goodfield JD, Rodgers FG, Crowley JL, Saihan EM. Skin surface electron microscopy in Pityrosporum folliculitis. The role of follicular occlusion in disease and the response to oral ketoconazole. Arch Dermatol. Feb 1990;126(2):181-4. [Medline].

  29. Ford GP, Ive FA, Midgley G. Pityrosporum folliculitis and ketoconazole. Br J Dermatol. Dec 1982;107(6):691-5. [Medline].

  30. Friedman SJ. Pityrosporum folliculitis: treatment with isotretinoin. J Am Acad Dermatol. Mar 1987;16(3 Pt 1):632-3. [Medline].

  31. Goodfield MJ, Saihan EM. Failure of isotretinoin therapy in Pityrosporum folliculitis. J Am Acad Dermatol. Jan 1988;18(1 Pt 1):143-4. [Medline].

  32. Abdel-Razek M, Fadaly G, Abdel-Raheim M, al-Morsy F. Pityrosporum (Malassezia) folliculitis in Saudi Arabia--diagnosis and therapeutic trials. Clin Exp Dermatol. Sep 1995;20(5):406-9. [Medline].

  33. Assaf RR, Weil ML. The superficial mycoses. Dermatol Clin. Jan 1996;14(1):57-67. [Medline].

  34. Bergbrant IM, Johansson S, Robbins D, Scheynius A, Faergemann J, Soderström T. An immunological study in patients with seborrhoeic dermatitis. Clin Exp Dermatol. Sep 1991;16(5):331-8. [Medline].

  35. Donnarumma G, Paoletti I, Buommino E, Orlando M, Tufano MA, Baroni A. Malassezia furfur induces the expression of beta-defensin-2 in human keratinocytes in a protein kinase C-dependent manner. Arch Dermatol Res. Apr 2004;295(11):474-81. [Medline].

  36. Elewski B. Does pityrosporum ovale have a role in psoriasis?. Arch Dermatol. Aug 1990;126(8):1111-2. [Medline].

  37. Faergemann J. Current treatment of cutaneous Pityrosporum and Candida-infections. Acta Derm Venereol Suppl (Stockh). 1986;121:109-16. [Medline].

  38. Faergemann J. Pityrosporum infections. J Am Acad Dermatol. Sep 1994;31(3 Pt 2):S18-20. [Medline].

  39. Faergemann J. Pityrosporum ovale and skin diseases. Keio J Med. Sep 1993;42(3):91-4. [Medline].

  40. Faergemann J, Johansson S, Back O, Scheynius A. An immunologic and cultural study of Pityrosporum folliculitis. J Am Acad Dermatol. Mar 1986;14(3):429-33. [Medline].

  41. Faergemann J, Maibach HI. The Pityrosporon yeasts. Their role as pathogens. Int J Dermatol. Sep 1984;23(7):463-5. [Medline].

  42. Ford G. Pityrosporon folliculitis. Int J Dermatol. Jun 1984;23(5):320-1. [Medline].

  43. Geis PA. Epidemiology, etiology, clinical aspects, and diagnosis of tinea versicolor. Int J Dermatol. Jul 1999;38(7):558. [Medline].

  44. Goodfield MJ, Saihan EM, Crowley J. Experimental folliculitis with Pityrosporum orbiculare: the influence of host response. Acta Derm Venereol. 1987;67(5):445-7. [Medline].

  45. Hanna JM, Johnson WT, Wyre HW Jr. Malassezia (Pityrosporum) folliculitis occurring with granuloma annulare and alopecia areata. Arch Dermatol. Oct 1983;119(10):869-71. [Medline].

  46. Heid E, Grosshans E, Provencher D, Basset M. [Pityrosporum folliculitis (author's transl)]. Ann Dermatol Venereol. Feb 1978;105(2):133-8. [Medline].

  47. Jillson OF. Pityrosporum folliculitis. Cutis. Mar 1985;35(3):226-7. [Medline].

  48. Lim KB, Boey LP, Khatijah M. Gram's-stained microscopy in the etiological diagnosis of Malassezia (Pityrosporon) folliculitis. Arch Dermatol. Apr 1988;124(4):492. [Medline].

  49. Ljubojevic S, Skerlev M, Lipozencic J, Basta-Juzbasic A. The role of Malassezia furfur in dermatology. Clin Dermatol. Mar-Apr 2002;20(2):179-82. [Medline].

  50. Longley BJ. Fungal diseases. In: Elder D, Elenitas R, Jaworsky C, Johnson B, eds. Lever's Histopathology of the Skin. 8th ed. 1997:522.

  51. Schmidt A. Malassezia furfur: a fungus belonging to the physiological skin flora and its relevance in skin disorders. Cutis. Jan 1997;59(1):21-4. [Medline].

  52. Sina B, Kauffman CL, Samorodin CS. Intrafollicular mucin deposits in Pityrosporum folliculitis. J Am Acad Dermatol. May 1995;32(5 Pt 1):807-9. [Medline].

 
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