Malassezia (Pityrosporum) Folliculitis Workup

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

Laboratory Studies

  • A potassium hydroxide (KOH) preparation may be helpful for microscopic identification of the yeasts associated with Pityrosporum folliculitis (PF).
  • Culturing and identification of the organism are rarely performed, and the tests usually are not available.
  • For Malassezia yeasts to grow, olive oil must be added to the culture media. This is not a routine study for the mycology laboratory.
  • Shibata et al report the presence of galactomannan on cells of Malassezia species, which they suggest has not previously been reported in the literature. Results of their comparative antibody reaction studies lead them to suggest the potential for antigen detection as a diagnostic tool in Malassezia infection.[24]
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Histologic Findings

The basic lesion observed at histologic evaluation is that of folliculitis. The ostium of the hair follicles is dilated, with keratin plugging, cellular debris, and an inflammatory infiltrate including lymphocytes, histiocytes, and neutrophils. Monocytic, perifollicular infiltrate, and mucin deposits are observed around the infundibulum. Some follicles may be cystic and ruptured.

Malassezia yeasts are observed in the central and deep follicle, but they are most densely present in the ostium and pilary canal. Periodic acid–Schiff (PAS) and Grocott-Gomori methenamine-silver staining reveal the oval single-budding yeast; however, these organisms can be observed without stain as well. No mycelial forms are observed with staining. Also detected are 2-4 µm PAS-positive spores in the entire follicle. Most often, spores are observed as aggregates. Both methylene blue and Parker ink staining have been suggested as useful to detect Malassezia; however, Parker ink is a more specific stain for the organism.

High titers of circulating immunoglobulin G antibodies against P ovale can also be detected in persons with this disease.[25]

Skin biopsy is usually reserved for the diagnosis of lesions that resemble Pityrosporum folliculitis but are located on surfaces where Pityrosporum folliculitis less commonly occurs. A diagnosis of Pityrosporum folliculitis in these unusual locations may indicate more severe disease. Early biopsy should be considered in patients with significant immunosuppression, such as those with AIDS, because the differential is much broader in these patients.[26, 27]

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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.

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