Medication Summary
The goal of pharmacotherapy for Pityrosporum folliculitis is to reduce morbidity and prevent complications.
Antifungals
Class Summary
Antifungals are used in the first-line therapy of Pityrosporum folliculitis. The use of topical agents has few adverse effects besides an allergic reaction to the active medicine or inactive component. The mechanism of action usually involves the inhibition of pathways (eg, enzyme, substrate, transport) that are necessary for sterol and/or cell membrane synthesis, or the permeability of the cell membrane (polyenes) of the fungal cell is altered.
Ciclopirox (Loprox)
Ciclopirox interferes with DNA, RNA, and protein synthesis by inhibiting the transport of essential elements in fungal cells.
Ketoconazole (Extina, Nizoral shampoo, Xolegel)
Ketoconazole is available as a tablet, a 2% cream, and a 1% or 2% shampoo. It is a midazole broad-spectrum antifungal agent; it inhibits the synthesis of ergosterol, causing cellular components to leak and resulting in fungal cell death.
Econazole topical (Ecoza)
Econazole is effective in cutaneous infections. It interferes with RNA and protein synthesis and metabolism. Econazole disrupts fungal cell wall permeability, causing fungal cell death.
Topical Skin Products
Class Summary
These agents are helpful in the treatment of itching and flaking associated with dermatitis.
Selenium sulfide topical (Tersi, Dandrex, Selsun Blue, Head & Shoulders)
Selenium sulfide blocks the enzymes involved in epithelial tissue growth; use 1% or 2.5% shampoo and/or lotion.
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This photo is high-power hematoxylin and eosin staining of a biopsy confirming Pityrosporum folliculitis. There is a hair shaft within a hair follicle with scattered amphophilic staining circular Pityrosporum yeast. Courtesy of Ronald Rapini, MD.
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Left: A 25-year-old man with complaints of slightly pruritic, monomorphic follicular papules, pustules, and secondary keloid on the upper trunk and neck. Right: Scanning electron microscopy of the hair follicle from the upper trunk. This demonstrated a large number of globular or orbicular-ovate yeasts of budding daughter cell, with collar structure around the budding. Courtesy of Wikimedia Commons by Ran Yuping et al (https://commons.wikimedia.org/wiki/File:Pityrosporum_folliculitis_2.jpg).
