Malassezia Folliculitis
Malassezia folliculitis, also referred to as Pityrosporum folliculitis, is an underdiagnosed condition that mimics acne vulgaris. This unique type of folliculitis affects the back, chest, and upper arms in healthy teenagers and young adults and can also b
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Malassezia Folliculitis Patricia K. Farris and Andrea Murina
9.1
Introduction
Malassezia folliculitis, also referred to as Pityrosporum folliculitis, is an underdiagnosed condition that mimics acne vulgaris. This unique type of folliculitis affects the back, chest, and upper arms in healthy teenagers and young adults and can also be seen in patients with underlying immunosuppression. Malassezia folliculitis is caused by an overgrowth of Malassezia yeast that thrives in the sebaceous rich environment of the hair follicle. Direct microscopic examination with potassium hydroxide and skin biopsy can be used to identify the presence of yeast within the follicle thus confirming this often elusive diagnosis.
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Background
The Malassezia genus of yeast is considered to be normal skin flora and is found in the stratum corneum and hair follicles of up to 90 % of individuals [1]. This lipophilic dimorphic yeast can be pathogenic and has been implicated in common skin disorders such as seborrheic dermatitis and pityriasis versicolor [2]. Malassezia folliculitis was first described by Weary et al. in 1969 as an acneiform eruption in the setting of antibiotic therapy with tetracyclines [3]. It is characterized as an invasion of hair follicles by large numbers of Malassezia yeast. Malassezia furfur,
P.K. Farris, M.D. (*) Department of Dermatology, Old Metairie Dermatology, 701 Metairie Road, Metairie, LA 70005, USA e-mail: [email protected] A. Murina, M.D. Department of Dermatology, Tulane University, 1430 Tulane Avenue New Orleans, LA 70112, USA J.A. Zeichner (ed.), Acneiform Eruptions in Dermatology: A Differential Diagnosis, DOI 10.1007/978-1-4614-8344-1_9, © Springer Science+Business Media New York 2014
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M. pachydermatis, and M. globosa are the predominant causative organisms [4]. This disease is often seen in healthy teens and young adults and is thought to be the result of follicular occlusion creating the sebaceous rich environment in which Malassezia thrives [5]. In this regard, the pathogenesis is similar to that of acne vulgaris. Staphylococcus and Propionibacteria can also be present in the follicles. Although they are distinct clinical entities, acne vulgaris can occur concomitantly with Malassezia folliculitis. Sweeney et al. reported a series of adolescent girls who had traditional papules, pustules, and comedones of acne but also displayed monomorphic papules and pustules that were pruritic and flared during hot humid weather [6]. Potassium hydroxide examination of the latter showed Malassezia yeast and all patients responded to topical and systemic antifungal treatment. Steroid acne seen after topical or systemic corticosteroid therapy has been associated with an overgrowth of Malassezia. A study looking at direct microscopic examination of material gathered using a comedo extractor from lesions of 34 patients with steroid acne demonstrated that 76 % were positive for Malassezia spores [7]. Treatment with itraconazole resulted in clinical improvement and reduced spore lo
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