This condition is now also known as Malassezia furfar folliculitis or simply Malassezia folliculitis. Folliculitis is an inflammation of the surface of the hair follicle on the skin of the body. It can occur anywhere on the skin, but it is more common on the face, neck, buttocks and thighs.
You may also find folliculitis in the beard area, known as beard folliculitis or pseudofolliculitis, and sometimes on the scalp along the frontal line of implantation with the small rash, a lot of itching like pustules (small blisters with pus on the inside).
Folliculitis is a rather nonspecific term that refers to inflammation of the hair follicle (in clinical practice, this term does not include vulgar acne). The most common etiology of folliculitis is bacterial infection, often due to Staphylococcus aureus.
Folliculitis mainly affects the skin of younger adults. Folliculitis appears as small, round and slightly elevated pimples filled with pus or pustules that form around the hair follicles, which lie in the center of each lesion.
The affected areas usually cause mild discomfort and infected lesions. The itching is common and the discomfort is often greater.
A number of related species of yeast from the genus Malassezia are now believed to cause the disease. It usually affects people with oily skin, and is particularly common on adolescents and young adults.
The disease is also associated with the use of some steroid treatments. It also tends to be worse when using tight clothing and sweating.
The use of antibiotics can aggravate this condition, as they tend to kill off skin bacteria; their absence allow the yeast species to proliferate with less competition. Other conditions, such as diabetes or being overweight, can increase the risk of folliculitis. The use of the contraceptive pill can also increase the risk of folliculitis.
Folliculitis is often initiated by a slight physical injury to the follicles, such as friction caused by tight clothing, or by incarnated hairs on the beard area in men. Less commonly, folliculitis is caused by a fungal infection, such as dermatophytes or Pityrosporum, by Pseudomonas aeruginosa (“ringworm folliculitis”).
Folliculitis can occur in patients exposed to water sources that are contaminated by that organism.
Folliculitis is caused by many different types of organisms. The most common causes are:
• Bacteria: Staphylococcus aureus is the most common bacterium that causes folliculitis and is known as staphylococcal folliculitis.
• Yeast: Pityrosporum ovale is the most common yeast to cause folliculitis. It is an infection similar to acne that is known as folliculitus pityrosporum.
• Fungi: Fungus folliculitis is caused by a fungus and is contagious.
• Other causes include injury or damage to the hair follicle by friction with tight clothing, by blockage of the hair follicle, or by shaving.
Symptoms of Folliculitis
Reddish, itchy spots or pimples are seen, typically on the upper back, chest, upper arms, or face. The spots occur in hair follicles. The overall appearance may be similar to acne (a bacterial skin disease), and the two conditions may be confused.
Some patients may suffer from both. Patients may also suffer from dandruff and seborrheic dermatitis, which have also been linked to Malassezia species.
- Ketoconazole (Nizoral) is a possible treatment for this disease. Ketoconazole is a synthetic anti-fungal agent, active against yeast species. Oral ketoconazole is usually considered the most active form, although a skin cream can also be used. Side effects from oral ketoconazole include nausea, diarrhea, and liver toxicity.
- Itraconazole (Sporanox) is another synthetic anti-fungal agent, usually taken orally. It is not suitable for those with heart problems.
- Fluconazole (Diflucan) is another synthetic anti-fungal agent. It is typically taken orally.
- Clotrimazole is a synthetic anti-fungal agent, usually used as a skin cream.
- Ciclopirox olamine is a synthetic anti-fungal agent, used as a skin cream.
Photodynamic Therapy is a new method currently being investigated. A laser light is used, in conjunction with a sensitizing compound. Initial results on six patients were encouraging, but positive results from full-scale clinical trials are needed before this method can be adopted.
Although fungicides are usually effective in clearing the folliculitis, the disease is liable to recur. Oral fungicides have various side-effects, so can only be taken for a limited period of time. Patients need to consider what they can do to make the disease less likely to return.
Sufferers should be advised to avoid tight clothing and hot or humid situations. Cotton or linen clothing should be worn, rather than synthetic materials. Sweating tends to aid the disease, so sufferers should shower using plenty of shower gel immediately after any exercise. Overweight patients should lose weight, which ought to reduce sweating and so help combat the disease.
The oral contraceptive pill is believed to increase the risk of folliculitis, so women with the disease who are on the pill may wish to consider alternative methods of contraception. Greasy formulations of skin care products or sun block should be avoided. Although the disease may recur, it tends to become less virulent as sufferers become older.
Treatment will depend on the type of organism or lesions caused by folliculitis. Most cases are mild and can be treated with a cleansing regimen of the skin either with a mild cleanser such as the antibacterial Cetaphil bar daily with your bath or shower.
The cleanser can cause some dryness, which can be treated with a mild moisturizing cream like Cetaphil lotion. Some more extensive treatments include topical antibiotics or anti fungal creams.
Topical medications are sometimes used in combination with oral antibiotics or oral antifungal medications for optimal results. Antihistamines may be prescribed to reduce inflammation and itching.
• Take showers of warm water (never hot) every day or once a day.
• Avoid the heat and leisure activities that make you sweat like aerobics or running.
• Avoid shaving when possible, if necessary, use a new razor blade or electric razor.
• Wear loose clothing to prevent friction and irritation of hair follicles.
• Avoid contact with greasy emollients, cream-based tanning oil, tar and fat products.
• Wear clean clothing every day to reduce the chances of infection.