Malassezia Folliculitis is an inflammatory condition that affects the surface of the hair follicle on the skin of the body.
This condition 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, 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 common acne).
The most common etiology of folliculitis is a 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 something typical of this condition, as well as a remarkable ache.
More often than not, the organism responsible for the development of this disease is a yeast species that occur naturally on the skin, such as Pityrosporum ovale.
Some 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 prevalent in adolescents and young adults.
The disease is also related to the use of some steroid treatments. It 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 allows the yeast species to reproduce with little to no trouble.
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.
Less commonly, folliculitis occurs due to 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.
To sum it up, 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 folliculitis pityrosporum.
Symptoms of Folliculitis
People often see reddish, itchy spots or pimples, 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 are probably related to Malassezia species.
- Ketoconazole (Nizoral) is a possible treatment for this disease. Ketoconazole is a synthetic antifungal agent, active against yeast species.
- Oral ketoconazole in its most active form, although patients can use a skin cream too.
- 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 usually comes as oral medicine.
- Clotrimazole is a synthetic antifungal agent, usually used as a skin cream.
- Ciclopirox olamine is a synthetic antifungal agent, used as a skin cream.
Photodynamic Therapy is a new method currently being investigated. Laser light gets used, in conjunction with a sensitizing compound.
Initial results on six patients were encouraging, but researchers need positive results from full-scale clinical trials before doctors get to adopt this method.
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.
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 capsules can probably increase the risk of folliculitis, so women with the disease who are on the pill may wish to consider alternative methods of contraception.
People should avoid greasy substances for topical use such as skin care products or sunblocks. Even if the disease may recur, it tends to become less virulent with age.
Treatment of folliculitis focuses on eliminating the causative agent and includes topical, antibacterial or antifungal preparations.
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 gentle cleanser such as the antibacterial Cetaphil bar daily with your bath or shower.
The cleanser can cause some dryness, which can get treated with a mild moisturizing cream like Cetaphil lotion. Some more extensive treatments include topical antibiotics or anti fungal creams.
Sometimes, patients can use topical medications 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.