Medicine :: How is Pityrosporum Folliculitis treated?

Pityrosporum folliculitis is a common kind disorder in young or middle-aged adults that involves
follicular papules and pustules localized predominantly on the back and chest. As the name
suggests, it is caused by the invasion of the hair follicle by Malassezia yeasts. Although Malassezia
yeasts are a part of the normal human microflora, under certain conditions they can cause
superficial dermatological conditions. The invasion results in the development of erythematous
papules, and sometimes pustules, which may be either asymptomatic or itchy. Usually pityrosporum
folliculitis is present along with staphylococci and propionibacteria in the follicles.
The Pityrosporum folliculitis infection is lipophilic (requiring the presence of lipid substances for
their development, in either skin sebum or culture media) yeasts commonly found on skin and body
surfaces of humans and animals. There are seven global warming essay proposed species in the
genus Malassezia based on molecular, morphological, and biochemical profiles. Their variable
morphology and the difficulty in isolating and maintaining them in culture have brought about a
long-lasting controversy on the role of the Malassezia yeasts in various skin conditions. During the
past two decades, this group of yeasts has gained increasing importance, and great progress has
been made in defining the ecology and implicit role of the different species in associated
pathological disorders.
Malassezia yeasts are classified as superficial mycoses that, by definition, do not invade past the
cornified epithelium. In Pityrosporum folliculitis, however, the organism is present in the osteum and
central and deep segments of the hair follicle. All the species have distinct morphological
characteristics, which allow them to be differentiated from other yeasts. The cells are round, oval or
cylindrical, depending on the species. The reproduction of Malassezia is asexual with unipolar
budding, the daughter cells being formed successively in a single locus, leaving a prominent scar on
the mother cell. Some species may develop pseudomycelium in vivo as well as in vitro.
With regards to the Pityrosporum folliculitis, Malassezia yeasts require free fatty acids to survive.
The yeasts hydrolyze triglycerides into free fatty acids and create long-chain and medium-chain fatty
acids from free fatty acids, resulting in a cell-mediated response, which leads to inflammation.
Because of their dependence on lipids for survival, Malassezia yeasts are found in sebum rich areas
of the body such as the trunk, back, face and scalp.
The pathogenic agents identified in Pityrosporum folliculitis are yeasts from the genus
Pityrosporum-Pityrosporum orbiculare and Pityrosporum ovale, which are collectively known as
Malassezia furfur. It is not clear whether the organism plays a pro-active causative role or whether
there is merely a proliferation of Malassezia in the enlarged follicle. However, direct microscopy and
histopathology show that there is a definite and clear pattern of colonization of hair follicles by
Malassezia yeasts. The role of Malassezia yeast in pityrosporum folliculitis is further endorsed by the
fact that topical antifungal treatment is effective in most cases.
Most infectious diseases seen by dermatologists and clinicians can be successfully managed if the
true etiology of the patients' dermatosis is known. After that, it is a simple process of therapeutic
follow up that ensures resolution of the problem. Pityrosporum folliculitis has a tendency to happen
again; treatment must be two-pronged. Therapy must be directed both at restraining yeast
overgrowth as well as tackling predisposing factors, to avoid recurrence.
Specific treatment for pityrosporum folliculitis can be divided into Topical treatment and Oral

treatment. Topical treatment includes antidandruff shampoo as a cleanser and Topical antifungal
agents, especially ketoconazole or ciclopirox creams or econazole foaming solution. For the oral
treatment, Azole antifungal agents including ketoconazole, fluconazole and itraconazole can be used
in the treatment of pityrosporum folliculitis.