Is it Acne or Malassezia Folliculitis? (The Devil Is In The Details)

Pityrosporum folliculitis, also known as Malassezia folliculitis is a condition that causes breakouts on your skin.

How is this condition different from typical acne? How do you know is it acne or Malassezia folliculitis?

Well, as the title suggests – the devil is in the details, therefore I have to repeat the first line:

Malassezia folliculitis is a condition that causes breakouts on your skin.

Let me break that down for you.

It happens when the yeast which naturally lives on your skin, gets into your hair follicles and manifests itself through causing breakouts in areas with a lot of sebaceous activity.

This can be the T-zone, shoulders, back, and chest.

While typical acne breakouts can be blamed on hormones, clogged pores, and overgrowth of the bad bacteria living on the skin, malassezia folliculitis distinguishes itself from these.

It has absolutely nothing to do with hormones and clogged pores because it is an overgrowth of yeast that causes the breakouts.

Malassezia folliculitis can be challenging to recognize and is often misdiagnosed for common acne vulgaris.

This misdiagnose can very often lead to the suggestion of wrong treatment options that may potentially aggravate the condition instead of improving it.

So how can we recognize the difference between acne vulgaris and malessezia folliculitis?

What Is Malassezia Folliculitis?

What Is Malassezia Folliculitis

Malassezia folliculitis is an infection of hair follicles caused by lipophilic malassezia yeasts.

It is a species of fungi that is a part of the skin’s microbiome which is essentially the first line of defense against disease, infection, and pathogen attack.

Often referred to as our acid mantle, the microbiome has a pH of 4.5 – 5.5 and maintains the ideal environment to prevent pathogen attack and promote the growth of healthy bacteria on the skin.

Changes in pH, low levels of hydration, and harsh environmental factors can all take effect on the bacteria living on your skin.

This essentially leads to concluding that “one bad bacterium too many” can cause massive flare-ups, sensitivity, blemishes and…you’ve guessed it?

Fungal infections

Malassezia folliculitis is a polymorphic, lipophilic microorganism, which means that this little *says something really bad* thrives in the presence of sebum which is our natural oil produced by the sebaceous glands to keep our skin naturally moisturized.

Different Species of Malassezia Folliculitis

types of Malassezia Folliculitis

There are multiple malassezia species that have been isolated from human and animal skin and some of them include:

  • M. furfur
  • M. globosa
  • M. sympodialis
  • M. restricta

Malassezia folliculitis is most commonly associated with Malassezia furfur and Malassezia globosa but the pathogenic yeast plays a role in many other skin conditions, such as:

Causes of Malassezia Folliculitis

Malassezia infections are mostly endogenous which means that they are produced from the inside of the skin and originate from colonized skin.

It is caused by an overgrowth of yeast that gets into the hair follicles and uses the sebum in the follicle as food and fuel to thrive and cause breakouts to erupt on the skin’s surface.

Malassezia is incapable of synthesizing its own fatty acids and it needs sebum to build their own mid-length and long-chain fatty acids in order to thrive.

Or in simple terms: Malassezia gets into the hair follicles of our skin and considers the place to be a grocery store. 

Antibiotics, birth control pills, hormonal changes, and medicine used to stabilize hormones are also very likely to develop this condition, as they disrupt the natural balance of bacteria on and in your body.

Which brings us to the next part.

Why Is It Important To Recognize Malassezia Folliculitis?

The reason it’s important to distinguish Malassezia folliculitis is that it can very easily be misdiagnosed with common acne breakouts.

Depending on the severity of the breakouts you may be prescribed strong antibiotics such as Accutane in order to treat the condition effectively.

While Accutane is known to have some serious side effects, this treatment will not improve malassezia folliculitis, but on the contrary, the yeast is able to find a way to thrive beside it, making the condition even worse.

You can recognize if you have malassezia folliculitis by following the pattern of the growth and placement of the occurring breakout.

Areas that are more active in sebum production such as the T-zone is the ideal placement for the yeast to thrive, so this area is most commonly affected, unlike common bacterial or hormonal acne breakouts that typically occur on the cheeks and jawline.

If you are suspecting that you have malassezia folliculitis rather than acne vulgaris, see a dermatologist and ask to be specifically tested for this condition before arriving at your appointment.

The doctor will need to scratch your skin gently in the area where you have the symptoms to get a cell sample. This will then be evaluated under a microscope and tested to see if it’s pitryosporum folliculitis (the actual condition).

Why Am I so Angry At It?

Allow me to vent a little under this paragraph.

I have been suffering from beyond annoying and obnoxious acne breakouts. And unfortunately, it took me quite some time to be able to make a difference between hormonal, bacterial, and yeast-grown acne.

What has been happening the entire time was the following:

  • acne vulgaris on the temples
  • hormonal acne on the cheeks and jawline
  • malassezia folliculitis on the chin and forehead

Throw a little bit of spicy post-inflammatory erythema (PIE) after all this leaves me with a pretty damn good reason to be pissed off at this little pest in case you’re still asking. *sighs*

Moving on.

How to Treat Malassezia Folliculitis Successfully?

what is acne mechanica

There are several treatments your doctor can prescribe for this condition.

The first and most important principle in treating this condition is to eliminate predisposing factors. If you are currently taking oral antibiotics and suspecting that you have pityrosporum folliculitis, discontinuing the antibiotics may result in mild improvement.

Additionally, your doctor may prescribe taking an oral antifungal drug called Itraconazole for seven days and following it up with monthly maintenance.

Itraconazole has shown to have some of the best medical outcomes after several searches have been done.

Since many people (myself included) have both acne and pityrosporum folliculitis due to malassezia, a prescription cocktail including both steroid and topical anti-acne cream may be prescribed.

Other topical remedies that you can use to treat pityosporum folliculitis at home can include selenium sulfide shampoo, purchased from the pharmacy or Econazole cream to kill the overgrowth of yeast on your skin.

Lastly, if your condition can be considered as mild, you can try applying diluted tea tree oil to the area up to twice a day.

I have personally found swimming in the sea extremely helpful for my condition, so bathing in a solution of sea salt may also help to dry out the skin and treat the yeast overgrowth.

Final Thoughts

Malassezia (Pityrosporum) folliculitis, unfortunately, cannot be prevented. But there are steps you can take to reduce the risks of future breakouts.

Pay close attention and care of areas on the skin that are prone to oil buildups. Additionally, washing with an antifungal soap and shampoo may help make your skin less prone to yeast overgrowth.

Observe any changes in the problematic areas and visit a doctor if you think it’s necessary.

How to Treat Malassezia Folliculitis Successfully

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