Malasseziafolliculitis B36.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 22.06.2021

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Synonym(s)

Malassezia folliculitis; Pityrosporumfolliculitis; Pityrosporum folliculitis

History
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Weary, 1969; Potter, 1973

Definition
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Chronic inflammation of the hair follicles by the yeast fungus (Malassezia spp.; esp. Malassezia globosa; s.a. Malassezia furfur; s.a. Pityrosporum). Common in long-term continuous or recurrent antibiotic-treated patients (in a larger observational study, this was > 75% of patients who had previously treated acne with long-term antibiotics - Prinaville B et al. 2018). Also in immunosuppressed patients.

Etiopathogenesis
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Microbiotic dysbalance (of the skin) due to frequent antibiotic pre-treatments (e.g. in women due to recurrent cystitis). Immunosuppression through viral infections (e.g. HIV infection) or through immunosuppressive therapies.

Manifestation
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w>m (not secured!)

Adult age (20-50 years); also described in (immunocompetent) infants and toddlers.

Frequently occurring in patients with long-term glucocorticoid, antibiotic or immunosuppressive therapy.

Localization
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Mainly located on the back in the seborrhoeic zones; less frequently in the centrofacial parts of the face.

Clinical features
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Mostly (not always) clear signs of seborrhoea; frequent condition after acne vulgaris.

Clinically, there are disseminated, follicular, inflammatory, red, itchy papules 0.2-0.4 cm in size, more rarely also papulopustules. There are also smaller skin-coloured epithelial cysts. Healing with crust formation. More than half of the patients suffer from marked pruritus.

Pathogen detection in direct preparation, in culture or in histological section (PAS staining).

Histology
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Serial sections and PAS staining usually show dilated follicular infundibula with overlying parakeratotic keratinization. In the upper parts of the follicular excretory ducts (sometimes also in the deeper parts) numerous PAS-positive fungal elements. Perifollicular mostly strong lymphocytic, occasionally also neutrophilic infiltrate.

Differential diagnosis
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Complication(s)
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In rare cases, malassscia sepsis may occur in long-term immunocompromised patients as well as in parenterally fed newborns or premature infants (catheter-associated transmission; Iatta R et al. 2014) (pathogen: M. pachydermatis; M. furfur).

External therapy
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Remove any crusts with 2-5% salicylic acid ointment(e.g. Salicylvaseline Lichtenstein, Salicylic acid ointment 2-5% (NRF 11.43.) or moist dressings. Wash off with quinolinol (e.g. quinosol 1:1000).

Antimycotic treatment with a broad-spectrum antifungal agent as solution/spray e.g. 1% Clotrimazole solution(Fungicid-ratiopharm Pumpspray, Clotrimazole solution Hydrophile 1% (NRF 11.40.).

Altermative: multiple washes with antimycotic shampoos (e.g. Epi-Pevarayl® PV).

Internal therapy
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Antimycotic therapy with ketoconazole (e.g. Nizoral) once/day 200 mg p.o. for 7-14 days (Prindaville et al. 2018)

Alternatively itraconazole (e.g. Sempera) 1 time a day 200 mg p.o. for 7-14 days.

Remember! In many cases chronic course, so that the systemic therapy scheme has to be repeated after a therapy-free interval (3 months)!

Progression/forecast
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Chronic course with resistance to therapy.

Literature
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  1. Anane S et al (2013) Malassezia folliculitis in an infant. Med Mycol Case Rep 2:72- 74
  2. Crespo Erchiga V et al (2002) Malassezia species in skin diseases. Curr Opin Infect Dis 15: 133-142
  3. Faergemann J et al (2001) Seborrhoeic dermatitis and Pityrosporum (Malassezia) folliculitis: characterization of inflammatory cells and mediators in the skin by immunohistochemistry. Br J Dermatol 144: 549-556
  4. Iatta R et al. (2014) Bloodstream infections by Malassezia and Candida species in critical care
  5. patients.Med Mycol 52:264-269.
  6. Mota R et al (2015) Malassezia folliculitis in an immunosuppressed patient. Dermatologist 62: 725-727
  7. Pedrosa AF et al (2014) Malassezia infections: a medical conundrum. J Am Acad Dermatol 71:170-176
  8. Potter BS et al (1973) Pityrosporum folliculitis. Report of seven cases and review of the Pityrosporum organism relative to cutaneous disease. Arch Dermatol 107: 388-391
  9. Prindaville B et al.(2018) Pityrosporum folliculitis: A retrospective review of 110 cases.
  10. J Am Acad Dermatol 78:511-514.
  11. Rubenstein RM et al (2014) Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol 7: 37-41.
  12. Song HS et al (2014) Comparison between Malassezia folliculitis and non-Malassezia folliculitis. Ann Dermatol 26:598-602
  13. Viana de Andrade AC et al (2013) Pityrosporum folliculitis in an immunocompetent patient: clinical case description. Dermatol Online J 19:19273
  14. Weary PE et al (1969) Acneform eruption resulting from antibiotic administration. Arch Dermatol 100: 179-183

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 22.06.2021