Pityrosporum (Malassezia) Folliculitis: Treatment & Prevention

pityrosporum folliculitis

Do you struggle with tiny, raised, red bumps all over your chest or your back or even your face? Do these bumps itch and become inflamed and irritated when scratched? Have you had them for a long time, and nothing seems to make them go away? You may have been diagnosed with acne vulgaris. Or, you may have been told you are suffering an allergic reaction. If you haven’t been able to get rid of these itchy and unsightly little bumps, you may have a skin disorder called Pityrosporum folliculitis.  Read below for natural treatment and prevention tips.


Pityrosporum folliculitis is a common condition that causes severe, pimple-like breakouts on your skin. It is an inflammatory skin disorder that is triggered by an overgrowth of a group of yeasts known as Malassezia. For most people, these yeasts thrive naturally and peacefully on the skin’s surface and within the pores. However, for others – especially those with oily skin – they can cause persistent inflammation and irritation under the skin’s surface.


Pityrosporum folliculitis occurs when the yeast bacteria, specifically the type of yeast called Pityrosporum ovale, gets underneath the skin layers and into your hair follicles. Many times, because it looks so like acne, you may think you are having recurring breakouts that won’t go away. In response, you may attempt to treat the breakouts with acne medication. Unfortunately, Pityrosporum folliculitis does not respond to acne treatments and, in fact, can be made worse by them. This is because it is fungus – not bacteria – that is causing the breakouts.

Pityrosporum folliculitis typically affects your face, the area around your hairline, your chest, your back or your upper arms. More specifically, it is most common where your skin is most oily. The rash-like condition contains a combination of small pus-filled bumps called pustules and small, hard and raised bumps called papules. These tiny bumps – especially the pustules – closely resemble acne, but what sets Pityrosporum folliculitis apart from a case of pimples is its tendency to itch and feel very uncomfortable. When scratched, it can lead to a stinging sensation and the bumps may look like allergic hives and become inflamed, irritated and red.


As stated, Pityrosporum folliculitis is caused by an overgrowth of yeast bacteria on your skin. The overgrowth may be caused by certain factors such as:

Internal Factors

  • Diseases such as diabetes, HIV, Hodgkin’s Lymphoma
  • If you are an organ or bone marrow transplant recipient
  • Excessive sebum (oil) in your skin
  • Nutritional disorders
  • Immunologic deficiencies
  • Prolonged use of broad-spectrum antibiotics*
  • Pregnancy
  • Obesity
  • Oral contraceptive use
  • Steroid use
  • Stress or fatigue

External Factors

  • Hot, humid environments
  • Wearing clothing that doesn’t “breathe”
  • Sunscreen and oily emollients (such as coconut oil) applied to the skin

*Also, because Pityrosporum folliculitis is often mistaken for acne, oral antibiotics can aggravate the condition and make it worse. Skin-inhabitant bacteria and yeasts are normally in competition on the skin surface, so when antibiotics are used to suppress bacteria, Pityrosporum ovale yeasts can overgrow.


Pityrosporum folliculitis affects males and females, as well as people of all races, equally. It typically occurs in adolescents and young adults. Also, if you have excessively oily skin, you are more prone to the condition. Those who suffer with Pityosporum folliculitis may also have conditions such as dandruff, seborrheic dermatitis or tinea versicolor – which is a yeast-type fungus that creates bleach-like patches on the skin.


Diagnosing Pityrosporum folliculitis can be difficult. Although it is a benign condition, its symptoms are unsightly and uncomfortable. To make things worse, because it mimics the look of common acne vulgaris, the condition is most often diagnosed and treated incorrectly.

If you have tried traditional acne medication and it isn’t relieving your symptoms, or it is making them worse, you should be tested for Pityrosporum folliculitis. A dermatologist can properly diagnose the condition by gently “scratching” your skin in an affected area to get a cell sample. The sample can be evaluated to let you know if you have Pityrosporum folliculitis.


Treating Pityrosporum folliculitis should address both the yeast overgrowth and the predisposing factors or the condition will return more quickly. There may be a need to discontinue use of oral contraceptives, or to begin a weight-loss routine, for example. Limiting exposure to hot, humid conditions and wearing more breathable fabrics may also help reduce the symptoms, as well.

Treatment is necessary, however, to successfully remedy the condition. Pityrosporum folliculitis responds to both oral and topical medications, but oral treatments seem to be the most effective.

Prescription Oral Antifungals

  • Itraconazole (known to have some of the best clinical outcomes)
  • Bifonazole
  • Ketoconazole

All three oral medications fall under the largest group of antifungals called Azoles. They work so well because they can break through the fungal cell wall and stop its ability to grow and function properly. They also have anti-inflammatory properties, are well tolerated and have high efficacy rates.

Since you may have both acne and Pityrosporum folliculitis – which makes the condition even more difficult to diagnose and treat – you may need a prescription “cocktail” of a steroid and topical anti-acne cream in addition to an oral antifungal medicine.

Topical Antifungals

Topical creams, lotions and shampoos that treat Pityrosporum folliculitis are not effective by themselves, but they may be used in conjunction with oral treatments to help reduce the yeast overgrowth and keep it contained after the condition heals.

The use of a 2% ketoconazole shampoo to cleanse the affected areas tends to be the most effective. The recommended use is twice weekly (keeping contact on skin for 3-5 minutes before rinsing) over a span of four weeks. After the condition has cleared, once weekly use has been shown to be effective in preventing relapse. Other topical solutions may include:

  • Lotions, creams and shampoos containing the antifungal agent zinc pyrithinone
  • Shampoos containing the antifungal agent selenium sulfide
  • Prescription creams containing the antifungal agent econazole nitrate

Natural Treatments

Along with prescribed oral antifungal medications, there are some more “natural” and over-the-counter treatments that you may want to try. Given the fact that Pityrosporum folliculitis is a stubborn and hard-to-get-rid-of condition, you may want to experiment with as many options as you can in order to find the right remedy that works for you. Some of these treatments include:

  • Melaleuca alternifolia – otherwise known as tea tree oil, it contains strong antifungal, antimicrobial and anti-inflammatory properties.
  • Azelaic acid – it reduces the overall fatty acid content of skin, helping to destroy the Malassezia yeasts.
  • Caprylic acid oil – MCT oil, which has some of the strongest antifungal properties.
  • Sulfur cream – it serves as a keratolytic, meaning it sloughs off dead skin. It also produces pentathionic acid when applied to the skin, which is toxic to fungi.
  • Urea cream – a naturally occurring substance in urine, urea is both keratolytic and hydrating. It has been known to treat many hard-to-treat skin conditions.
  • Raw honey masks – honey has powerful antimicrobial properties and protects against pathogens.

Unfortunately, even after successful treatment, Pityrosporum folliculitis tends to recur periodically—but there are steps you can take to help extend the time between bouts of itchy breakouts.


  • Wearing loose shirts, especially during exercise or in hot, humid weather. Tighter clothing can trap sweat and oil, worsening the bumps and itchiness.
  • Avoid applying thick, balm-like oils and moisturizers – especially on areas prone to the condition.
  • Using lightweight, oil-free gels and sprays in place of oily sunscreen.
  • If you are also dealing with acne, avoid acne-treating antibiotics at all costs. Antibiotics kills the bacteria which, in turn, causes the Pityrosporum ovale yeast to overgrow.


Pityrosporum folliculitis is a difficult condition to diagnose and treat successfully. Because you are dealing with a stubborn, yet naturally-occurring, yeast that overgrows and causes red, itchy and acne-like bumps, you will need to seek the help of a doctor who can identify it. Many times, relapses of the skin condition can occur, but once you find a regimen – that must include prescription oral antifungal medications – Pityrosporum folliculitis can be kept under control and your skin can be free from those irritating and unsightly little bumps.

If you found this article on Pityrosporum Folliculitis interesting, you may also enjoy reading The Best Essential Oils for Skin.