Which physical findings are characteristic of Malassezia (Pityrosporum) folliculitis?

Updated: Apr 03, 2020
  • Author: Sarah Sweeney Pinney, MD, FAAD; Chief Editor: William D James, MD  more...
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Answer

Multiple, discrete, 2- to 4-mm erythematous monomorphic, papules and, later, pustules are observed. Lesions have a definite follicular pattern. Material expressed from pustules is white to yellow.

Pityrosporum folliculitis is present on body locations in which Malassezia organisms are most abundant: back and chest, neck, shoulders, scalp, [25] upper arms (occasional), and face.

Under a Wood light, bright blue or white fluorescence is observed in clinically uninvolved follicles in the location of the lesions.

Dermoscopy may demonstrate perifollicular erythematous papules and pustules with "dirty-white" perilesional scale. [26]

Pityrosporum folliculitis often is mistaken for acne vulgaris; however, no comedones or cysts are associated with Pityrosporum folliculitis. [27]

Patients may also have coexisting seborrheic dermatitis. [21]

See the image below.

Left: A 25-year-old man with complaints of slightl Left: A 25-year-old man with complaints of slightly pruritic, monomorphic follicular papules, pustules, and secondary keloid on the upper trunk and neck. Right: Scanning electron microscopy of the hair follicle from the upper trunk. This demonstrated a large number of globular or orbicular-ovate yeasts of budding daughter cell, with collar structure around the budding. Courtesy of Wikimedia Commons by Ran Yuping et al (https://commons.wikimedia.org/wiki/File:Pityrosporum_folliculitis_2.jpg).

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