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Malassezia folliculitis (previously called ‘pityrosporum folliculitis’) is due to proliferation of a yeast, called malassezia, within the hair follicles. the causes of malassezia folliculitis are not fully understood but the following are believed to be important - external factors include - the yeast tends to overgrow in hot, humid, sweaty environments. sweating is encouraged by wearing occlusive clothing. sunscreens and greasy emollients may occlude the follicles. the host factors include - oily skin (provoked by hormonal influences). obesity. pregnancy. stress or fatigue. systemic illness, including - diabetes mellitus. immune deficiency. medications, such as - broad spectrum oral antibiotics (often prescribed for acne), which suppress skin bacteria allowing yeasts to proliferate. oral steroids such as prednisone (steroid acne). oral contraceptive pill. both topical and oral antifungals are effective agents in the treatment of pityrosporum folliculitis (pf). oral antifungals have the advantage of dramatic, immediate clearing of the lesions and are the most effective treatment. patients have been successfully treated with oral pulse itraconazole and weekly fluconazole. a course of oral ketoconazole and topical ketoconazole shampoo (nizoral) is currently the recommended treatment. oral medication should be discontinued when the lesions resolve. because relapse almost always occurs when treatment is withdrawn, topical ketoconazole is indefinitely continued after successful initial treatment with oral medication. other topicals that are used to treat pityrosporum folliculitis are ciclopirox olamine cream, econazole cream, alcohol and salicylic acid solution (with or without benzoic acid 5%), propylene glycol 50% in water, and selenium sulfide shampoo. in cases associated with antibiotic use, discontinuing the antibiotic may be helpful. retinoids, which are used for comedones in acne, have no effect because no comedones are present in pityrosporum folliculitis. tetracycline does not help in pityrosporum folliculitis, and if prescribed, it may exacerbate the condition by further destroying the normal bacterial skin flora and allowing further spread of malassezia yeasts. specific treatment can be divided into - topical treatment = antidandruff shampoo as a cleanser. topical antifungal agents, especially ketoconazole or ciclopirox creams or econazole foaming solution. oral treatment = azole antifungal agents including - ketoconazole and itraconazole (which are what you have been prescribed). isotretinoin to reduce seborrhoea. it would seem that your doctor has your treatment ‘in hand’, so to speak and you are receiving what could be considered as the ‘normal’ and recommended medications. bear in mind that these conditions are not cured or caused to vanish over night. as mentioned above they also have a tendency to reappear. you would be advised to discuss your concerns with your doctor and determine if there is another way forward if the present regimen is not showing any improvement.
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