Malassezia (Pityrosporum) Folliculitis Masquerading As Recalcitrant Acne

Abstract

Malassezia (Pityrosporum) folliculitis is a relatively common skin infection that affects the hair follicles. The condition is characterized by monomorphic perifollicular skin lesions and itching without comedones. Malassezia folliculitis significantly resembles acne vulgaris and steroid acne but is subtly distinct and managed differently. Oral antifungals are preferred for the treatment and result in a dramatic improvement in the disease condition. Early recognition of the disease is important for satisfactory clinical outcomes. This case reports about a female in the reproductive age group, who took multiple treatments for erythematous papular lesions on her face with a provisional diagnosis of acne vulgaris. After observing no improvement over the last three months, she visited the Dermatology clinic at a tertiary care hospital. A diagnosis of Malassezia folliculitis was considered and confirmed on microscopic examination and oral and topical antifungals were prescribed. She reported significant improvement in her skin lesions after two weeks of treatment.