Malassezia Folliculitis Diagnosis and Treatment in London

Understanding Malassezia folliculitis

Malassezia folliculitis is a common, under-recognised cause of “acne-like” spots. The skin’s normal yeast (Malassezia species) thrives in oily, humid conditions. When the balance between yeast, bacteria and the skin’s immune response tilts, yeast overgrows inside hair follicles, triggering inflammation. The result is an eruption of small, similar-looking bumps and pustules that cluster around hair follicles and itch—often intensely. Unlike acne vulgaris, comedones (blackheads/whiteheads) are usually absent, and standard acne antibiotics may be unhelpful or even exacerbate symptoms.

Because flares are strongly influenced by environment and skincare choices, two people with the same underlying tendency can have very different day-to-day control. The good news is that targeted antifungal therapies and simple habit changes usually deliver clear, rapid improvement—and with a tailored maintenance plan, recurrences can be minimised.

Causes of Malassezia folliculitis

Everyone carries Malassezia yeasts on their skin; they feed on sebum (skin oil). Problems arise when conditions favour overgrowth within follicles. Common drivers include heat, humidity, tight clothing, oily skincare, long-term acne antibiotics, sweating, and immunosuppression. Athletes and those living in tropical climates are particularly prone.

Symptoms of Malassezia folliculitis

• Clusters of small, uniform follicle-centred bumps or pustules
• Intense itch or prickling sensation
• Common on back, chest, shoulders, upper arms, sometimes jawline
• No comedones (blackheads/whiteheads)
• Flares with heat, sweat, or oily products
• May leave temporary pigmentation after healing

Malassezia Folliculitis Diagnosis

Diagnosis is largely clinical, based on pattern and history. Where needed:

• Skin scrapings/tape test: Microscopy may show yeast.
• Dermoscopy: Helps visualise follicle-based lesions.
• Response to therapy: Rapid clearance with antifungals is diagnostic.
• Swabs: Exclude bacterial folliculitis if suspected.

Malassezia Folliculitis Treatment and management

Successful treatment combines antifungals with lifestyle adjustments:

• Topical washes: Ketoconazole 2% shampoo or selenium sulphide 2.5% lotion used as body wash, left on for 3–5 minutes before rinsing.
• Topical antifungal creams: Ketoconazole, clotrimazole, or econazole for smaller areas.
• Oral antifungals: Short courses of fluconazole or itraconazole for widespread, recurrent disease.
• Trigger control: Shower after exercise, wear breathable fabrics, avoid heavy oils.
• Maintenance: Weekly antifungal washes to prevent recurrence.

Living with Malassezia folliculitis

With correct management, prognosis is excellent. Most patients notice improvement within 1–2 weeks of treatment. Relapses are common in humid weather or with frequent sweating, but maintenance routines and early rescue treatments help long-term control.

Your first visit — what to expect

1. History: Review of itch, triggers, previous acne treatments, medications.
2. Examination: Lesion type, distribution, signs of acne or bacterial infection.
3. Investigations: Rarely needed; skin scraping or swab if uncertain.
4. Management plan: Personalised antifungal treatment plus lifestyle advice.
5. Follow-up: Usually within 2–4 weeks to assess progress and adapt plan.

Reviewed by: Dr Mohammad Ghazavi, Consultant Dermatologist
Skinhorizon Clinic, 4 Clarendon Terrace, Maida Vale, London W9 1BZ
Last reviewed: 22 August 2025