MALASSEZIA FOLLICULITIS. A CASE REPORT
TL;DR
A 38-year-old man returning from Spain presented with pruritic papules and pustules on the back, chest, shoulders, and face and treatment with clotrimazole cream, ketoconazole 2% shampoo, and fluconazole 150 mg weekly for four weeks resulted in clinical resolution.
Abstract
Background: Malassezia folliculitis (MF) is an inflammatory disorder of the hair follicles caused by overgrowth of lipophilic Malassezia yeasts. It typically presents as monomorphic, pruritic follicular papules and pustules on seborrheic areas and is often misdiagnosed as acne vulgaris or bacterial folliculitis. Case report: A 38-year-old man returning from Spain presented with pruritic papules and pustules on the back, chest, shoulders, and face. No comedones were present. A routine bacterial culture was negative, and previous antibiotic and anti-acne treatment had been ineffective. Wood's lamp examination showed yellow-green fluorescence, and direct microscopy with methylene blue and Gram staining demonstrated abundant Malassezia yeasts. Treatment with clotrimazole cream, ketoconazole 2% shampoo, and fluconazole 150 mg weekly for four weeks resulted in clinical resolution. Conclusion: Malassezia folliculitis should be considered in monomorphic, pruritic, treatment-resistant acneiform eruptions. Direct microscopy is a rapid confirmatory method, and antifungal therapy is generally effective, although recurrence may require maintenance treatment.