Last updated: May 20, 2019
Richard Honaker M.D.
Primary Care Physician
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Your acne products could be causing your pimples! Check out our guide to pityrosporum folliculitis. The little red bumps that actually get worse by using acne treatments.
Are you wishing for clear skin but everything you try seems to be making it worse? Your issue may not even be acne but folliculitis. A skin condition that so closely resembles acne even doctors can misdiagnose it and using acne products for it can actually make the condition worse. We asked one of our resident GPs Dr. Honaker to lend us his insights on this common skin condition.
What Is Pityrosporum Folliculitis?
This common skin condition often mimics acne occurs when yeast bacteria, which occurs naturally on your skin gets under your skin and into your hair follicles. Once it gets into the hair follicles it will multiply and cause itchy, acne like bumps on the skin.
How is it Different from Other Types of Folliculitis?
Many forms of folliculitis (think razor burn, hot tub folliculitis and barber’s itch) are caused when bacteria, fungi or a virus is able to penetrate damaged hair follicles. The hair follicles are damaged by everyday activities such as:
- Rubbing or scratching your head
- Habitual wearing of hats or helmets
- Improper shaving methods
- Wearing tight clothing
- Allowing hair products to build up on the scalp
- Visiting hot tubs, whirlpools or heated pools that are not properly maintained
Pityrosporum folliculitis differs from other types of folliculitis as it is caused by an overgrowth of yeast.
The yeast that causes pityrosporum folliculitis is different from the yeast that causes yeast infections (thrush) or the yeast used in baking. This yeast is naturally occurring on the skin and usually does not cause any issues.
Another difference is that many forms of folliculitis can clear up without medical intervention and the healing process can be helped by the application of antibiotic cream or with antibacterial soap.
A study determined that pityrosporum folliculitis was more common after antibiotic use. Unlike most types of folliculitis, pityrosporum folliculitis improved after oral or topical antifungal use.
Signs and Symptoms of Pityrosporum Folliculitis
This type of folliculitis can leave bumps that are 1-2 mm in diameter and may or may not be filled with pus. The bumps are about the same size as a pin and uniform in appearance. It is common to find these bumps on the upper chest and upper back. Some patients will be affected on their forearms, face, lower legs and face.
While often mistaken for acne, it is possible to have both conditions at the same time as many people affected have oily skin.
Many patients seek out treatment for this type of folliculitis because it can be very itchy. The itchiness can come on sporadically and be followed by a stinging sensation. After scratching you may notice a red hive-like appearance on the skin.
Risk factors for Pityrosporum Folliculitis
The condition can affect young to middle aged adults of either sex. It is often associated those who suffer from seborrheic dermatitis or severe dandruff.
While the exact reasons for the development of pityrosporum folliculitis is not known, it is believed that external factors or a weakened host may play a factor.
The following are also believed to be associated with the development of pityrosporum folliculitis:
- Wearing synthetic fabrics that don’t allow the skin to breathe can be associated with pityrosporum folliculitis as yeast can grow in warm, moist and sweaty environments.
- Using greasy sunscreens and oily moisturizers
- If you have naturally oily skin. Yeast feeds on skin oil. The production of skin oil largely depends on your hormone levels.
- A decreased resistance to microorganisms
- Oral steroids such as prednisone
- Oral contraception pill
- Being overweight, which can result in tight clothes and excessive sweating
- Stress or fatigue
Why can Antibiotics for Acne Cause Pityrosporum Folliculitis?
Pityrosporum folliculitis is often misdiagnosed for acne because the differences between the two skin ailments are fairly mild.
Unfortunately, treatment for acne can actually contribute to the development of pityrosporum folliculitis. This is because yeast and bacteria are naturally in competition on the skin. When medication is taken for acne the bacteria is diminished and the yeast is able to overgrow.
How is Pityrosporum Folliculitis Diagnosed?
Getting a proper diagnosis can be challenging since this skin condition mimics acne so closely. If you are getting treatment for acne and it is not improving asking your dermatologist to screen you for folliculitis can be a good step.
Screening for Folliculitis
Getting screened for folliculitis is a simple procedure done by a dermatologist. The affected area will be scratched gently to get a cell sample. Then the sample will be examined under a microscope to evaluate and test for folliculitis.
Treatment of Pityrosporum Folliculitis
There are some factors that can make this type of folliculitis difficult to treat. In order to stop the condition from returning both the yeast overgrowth and the predisposing factors that caused the yeast overgrowth need to be addressed. Unfortunately, these reasons are not always clear. In these cases, the folliculitis will reappear once the anti-yeast treatment is stopped.
In order to fully eradicate the folliculitis you must address the reason for its original cause. This may mean
- Losing weight
- Discontinuing your acne treatment
- Wearing more breathable fabrics
- Changing the type of moisturizer or sunscreen used
- Changing the type of contraception used
- Practicing more self care
Types of Treatment
Topical therapy is not always effective but is a good first step to eradicating the folliculitis. These treatments can include:
- Nizoral or Selsun Shampoo-apply weekly for 10 minutes in the shower and then rinse
- Apply 50% propylene glycol in water with a gauze pad applied twice daily for three weeks, then move down to twice a week for maintenance
- Spray Lamisil solution on the affected area daily for 14 days and then weekly treatments
- Loprox or Nizoral can be used for spot treatments
Oral treatments are considered to be the most effective for this type of folliculitis. These treatments include:
Most treatments take between 7-14 days to see a difference and recurrences are expected.
There are some easy ways to treat your pityrosporum folliculitis at home. Here are a list of some home remedies to tame the yeast growth.
- If your symptoms are occurring around your hairline a selenium sulfide shampoo may help such as Head and Shoulders or Neutrogena
- Apply diluted tea tree oil to the area with a cotton pad twice daily
- Bathe in a sea salt bath to help dry out the infection
How to Prevent Pityrosporum Folliculitis
This type of folliculitis can be difficult to prevent but there are still steps you can take to protect your skin from yeast overgrowth.
- Wash with antifungal shampoo and soap to discourage yeast overgrowth
- Use a gentle oil-based astringent daily on the areas of your skin that are especially oily
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Disclaimer: This article provides general information and is not intended to diagnose, treat or cure any disease or medical condition. If you require specific advice, please consult one of our medical professionals through the app. However, in case of an emergency, please call 911.
About Richard Honaker M.D.
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