Malassezia Folliculitis: An Underdiagnosed Mimicker of Acneiform Eruptions.

Abstract

Malassezia folliculitis, previously known as Pityrosporum folliculitis, is a common yet frequently misdiagnosed dermatologic condition caused by Malassezia yeast overgrowth in hair follicles. Its monomorphic, pruritic papules and pustules closely mimic acne vulgaris, often leading to inappropriate antibiotic use. This review summarizes current evidence on the epidemiology, clinical presentation, diagnostic challenges, and management of Malassezia folliculitis. A high index of clinical suspicion is critical in patients with recalcitrant acneiform eruptions. Diagnosis is supported by dermoscopy, potassium hydroxide preparation, Wood's lamp, and response to antifungal therapy. Topical and oral antifungal agents are highly effective although relapses are common and access to off-label treatments may be limited. Greater awareness of the distinct clinical features of Malassezia folliculitis and treatment response can improve diagnostic accuracy and enhance patient outcomes.