Hello Dr. Bailey,
I’m wondering if you can answer some general information questions about the skin condition pityrosporum folliculitis. Is it necessary to wash clothing, bedding, and other items that come into contact with the infected skin on a daily basis? Also, I am wondering what your success rate is for treating patients with this condition with products containing pyrithione zinc, as opposed to topical and/or anti- fungal medications, especially if the condition covers a significant part of the body, i.e. the face, neck, shoulders, and chest? Is it important to continue using the zinc products after the condition has gone away for some recommended time period, generally speaking? And last, does the zinc address the itch associated with this condition?
Thank you and I greatly appreciate your help if you are able to answer any of these questions.
Pityrosporum folliculitis is one of the most common forms of back acne and it’s really challenging. Your questions are what I would consider the ‘advanced’ questions for pityrosporum folliculitis treatment and they’re really intriguing – and fun!. I’m going to outline general educational information for each of your questions based on how I take care of the patients in my dermatology practice who have this type of back and chest acne.
For my patients with really stubborn pityrosporum folliculitis type of acne I recommend they take care to keep clothing and bedding clean. The main important goal is to remove the skin oils from the cloth. After working out it’s also important to change into dry, clean clothing so that the skin drys off quickly because the yeast organism that causes this condition loves moist, oily skin.
Regarding my topical treatment success, yes, I have a very high success rate treating this condition topically, both for acute intervention and chronic management of new outbreaks. My ‘go-to’ treatment is a pyrithione zinc cleanser and an exfoliating sponge. I often add benzoyl peroxide cleanser too which is why the ingredient combo is in my Back Acne Kit.
To control really stubborn cases of pityrosporum folliculitis type of back acne though I often need to prescribe a course of oral ketoconazole. This is a medicine with a lot of drug interactions and of course it has a bunch of side effects too. Patient need to be fully informed of all this important information before choosing this therapy. It’s also important that they have an accurate diagnosis made by their dermatologist.
Also, there is no complete ‘cure’ for pityrosporum folliculitis so we always continue topical care to maintain skin clearing. We still occasionally need to retreat with another course of oral ketoconazole when the skin flares up in spite of our best efforts. Sometimes oral tetracycline works too and if I’m using tetracycline to treat a patient’s acne vulgaris we often ‘kill two birds with one stone’.
I don’t usually use topical antifungals for pityrosporum folliculitis because I have not been impressed with the results and the topical cream application is inconvenient (to impossible) given that the condition is on the back.
The itch of this condition is due to the folliculitis (yeast and white blood cell party in the pore) and so controlling the outbreak is how I address the itch. The zinc is not in and of itself an anti-itch treatment.
On a final note, for pityrosporum folliculitis I always recommend showering asap after sweating, keeping the skin degreased as much as possible and making supportive dietary changes like cutting carbs, greasy foods, diary and junk. That’s all outlined in some of my other acne and pityrosporum folliculitis posts below.
These are good questions. I can see your giving this some really good and detailed thought, I love it!
Cynthia Bailey MD, Dermatologist
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Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only