Pityrosporum Folliculitis Acne Treatment: even many doctors don’t know this

Cynthia Bailey, MD|October 3, 2010

pityrosporum folliculitis acne treatment from Dr. Bailey


This is Part 2 of a series on the pityrosporum folliculitis acne.

I see a lot of people with pityrosporum folliculitis and almost all of them have tried unsuccessfully to treat their pimples with the wrong medicines;  they've either used medicated acne skin care products or been treated with prescription acne medicines by another physician. The problem is that acne medicines treat pimples and blackheads caused by the bacteria p. acnes.  They don't treat yeast and the breakouts of pityrosporum folliculitis type acne are due to an overgrowth of the pityrosporum yeast. Medicines that kill this yeast are necessary to control the pimples and blackheads of pityrosporum folliculitis. It's also possible to have both regular acne vulgaris AND pityrosporum folliculitis together, and both need treatments or the breakouts persist. In Part 1 of this series I described the difference between pityrosporum folliculitis and regular acne.  Here in Part 2 I am going to outline my treatment approach.

My treatment strategy for pityrosporum folliculitis is two fold:

  1. Control the growth of the yeast
  2. Clean out the pores.

I’ll give you an overview of how I treat my patients who have pityrosporum folliculitis, but I recommend you start any treatment by seeing your dermatologist for an accurate diagnosis and medically supervised care.

Dermatologist Dr. Cynthia Bailey’s Treatment Of Pityrosporum Folliculitis Acne

Treatment To Control Skin Yeast Growth

  • calming zinc soap for pityrosporum folliculitis acnefoaming zinc cleanser best for back acne2% pyrithione zinc in either a soap or shampoo are my first choice to treat pityrosporum folliculitis. I have patients use Calming Zinc ®  soap on their face and Foaming Zinc Cleanser on their back, neck and chest.  My Foaming Zinc Cleanser lathers well and works as a shampoo so it can be used on the scalp too.  The product's cleanser base is a little harsh for the face which is why I use Calming Zinc for facial skin.  2% pyrithione zinc is over the counter and does not require a prescription.
  • Prescription medicines such as sodium sulfacetamide cleansers, or a short course of oral anti-yeast pills are a last resort if the 2% pyrithione zinc isn't controlling the breakouts sufficiently.  They would only be prescribed by a physician after an exam and consultation if there is no allergy or contraindication to the use of these medicines.
  • I stress the importance of washing the involved skin at least twice daily and as soon as possible after sweating using the medicated cleansers. Pityrosporum yeast thrives in sweat and oil so skin should be kept as sweat and oil free as possible.

Treatment To Unclog Clogged Pores And Blackheads

  • complete professional back acne treatment kitUltimate Acne Solutions Skin Care KitI have patients use products with one or several of the effective keratolytic skin care ingredients (keratolytics are ingredients that break up clumped dead skin cells).  These include benzoyl peroxide, glycolic acid, salicylic acid or prescription retinoids like tretinoin (Retin A).  These are used as cleansers or leave on products in treatment pads, lotions or creams.  I choose the product depending on the person’s skin type and tolerance to these potentially harsh ingredients.  Powerful professional strength keratolytics are found in my Back Acne Treatment Kit and Ultimate Acne Solutions Skin Care Kits as well as my Glycolic Acid Facial Treatment Kits and my Glytone Body Wash.

Click here to see the Clarisonic Plus Sonic Brush System

Dermatologist Recommended Clarisonic Plus Brush System

The take home message is that not every breakout of pimples and blackheads is acne vulgaris.  The skin yeast germ pityrosporum can cause acne too and standard acne medicines don’t treat it.  Treating this yeast may be all that stands between you and clear skin.  See your dermatologist if you think you have pityrosporum folliculitis. There are even more causes of acne beyond acne vulgaris and pityrosporum folliculitis.  If your looking for additional information, please read my article Common Reasons Why Your Acne Treatment Might Not Be Working.

Do you have any ‘strange’ acne stories or surprising acne cures?

I’d love to hear from you if you do.  Send them to me as a comment below or using the Ask Dr. Bailey link on the top of the page. Related posts: Treating Teenage Acne: Dermatologist's Complete Info To Clear Acne Fast 4 Diet Changes That Can Improve Your Acne How To Correctly Use RetinA (tretinoin) For Anti Aging And Acne Skin Care How To Unclog Clogged Pores Photo: Gratitude and thanks to Buggolo

I used to have good clear skin that I took pride in which is why I was surprised to get acne that occurred with my pregnancy. I would pop them and tiny little white hairs that Id never seen on my face before would come out with the head. But I assumed the acne and hairs were simply from hormones. But it didn’t go away when I had my daughter 1 year ago. Instead it only kept getting worse.

Now along with the pimples, I have hundreds among hundreds of little bumps under the skin mostly occurring on my forehead. My skin is so uneven that concealer usually looks hideous and powder makes my skin peel and crack. (I also occasionally get small bumps on my scalp that itch and sometimes move like whack-a-moles if I really I try to dig them out).

My face isn’t always as itchy but I can’t believe it took me so long to realize these bumps on my face and scalp might be related…

Sometimes my face will start to look clearer mostly when I eat healthier than usual and avoid touching my face and the acne pimples start to clear up. People will compliment my skin BC its clearer than usual, but I can still see those horrid uneven bumps! I thought it was BC my skin or pores were destroyed from pimple popping.

I began to lose hope and started thinking there was no solution short of cosmetic surgery. Just last night I stumbled across information online stating that the problem could be due to yeast overgrowth and there are cures. I’ve never been so hopefully ecstatic!!

I ordered some ketaconazole. Have you seen as much success with that as the topical zinc? I’ve also read olive oil or argan oil scrub with oatmeal or sugar may be effective at cleansing, but Im hesitant, too concerned the oil will further clog the pores. I’m also going to continue using aloe straight from the plant as I’ve seen slight success with that at making the skin smooth.

Also, I’ll add that I have some skin discoloration at the top corner of my forehead. My skin had peeled a couple months ago and the pigmentation just never came back. I work outside and thought that may be from sun damage but now I’m wondering if that also may be due to a related infection. Regardless, I worry about it getting worse and am looking for the least harsh treatment to my skin available. That is my skin story thus far and would appreciate any feedback.

Hello Lauren,
I rely on zinc pyrithione for my pityrosporum folliculitis patients. It is cost effective and really helps the skin problem. Some complexions can become allergic to zp and for those I use lotrimin or ketaconazole. As always, I must remind readers that I can’t give medical advice for anyone’s specific skin problem; I share my general knowledge and experience in the hopes that it starts an effective conversation between a reader and their treating physician. Best wishes, CBMD

By Lauren on 2016 10 15

Hi!!! I recently ordered a zinc soap from Amazon and around the same time I started
The Candida Diet. I’ve also used Nizoral shampoo a few times.

I should tell you I’ve had this condition in my face for about 10 months now
And it started on my forehead and gradually moved to my cheeks.
I thought it was acne the whole time until about 3 months ago
Which was when I found out about yeast causing skin problems.

So I’ve been using the soap and doing the Candida diet w a lot of success.
I still have a few bumps on my forehead but there’s only like 2 or 3
And my cheeks are fairly clear.

Do u think the diet you suggested is okay instead of the CANDIDA Diet? I’ve been off sugar for some time but I would like to enjoy a vanilla latte once in a while.

By Alexia V on 2016 10 17

Oh, also do u think this will be a lifelong problem or do u think it will go away
Someday? Thank you. I’m so greatful to have found your website.

By Alexia on 2016 10 17

Hello Alexia,
I can’t comment on the Candida Diet but sugar does fuel acne. My diet is proportional and there is room for a treat so long as the majority of the diet is health promoting. Here is the free ebook that I wrote: https://www.drbaileyskincare.com/info/ebook/view/healthy-eating-guide

Yes a tendency to support the growth of pityrosporum may be something a complexion lives with forever. That said, I don’t see pityrosporum folliculitis in the elderly wink I hope that helps give you hope. Keep up the good work.

By Cynthia Bailey, MD on 2016 10 25

Hello, I recently bought your calming zinc soap. How long do you recommend using it before seeking a dermatologist opinion if it does not clear up the problem? Thank you.

By Amanda on 2016 11 01

Hello Dr. Bailey,

I am so happy to have found your website!  It has been a tremendous help.  I have struggled with pityrosporum folliculitis for years.  I have been able to keep it under control with the use of ketaconazole Nizoral shampoo but anytime I use sunscreen on my forehead, it comes right back.  This is extremely frustrating.  Is there a sunscreen you would recommend that will not exacerbate the pityrosporum folliculitis?  Thank you for your time.

By Erin on 2016 12 09

Hello Erin,
I like a dry type of sunscreen and of course zinc oxide. The Sheer Strength Pure Physical Mineral Sunscreen is fantastic and might be a fit https://www.drbaileyskincare.com/sheer-strength-pure-physical-sunscreen It is mattifying and feels great on the skin. It has amazing protection too. Thanks for the kind words!! Warm Regards, CBMD

By Cynthia Bailey, MD on 2016 12 15

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