I relate so much to this. I have had pityrosporum folliculitis on my back and chest for 8 years now. It took so many years to get it under control but now it's completely gone unless I don't stick to my routine. What worked for me was doing twice daily itraconazole for 7 days, then 4 weeks later do twice a day itraconazole for 2 days, then 4 weeks later do twice a day itraconazole for 2 days. In addition to this, every day put ketoconazole shampoo on your body and let it sit for 10 minutes, then shower. Twice a day put ketoconazole cream on. Once the itraconazole is done, what really works for me is to take one fluconazole pill for 3 days, then take one fluconazole pill weekly indefinitely. Continue using th ketoconazole cream and shampoo once a day indefinitely.

Remember, it took me 6 years of seeing different dermatologists and trying countless different things before I found this routine that worked for me. If I go off this routine at all, my folliculitis flares up. I hope this helps!

I'm in the same boat as the two of you. Battling for nearly a year and this stuff won't budge and spreads. Even worse its moved up to my neck and face....as if my chest and back weren't bad enough. I've tried fluconazole
and nothing. Nizoral shampoo is too harsh so I can't do the 10 minute body treatment I am using oral itraconazole now...on week 2 and ketaconaze cream 2xday. So far barely any results ughhhhh. Sammie Jessie do you use the cream om just active bumps or rub it all over? Going to a naturopathic Dr Wed. I could tell from my initial consult she is clueless about malassezia yeast but maybe if I share some articles she'll have some ideas.

Try to get an appointment with an infectious disease specialist if you can. They are the gurus of the medical world when it comes to all things antimicrobial. If this is truly a stubborn fungal infection then the right combination of oral and topical medication will do the trick; its just a question of what.

In the meantime, do consider trying combination Lotrimin+ Lotrimin Ultra

Thanks for the comment 99f. I'll definitely ask about infectious disease. These doctors want to act like because they're meds haven't worked then I must not have it. Now they want to call it acne or clogged follicles even though I had a positive biopsy. And yes my follicles are plugged ....with pityrosporum! When I ask them what they're plugged with then I get a shoulder shrug. Really? These doctors are truly clueless. The more I try to advocate for myself the more they brush me off like I'm some kind of hypochondriac. Soooo frustrating

You might have to go through hell and back trying various things such as sea salt baths (thread on this forum), diluted bleach baths, Selsun blue shampoo, various prescription topicals or oral antifungals (which you should definitely NOT research on your own and order through the internet  ) but I promise you it will be worth it. If I were you I'd research metronidazole and whether it has any effects on fungal infections

On 9/20/2017 at 8:55 PM, sammijessie said:

I relate so much to this. I have had pityrosporum folliculitis on my back and chest for 8 years now. It took so many years to get it under control but now it's completely gone unless I don't stick to my routine. What worked for me was doing twice daily itraconazole for 7 days, then 4 weeks later do twice a day itraconazole for 2 days, then 4 weeks later do twice a day itraconazole for 2 days. In addition to this, every day put ketoconazole shampoo on your body and let it sit for 10 minutes, then shower. Twice a day put ketoconazole cream on. Once the itraconazole is done, what really works for me is to take one fluconazole pill for 3 days, then take one fluconazole pill weekly indefinitely. Continue using th ketoconazole cream and shampoo once a day indefinitely. 

Remember, it took me 6 years of seeing different dermatologists and trying countless different things before I found this routine that worked for me. If I go off this routine at all, my folliculitis flares up. I hope this helps! 

First of all im sorry for the late response, I didnt get any notifications from this website so I figured no one had replied.
Wow 8 years is alot. About the itraconazole routine, my GP doesn't want me to use oral antifungals for an extended period of time or as a maintenance routine so sadly I don't think she would let me. I've also tried ketaconazole shampoo in the mean time but that didn't seem to do much for me ( it did on my scalp, worked wonders for my dandruff). My GP put me on a new course of fluconazole for six weeks and told me to use ketaconazole cream afterwards for maintenance but the thing is, my fluconazole course is over now and my folliculitis is not even close to being gone so I'm afraid the ketaconazole cream won't make it better now that I have to stop taking the fluconazole. She wanted to see me after 6 weeks for a check up but I'm afraid she has ran out of ideas :(.

On 10/27/2017 at 7:52 PM, Nicole_CA said:

I'm in the same boat as the two of you. Battling for nearly a year and this stuff won't budge and spreads. Even worse its moved up to my neck and face....as if my chest and back weren't bad enough. I've tried fluconazole
and nothing. Nizoral shampoo is too harsh so I can't do the 10 minute body treatment I am using oral itraconazole now...on week 2 and ketaconaze cream 2xday. So far barely any results ughhhhh. Sammie Jessie do you use the cream om just active bumps or rub it all over? Going to a naturopathic Dr Wed. I could tell from my initial consult she is clueless about malassezia yeast but maybe if I share some articles she'll have some ideas.

You should use the ketaconazole cream all over the area that is infected not just on the active bumps! That way it can prevent new bumps from forming. And sadly not many doctors know about the malassezia yeast and also not much research has been done on it. I study biology and I find it very interesting to research some stuff so I've looked quite a bit on pubmed etc. for articles about alternative treatments but there aren't many articles about malassezia except that usual oral and topical antifungals such as ketaconazole, fluconazole, itraconazole etc. I just wish my GP would do a culture of my folliculitis to make sure it is a fungal infection ( im 99% sure it is, but maybe there is also something else apart from the malassezia that makes this infection so hard to cure) and send me to a dermatologist because she doesn't know that much about skin infections. I hope the itraconazole and ketaconazole cream work for you! Good luck.

On 12/7/2017 at 7:48 AM, 99f said:

Try to get an appointment with an infectious disease specialist if you can. They are the gurus of the medical world when it comes to all things antimicrobial. If this is truly a stubborn fungal infection then the right combination of oral and topical medication will do the trick; its just a question of what.

In the meantime, do consider trying combination Lotrimin+ Lotrimin Ultra

I've tried lotrimin ( well not that exact brand, but clotrimazole cream which has the same essential anti fungal ingredi«nt). It did something but not much. And I wish I could but I don't even know where to look for a specialist. My GP won't refer me to a dermatologist and if I would go to a dermatologist myself my insurance will not cover a single penny for sure. At this point though I would do anything to get rid of this, even if it costs alot of money.

By the way, do any of you guys have any knowledge about laser therapy or photodynamic therapy for fungal skin infections? I've found some people saying that laser hair removal is an option for folliculitis but all that does is get the hair follicle into a 'resting' phase where the follicle is still present but it just doesn't have active cells that make the hair able to grow. So with the follicle still being present I'm guessing it could still be a host to the fungus. Also I've found that laser therapy for toenail fungus can be very effective, but I havent seen laser therapy for fungal skin infections. Could the laser therapy for toenail fungus also be an option of fungal skin infections? I'm just super desperate to try anything since it has ruined my self confidence and is really controlling my life.

Sadly the oral itraconazole did not work on my face. It cleared up my neck and chest about 90% but not my face at all. Then 4 weeks after finishing the meds it all came back on my neck too. Nizoral shampoo left on my neck 10 minutes a day helped a lot of the bumps go down but my jawline and face are still covered. My derm prescribed ciclopirox shampoo and cream to try. My skin has become so sensitive I started by patch testing one side of my face with the cream. By day 5 my face was so red, inflamed and flaky I had to discontinue All these topicals have left my skin so red and irritated I don't know what to do. I went to a holistic esthetician and she recommended cold laser therapy. Apparently it heals skin on a cellular level and brings down inflammation. It won't kill yeast but maybe it'll help my skin repair itself some. I'm a little nervous because I've never done lasers and my face is so reactive but she feels there is 0 risk so I have an appt at the end of the month. I'll let you know how it goes!

6 hours ago, Nicole_CA said:

Sadly the oral itraconazole did not work on my face. It cleared up my neck and chest about 90% but not my face at all. Then 4 weeks after finishing the meds it all came back on my neck too. Nizoral shampoo left on my neck 10 minutes a day helped a lot of the bumps go down but my jawline and face are still covered. My derm prescribed ciclopirox shampoo and cream to try. My skin has become so sensitive I started by patch testing one side of my face with the cream. By day 5 my face was so red, inflamed and flaky I had to discontinue All these topicals have left my skin so red and irritated I don't know what to do. I went to a holistic esthetician and she recommended cold laser therapy. Apparently it heals skin on a cellular level and brings down inflammation. It won't kill yeast but maybe it'll help my skin repair itself some. I'm a little nervous because I've never done lasers and my face is so reactive but she feels there is 0 risk so I have an appt at the end of the month. I'll let you know how it goes!

Oh it sucks that your skin is so sensitive! My skin is sensitive but it can handle the harsh shampoos. Unforutnately, they don't work so it doesn't matter anyway. The cold laser therapy seems interesting, never heard of it before. I hope it works for you!

Ketoconazole 2% is a stronger version of Nizoral

On 11-1-2018 at 9:03 PM, 99f said:

Ketoconazole 2% is a stronger version of Nizoral

I know ! That's the one my GP prescribed me, I don't even have nizoral in my country haha. But the 2% didn't do much so yeah.

Okay question for you guys. Are you heat sensitive? Do you get diffuse redness to where it almost looks like constant flushing irritation that worsens with heat?Everywhere I have this folliculitis my skin looks flushed with huge pores and seriously inflamed. Even a warm office makes my face turn like a tomato. I don't know if my skin is just super irritated from topicals or if it's the fungus reacting. Doctors shrug their shoulder and say it's similar to rosacea but I know I don't have rosacea. This came on suddenly with the folliculitis and includes my upper chest and upper arms which can't be rosacea. It's awful. I'm gonna have to move to Alaska! 🙂

11 hours ago, Nicole_CA said:

Okay question for you guys. Are you heat sensitive? Do you get diffuse redness to where it almost looks like constant flushing irritation that worsens with heat?Everywhere I have this folliculitis my skin looks flushed with huge pores and seriously inflamed. Even a warm office makes my face turn like a tomato. I don't know if my skin is just super irritated from topicals or if it's the fungus reacting. Doctors shrug their shoulder and say it's similar to rosacea but I know I don't have rosacea. This came on suddenly with the folliculitis and includes my upper chest and upper arms which can't be rosacea. It's awful. I'm gonna have to move to Alaska! 🙂

Well I do have sudden red blotches when the temperature increases, for instance after the shower or exercise. But, this is a thing I've had all my life, so it doens't seem like something that is a side effect of my folliculitis. I haven't really paid attention to it but know that I think of it, it might have become a little worse since I've had folliculitis but I think that's just because the bumps get irritated after a shower/exercise and the skin surrounding it gets red temporarily too.

I am seeing one of the top dermatologists in my HMO group and Id like to share her advice for those who cant see a dermatologist or whose dermatologists have not been helpful.
She is very well-versed in this and is treating several patients for it right now. I got this after taking oral minocycline every day for 6 months for rosacea and went on vacation for two weeks to Brazil, which seems to be what really triggered it. I learned that taking oral antibiotics makes you very succipible to this. While that helped my face a lot (and my topicals are keeping it at bay), my scalp, back, shoulders, and butt got red bumps. I would say mine is (was) moderate and now is pretty mild and continues to improve. So, please keep in mind that because of the antibiotics, my pityrosporum has been difficult to combat as my skin and whole body recover from the bacteria that generally keeps this fungus in check comes back.

1. Pulse of 5 days oral itraconazole (200mg/say)
2. Daily 200 MG of oral fluconazole for several weeks now. Will probably be 3 months in total.
3. Wash every day (twice if it's hot and muggy or you just exercised) with:
- zinc soap (leave on for a minute)
- 2% Nizoral shampoo (use as body wash, leave on for 5 min)

Progress is so slow but it seems to be working. Thw hardest part is now waiting for all the dark marks to heal which will take many more months.