BACKGROUND: Malassezia folliculitis (MF), commonly referred to as "fungal acne" is a dermatological condition caused by colonization of the commensal fungus Malassezia, which turns pathogenic under certain conditions. MF presents as pruritic, erythematous papules and pustules and is often mistaken for other dermatological conditions, including acne vulgaris (AV). Interest in MF has intensified in recent years, likely due to social media trends, leading to concern regarding patients inappropriately applying antifungals without a confirmed diagnosis. METHODS: This narrative review summarizes the prevalence of MF, risk factors for the condition, MF pathogenesis, diagnosis, and treatment options. RESULTS: MF prevalence varies by geographic region and is higher in patients diagnosed with AV versus the general population. Risk factors include hot, humid weather, hair follicle occlusion, and immunocompromise. Increased sebum production, lipase activity, and inflammation contribute to the pathogenesis of both MF and AV. MF diagnosis includes clinical presentation and confirmatory tests such as direct microscopy and histopathology. The mainstay of treatment is antifungal medication, though given shared pathogenic mechanisms between AV and MF, acne topicals that target pathogenesis of both conditions, including benzoyl peroxide and retinoids, may be beneficial. CONCLUSION: Clinical presentation of MF resembles that of AV and other skin conditions, leading to misdiagnosis, delays in treatment, and persistence of MF in patients for years. This underscores the need for appropriate diagnosis and timely treatment. Given shared pathogenic mechanisms between AV and MF, further investigation of acne topicals that target the pathogenesis of both conditions for the treatment of MF is warranted.
Draelos et al. (Wed,) studied this question.