Background: Pityrosporum folliculitis is a common inflammatory skin disorder t hat may mimic acne vulgaris. Some adolescents with recalcitrant follicular pustu les or papules may have acne and Pityrosporum folliculitis simultaneously. Clini cal response is dependent on treating both conditions. Objectives: To demonstrat e the similarity in clinical manifestation between acne vulgaris and Pityrosporu m folliculitis, the benefit of potassium hydroxide preparation, and the benefit of appropriate antifungal therapy. Patients: We describe 6 female adolescents wi th concurrent Pityrosporum folliculitis infection and acne vulgaris. Interventio n: A potassium hydroxide examination was performed on all 6 patients from the ex udate of follicular pustules exhibiting spores consistent with yeast. All patien ts were treated with oral antifungals, and 5 of the 6 patients were also treated with topical antifungals. Results: Six of 6 patients improved with antifungal t reatment. All patients also required some ongoing therapy for their acne. Conclu sions: These patients demonstrate that follicular papulopustular inflammation of the face, back, and chest may be due to a combination of acne vulgaris and Pity rosporum folliculitis, a common yet less frequently identified disorder. Symptom s often wax and wane depending on the patient’s activities, time of the year, c urrent treatment regimens, and other factors. Pityrosporum folliculitis will oft en worsen with traditional acne therapy and dramatically respond to antifungal t herapy.
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