Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2024;14(1):e2024092 1

UV Dermoscopy for the Diagnosis 
of Pityrosporum Folliculitis

Arthur Macedo Goulart Silva1, Alexandre Ozores Michalany2,3, 
Gustavo de Sá Menezes Carvalho2,4

1 Dermatology resident at the University of Santo Amaro - UNISA - São Paulo (SP), Brasil

2 Preceptor of the dermatology clinic at the University of Santo Amaro - UNISA - São Paulo (SP), Brasil

3 Pathologist at the dermatology clinic at the University of Santo Amaro - UNISA - São Paulo (SP), Brasil

4 Dermatologist at AC Camargo Cancer Center, São Paulo (SP), Brasil

Citation: Silva AMG, Michalany AO, Carvalho GSM. UV Dermoscopy for the Diagnosis of Pityrosporum Folliculitis. Dermatol Pract 
Concept. 2024;14(1):e2024092. DOI: https://doi.org/10.5826/dpc.1401a92

Accepted: October 10, 2023; Published: January 2024

Copyright: ©2024 Silva et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Gustavo de Sá Menezes Carvalho, AC Camargo Cancer Center, 1167 Pires da Mota street, São Paulo / 
State: São Paulo, Zip-Code: 01529-001. Tel: 11-2189-5000 Email: gustavo.carvalho@accamargo.org.br

Case Presentation

We present a case of a 17-year-old girl with a history of 

disseminated erythematous follicular papules on the upper 

chest, back, and upper limbs for the past 2 years, accompa-

nied by mild itching and intermittent periods of exacerbation 

(Figure 1A). Upon examination, bright-green fluorescence 

was observed in the affected follicle using UV-induced flu-

orescence dermatoscopy (DL5, light 365nm, Dermlite®) 

(Figure 1B). A biopsy of a follicular papule confirmed the 

diagnosis of pityrosporum folliculits (PF) (Figure 1C). After 

treatment with fluconazole 150 mg/week for 6 weeks, his 

lesions completely resolved.

Teaching Point

PF is a cutaneous condition secondary to infection of the hair 

follicle by fungi of the genus Malassezia spp [1]. This fungus 

has enzymes, such as lipases and phospholipases, capable of 

hydrolyzing triglycerides into fatty acids, thereby promot-

ing follicular occlusion [1]. PF has a universal distribution, 

predominantly affects young adults, and is associated with 

antibiotic therapy, diabetes mellitus and immunosuppres-

sants [1].

With the advancement of new technologies, dermoscopy 

combined with UV light has become an effective tool in the 

investigation of such cases. In this case, the lesions presented 

with follicle-bound bluish white, as previously described [2], 

associated with the visualization of the central follicular 

bright green color only seen through the dermoscope with 

UV light.

We emphasize the importance of dermoscopy combined 

with Wood lamp in the diagnostic elucidation of this condi-

tion and encourage further scientific publications. The visu-

alization of this follicular staining can improve the diagnosis 

and treatment of these cases.



2 Image Letter | Dermatol Pract Concept. 2024;14(1):e2024092

References

1. Green M, Feschuk AM, Kashetsky N, Maibach HI. Clinical 

characteristics and treatment outcomes of Pityrosporum fol-

liculitis in immunocompetent patients. Arch Dermatol Res. 

2023;315(6):1497-1509. DOI: 10.1007/s00403-022-02506-0. 

PMID: 36517586. PMCID: PMC9750048.

2. Klatte JL, van der Beek N, Kemperman PM. 100 years of Wood’s 

lamp revised. J Eur Acad Dermatol Venereol. 2015;29(5): 

842-847. DOI: 10.1111/jdv.12860. PMID: 25428804.

Figure 1. (A) Diffuse follicular erythematous papules located on the trunk and upper limbs. (B) Bright-green fluorescence was observed in 

the affected follicle and bound bluish white (DL5 with UV light, 10x). (C) Hair follicle whose lumen of the sebaceous duct is enlarged by 

accumulation of secretion with focal parakeratosis and presence of spores (PAS, 400x).