Malassezia Scalp Hair Loss

Malassezia, formerly known as Pittosporum (Pityrosporum ovale), is a type of yeast that is a part of the human skin’s natural flora (microbiome).1 The Malassezia yeast also has a pathogenic potential and under certain favourable conditions, it can invade all the layers of the epidermis and also the host immune system both directly and through certain chemical mediators, causing various skin diseases involving the face, scalp, and thorax.1 According to a study published in PubMed comparing hair loss and the presence of Malassezia yeast, it concludes that the majority of the subjects who were carriers of Malassezia yeast were significantly higher in the group with hair loss.4 Let’s understand various skin diseases associated with Malassezia yeast, its treatment, and how it can cause scalp hair loss.

What is Malassezia folliculitis?

Malassezia Folliculitis is an inflammation of the hair follicles caused by Malassezia yeast. In Malassezia folliculitis, the microorganism Malassezia, which is found on healthy skin, starts to multiply and infects the hair follicles causing red itchy bumps like eruptions. The typical symptom of Malassezia folliculitis is acne-like, itchy papules and pustules found particularly on the upper back and chest.5 It can also be found on the forehead, hairline, chin, and neck. Malassezia folliculitis is often wrongly diagnosed as acne vulgaris. The risk factors for Malassezia folliculitis are hot and humid weather, excessive sweating (hyperhidrosis), immunosuppression, and occlusion of follicles by sunscreen and emollients.5 These factors are believed to trigger the multiplication of Malassezia yeast.

Is Malassezia the same as seborrheic dermatitis?

Although Malassezia yeast is a part of the human microbiome, it can cause different types of skin disease mostly related to the face, upper body, and scalp because of its pathogenic potential. Malassezia is a lipophilic yeast, which means they depend on exogenous lipids, which explains their distribution on seborrheic skin areas. The common skin conditions caused by Malassezia yeast are seborrheic dermatitis, head and neck dermatitis, pityriasis versicolor, and Malassezia folliculitis.1 It can also be associated with other skin conditions like atopic eczema and psoriasis. Basically, Malassezia yeast is the causative factor of seborrheic dermatitis.

Does Malassezia folliculitis cause hair loss?

In Malassezia Folliculitis, the patient presents with a breakout of an itchy acne-like eruption mainly on the upper back, chest, forehead (hairline), chin, and neck. There will be reddish bumps with itching. Malassezia folliculitis itself does not cause any hair loss. However, Malassezia Folliculitis is usually associated with various skin diseases such as atopic eczema, seborrheic dermatitis, and dandruff.3 Hence if timely diagnosis and treatment are not done, it can cause an excessively greasy and oily scalp with flakes rapidly shedding and can lead to hair loss.

How do you treat scalp Malassezia? 

Malassezia-associated scalp diseases are usually treated with antifungal therapy, and if there is inflammation involved, then anti-inflammatory medicines are prescribed. Most Malassezia infections respond well to antifungal therapy. However, a combination of topical and systemic antifungals is seen to be most effective in completely curing Malassezia-related diseases. These are general guidelines for treating scalp Malassezia, and a general physician or a dermatologist will help in prescribing the best suitable treatment depending on the severity of the disease.

  • Local Application: Topical antifungal therapy which is proven effective for the treatment of Malassezia includes creams or lotions containing azoles (eg: ketoconazole, fluconazole), selenium sulphide, and propylene glycol 50%.1 These include over-the-counter anti-dandruff shampoos like Nizoral or Selsun shampoo applied for 10 minutes and washed off in the shower, Lamisil solution sprayed on the skin, or Loprox or Nizoral cream to be applied on the spots.3
  • Oral Medication: Antifungal oral medication like Itraconazole 100-200mg is prescribed by a physician for a period of 3 to 4 weeks which shows an improvement of about 69 - 100%, and fluconazole 100-200 mg daily for 4 weeks shows clinical effect of about 80%.1

How do you know if you have Malassezia on your scalp?

According to a research article published in PNAS, for more than 100 years, Malassezia has been associated with dandruff, which is an easily recognizable skin flaking condition seen in almost 30 to 95% of people.2 Dandruff is basically dead skin cells, where skin cells grow rapidly and die off too fast, showing signs like dry white scales on the scalp which can be oily, itchy, and found all over the scalp or accumulated in patches. Malassezia yeast is believed to contribute to causing dandruff. This microorganism lives on the scalp of all healthy humans, however, the immune system of some people with dandruff may overreact to this organism. 

If you are experiencing excessive scaling on the scalp which is greasy and associated with itching, you must consult a physician who will help in diagnosing if it’s a Malassezia infection on the scalp. The presence of Malassezia is not sufficient to cause dandruff or other skin conditions, however, treating with antifungal materials does help in removing the flakes which are used to treat Malassezia yeast.2

What kills Malassezia yeast on the scalp?

As Malassezia is a type of fungi, topical antifungal therapy is prescribed as the first line of treatment. It can also be a combination therapy of antifungal local application along with oral intake of medicines, depending on the severity of the disease (Refer to “How do you treat Scalp Malassezia” above).

Why is my scalp coming off in chunks?

In Malassezia yeast infection on the scalp, patients usually present with moderate to severe dandruff, to a stage of seborrheic dermatitis. Patients present with erythematous, greasy, flaking scales all over the scalp. These scales keep proliferating and shed off rapidly in chunks due to Malassezia yeast. It can increase in dry and cold weather, under stress, and in any immunosuppressive conditions. 

If the scalp is coming off in chunks it usually indicates a severe form of dandruff or even seborrheic dermatitis. These are just general diagnoses, and ideally, a physician or a dermatologist will help in giving an accurate diagnosis and suitable treatment.

What triggers Malassezia?

Malassezia yeast is a naturally-existing microorganism found on human skin. Under certain conditions, this yeast starts to multiply invading the skin and even host immune mechanisms. 

Factors that trigger Malassezia yeast causing it to multiply are:3

  1. Hot and humid weather
  2. Excessive sweating
  3. Oral steroids
  4. Stress or Fatigue
  5. Immunosuppression
  6. Occlusion of hair follicles by sunscreens and emollients
  7. Oral contraceptive pills
  8. Poor immunity (decreased resistance to microorganisms)
  9. Being overweight, resulting in increased sweating and tighter clothing

What does Malassezia feed on?

Malassezia yeast is a lipophilic fungus that depends on exogenous lipids as they lack fatty acid synthesis,1 which explains its prevalence in seborrhoeic skin areas such as the face, scalp, and thorax. They are normally present all over the body's skin areas, except the palms and feet. Malassezia basically feeds on oil-secreting skin cells and hence, when it invades the cells, it produces excess oil and makes the skin look greasy and unhealthy.


Malassezia yeast is a complex fungus that is a part of the human skin’s natural flora and is found on normal healthy skin. However, under certain conditions, this fungus multiplies and infects the skin cells, causing various skin-related diseases. As this microorganism is found more on seborrheic areas of the skin, Malassezia-associated skin diseases are seen more on the face, scalp, and upper body.

Skin diseases such as seborrheic dermatitis, atopic eczema, head and neck dermatitis, Malassezia folliculitis, and even severe dandruff, if left untreated, can lead to Malassezia scalp hair loss. However, in most cases, hair loss is not permanent, follicles are still alive so the hair grows back once the skin condition is under control. Over-the-counter medicines such as an anti-dandruff shampoo or antifungal tablets do help in keeping Malassezia yeast under control, but a proper systemic and topical antifungal prescription by a physician will be needed to cure the disease completely.


  1. Saunte DML, Gaitanis G, Hay RJ. Malassezia-Associated Skin Diseases, the Use of Diagnostics and Treatment. Front Cell Infect Microbiol. 2020 Mar 20;10:112.
  2. Xu J, Saunders CW, Hu P, Grant RA, Boekhout T, Kuramae EE, et al. Dandruff-associated Malassezia genomes reveal convergent and divergent virulence traits shared with plant and human fungal pathogens. Proc Natl Acad Sci U S A. 2007 Nov 20;104(47):18730-5.
  4. Nematian J, Ravaghi M, Gholamrezanezhad A, Nematian E. Increased hair shedding may be associated with the presence of Pityrosporum ovale. Am J Clin Dermatol. 2006;7(4):263-6.
  5. Oakley A. Malasezzia folliculitis [Internet].
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Shalini Anoop

Bachelor of Homeopathic Medicine and Surgery (BHMS), Maharashtra University, India

Shalini Anoop is a Homeopathic Physician from India and has working experience in clinical, hospital and healthcare industry for over 10 years. She has worked in clinical research, pharmacovigilance and is a passionate medical article writer. She is currently undertaking Medical Article writing online from London.

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