Dandruff

Scalp

ADVANCED CARE GUIDE

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Copyright © Hairqare by Holinic 2022
Dandruff
Scalp

ADVANCED CARE GUIDE

 DIY SCHOOL

Table of Contents

6 28
Introduction What to Avoid if You have
Malassezia Folliculitis
8
Difference Between 60
Dandruff, Psoriasis, Oils That Won’t Aggravate
Seborrheic Dermatitis Malassezia

14 64
Dandruff vs. Dry Malassezia Treatment
and Flaky Scalp
66
18 Types of Antifungals
Scalp Conditions Associated
with Malassezia 76
Malassezia Natural
22 Treatment Options
Malassezia Symptoms: How
to Know You Have It 86
Diet and Malassezia
26
Causes of Malassezia- 88
Related Scalp Conditions Final Words

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Introduction

Itch. Scratch. Itch. Scratch. Itch. You know what’s next.

Does this routine look familiar to you? Have you tried all the
products produced on planet earth — maybe not all, but a lot
of them — and you still haven’t been able to stop this cycle?

Maybe there’s an aspect of this routine you haven’t considered,

because it’s not a very fun topic. But, over at the Hairqare Lab,
we love adding fun to long, science-y facts and amplifying it
to help you understand and read it better!

In this itch-taming book, we will discuss:

• the annoying critters behind your itchy scalp (how, why,

and where they breed)
• dandruff and its misconceptions
• main scalp conditions and what to do about them (things
to avoid, embrace, etc.)
• how to personally diagnose your scalp conditions, and
finally
• how to keep your hair squeaky-clean, itch-free, and
flake-free

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You will discover a wealth of information packed in this

“tiny” book, so get ready for the journey of a lifetime.
Even if you’re not too keen on reading, how about finally
getting your hands off your reddened scalp and feeling
some relief?

The treatment you need is sitting in the last chapter of

this book, and the last one is our favorite, so get going!

We all have quirks and unique traits that define us

perfectly. However, if all t you see is an oily scalp, crazed
itching, and flakes, these issues should never define you.
That’s why we’ve brought you this detailed and easy-to-
digest book that will help you rid your scalp of every itch,
excess oil, and flake.

Best,
Your Hairqare Lab Team
Difference Between Dandruff,

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Psoriasis, Seborrheic Dermatitis,

And Other Skin Conditions Caused
by Malassezia

Let’s start with a simple definition. Malassezia — formerly

known as Pityrosporum — these species are fungi that are part
of your skin flora. These fungi coat a newborn immediately
after birth and begin to decrease in number until the age of 12.

This means they are essential and helpful, but only on parts
of the skin that are not scalp-related. Everyone knows that
evil communication corrupts good manners, and too much
of a good thing can produce bad results. Something similar
happens to your skin and scalp. When Malassezia species
encounter your hair follicles or multiply on your skin, they turn
bad instantly.

In this state, they form colonies on your skin and scalp, from
which they specialize in attacking, sucking dry, and generally
causing harm to your skin and scalp.
Like every other fungus, Malassezia skin conditions are

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caused by an infection and overgrowth of the hair follicle.

One thing that worsens this condition is dirty hair from not
washing your hair as you should and using contaminated or
dirty fingers and hair tools. This is why you should always
use clean hands, accessories, and tools on your hair. As the
saying goes, a clean scalp a day keeps the fungus away —
it’s not a very popular saying.

There are only 14 of these species, which mostly look like

gibberish when listed together. So, here’s a table to help with
that:

M. slooffiae M. furfur M. yamatoensis

M. pachydermatis M. capre M. sympodialisis

M. nana M. globosa M. japonica

M. obtusa M. dermatis M. restricta

M. equina M. cuniculi

M. cuniculi species is the latest addition to the Malassezia

family. Oh, joy!
Because these fungi are mostly lipophilic (have a strong love

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for lipids and fats), these Malassezia live in the parts of your
skin where there are lots of lipids and fats. These places are
called the seborrheic regions. Malassezia causes small, itchy
bumps (pustules) to erupt on your skin in the areas affected
by the fungi. They form colonies, live, and feed off of the
fatty acids present in the normal sebum — that belongs to
you! They have no respect for privacy, these pests.

They take their sweet time to throw parties on your follicles

and feast on your sebum at will. The reason they do this is
the human sebum contains a complex mixture of yummy fats
and lipids: Squalane, triglycerides, wax esters, cholesterol
esters, fatty acids, sterol esters, and cholesterol lipids.
Malassezia species utilize this sebum by breaking down the
esters and triglycerides in the sebum. The results of this are
free fatty acids, diglycerides, and monoglycerides.

Along the way, the Malassezia species reproduce and make

a complete mess on your skin and scalp. While they make
your scalp their home — without even paying rent, the nerve!
— they break the sebum down into the by-products above,
including oleic acid.
This is where the problem starts and leads up to dandruff.

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So, how does your body react to this

new acidic tenant? About 50% of people
worldwide are sensitive to this acid. As
a result, your body tries to drive it away
— as it does to most foreign, unaccepted
bodies — by increasing the rate at which
your skin cells renew.

This leads to flaking that is visible on your

head and shoulders, and more negative
responses from your body just to get
rid of these nasty vermins. This reaction
by your body is what causes you to itch
more, scratch wildly, and wish you could
uproot your scalp for a while and deal
with the consequences later!

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Malassezia also leads to the inflammation of your hair

follicles, which further causes excessive oil secretion.
So, as your scalp breeds more Malassezia, be prepared
for an onslaught of tenderness, inflammations, and you
guessed it, oil. The more oil these fungi find on your
scalp, the more they feed, breed, and succeed! The
cycle is almost never-ending. Bummer!

These Malassezia siblings are also known to cause skin

conditions like seborrheic dermatitis, dandruff (as was
explained), fungemia, psoriasis, and tinea versicolor.
These conditions are results of the same species, but
they are all unique conditions and have somewhat
different symptoms.

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Most people mistake Malassezia folliculitis for acne, so

they tend to treat it like regular acne, and this worsens
the situation. You should know that it’s common to
misdiagnose Malassezia folliculitis as acne. To help you
differentiate between them, keep in mind that acne
has comedones (otherwise known as blackheads or
whiteheads), while Malassezia doesn’t have comedones.

Also, Malassezia is an extremely uncomfortable and

itchy condition. This is similar to acne, except acne
doesn’t cause itching.

Seborrheic dermatitis (or dandruff) is a co-occurring

condition with Malassezia folliculitis, and they both have
similar treatments, which you will see later!

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Dandruff vs. Dry

and Flaky Scalp

You know that indescribable feeling when you get out of

the shower and start to give your skin a bit of that TLC,
featuring some moisturizing lotion, soothing essential oil,
facial massage, and all that good stuff? How did you feel?
Happy, loved, and ready to conquer the world? This is just
how your hair and scalp feel after a thorough moisturizing
and pampering session.

Let’s remember those hard days where maybe you had to

stand in line for 16 hours without food and water? What,
you’ve never done that? Well, just imagine you did. The next
minute a fellow life form (like a bug) tries to interfere with
you, you flare up instantly! Your hair gives a similar reaction
to this situation.

Let’s break this down a bit. In this case, your hair is without
food (hair nutrients and vitamins) and water (proper moisture)
for days on end. Then, one day out of the blue (like the bug),
you decide to fix it up and style it for an occasion. We doubt
you’ll get anything besides a dry, frizzy, and “bad hair day”
look from this encounter. So, be honest, the days leading up
to the times your hair refused to “cooperate” with you,
were you moisturizing it ?

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Lack of moisture leads to a bad case of dry hair, and when

you expose it to the sun to suck up more of that moisture,
your hair and scalp get fed up with you and give you the cold
shoulder. During this period, your scalp gets so irritated that it
begins to flake. Picture dry and crusty soil on a hot sunny day.
Can you see the cracks and crusts within and how easy it is
to separate them? Unmoisturized and dry hair is very similar.

Dandruff Scalp

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Although dry and flaky scalp and dandruff have the same
main symptoms, they are two different conditions and don’t
require the same treatments. Where excess oil leads to too
much skin build-up, shedding, flaking, and even dandruff; dry
and flaky scalp are caused by generally neglecting your hair
and keeping moisture from it. If you expect your hair to still
grow in this state, you are mistaken.

The reason people don’t moisturize their hair is simple: They

are mostly uninformed or misled. Often, people hear, “Leave
your hair alone, and it will grow like weeds!” They think
moisturizing and treating their hair is classified as “touching”
it. In essence, you are touching your hair, but it’s essential for
healthy hair.

To prevent your hair and scalp from dryness and flaking,

moisturize your hair and scalp with a leave-in conditioner,
water, or other moisturizers like rosewater and moisturizing
mists, and seal in this moisture with butter and/or oil every
time you sense your hair and scalp need moisture. Lastly,
always keep your hair in not-too-tight protective styles. Tight
styles lead to a lot of breakage, irritation, and you guessed
it, flakes!

Now, the “leave your hair alone” part means when you are
not moisturizing or treating your hair, do not touch it. Also,
avoid switching up hairstyles unnecessarily; this will help
you minimize the tension, irritation, and manipulation on your
scalp.

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Scalp Conditions
Associated with Malassezia

Scalp Eczema (Atopic dermatitis)

Atopic dermatitis is a chronic and long-

Image credits: healthline.com

lasting condition that makes your scalp
super irritated, red, and itchy! You may
experience it with hay fear or asthma.
This angry red condition is associated
with the following Malassezia siblings:
M. globosa, M. furfur, M. sympodialis,
and M. restricta.

Dandruff

This one is a common condition. It leads

to scalp irritation, flaking, redness due
to itching, and more flaking. Dandruff
is a mild form of seborrheic dermatitis.
Most times, these symptoms are
embarrassing and difficult to deal with.
Dandruff is associated with M. globosa
and M. restricta.

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Psoriasis
The P in psoriasis should stand for patches! This condition
makes scaly, raised, and reddish patches appear on your
scalp. You can see it as single or several patches on a
spot or your entire scalp! It’s annoying how these things
rudely take up space on your scalp, we know. Psoriasis
can even spread to the back of your neck, ears (inside
and behind), and forehead. This condition is associated
with M. furfur, M. restricta, and M. globosa.

Image credits: everydayhealth.com

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Seborrheic dermatitis

Dandruff is a symptom of seborrheic dermatitis (SD). It

leads to inflammation and flaky scales on an itchy rash.
If you have light skin, you will see angry red patches; on
darker skin, you will see light patches. An oily scalp and
seborrheic dermatitis go hand-in-hand. You see why
dandruff is a symptom now? Other names for seborrheic
dermatitis are seborrheic psoriasis, dandruff, seborrheic
eczema, seborrhea, and cradle cap.

This condition is associated with M. furfur, M. globosa,

M. restricta, M. sympodialis, M. obtuse, M. slooffiae,
and M. yamatoensis. But, the fungus isn’t the only
causative agent. The bacterium staphylococcus is the
most common bacteria on the skin of SD patients! So, it
must be a causative culprit too.

Image credits: healthline.com

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Tinea versicolor

Tinea versicolor usually affects your shoulders, back,

and chest. But, it may spread to your face and lower
scalp! This condition does a bit of painting on the skin
and results in small, discolored patches. It could make
you self-conscious or emotionally distressed. You really
don’t want people seeing these embarrassing critters
onyou. Tinea versicolor is associated with M. globosa,
M. sympodialis, and M. furfur.

If you noticed, these conditions are caused by the same

fungus: Malassezia. So, if you treat them with the same
methods, drugs, etc., there’s every chance that there
will be an improvement.

Image credits:nutroo.me

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Malassezia Symptoms:
How to Know You Have It

There are many tell-tale signs of a Malassezia scalp or

skin infection. Some of them are:

9 Presence of white, pus-filled pimples

9 Presence of shedding or white, flaky scales as a
result of the irritated scalp and follicles
9 Presence of patches, purple or red rash, or
cracks on the skin
9 Visible white, moist, and soft areas

These are a bit similar to the symptoms and effects of

a dry, flaky scalp. But, remember to treat and diagnose
them differently from Malassezia-related scalp and skin
infections because they are two different conditions.

When you wrongly diagnose and treat both conditions

the same way, you could worsen the situation to grave
degrees, so make sure you’ve got the right bandit in your
net. Hopefully, that makes sense. Here are full-proof ways
to properly self-diagnose for Malassezia.

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1. Using Skin Scrapings

Get some skin scrapings from your scalp, the back of your
nails, or skin — obviously. Using potassium hydroxide
preparations [this is a drop of 20% potassium hydroxide
(KOH)], view the scrapings with a microscope. If you have
Malassezia, you will notice long hyphae and clusters of
yeast cells in a “spaghetti and meatballs” form.

Here are the steps:

1. Place your scrapings on a clean slide.

2. Add a drop of 20% potassium hydroxide.
3. Place the cover glass on the slide and gently
press to get rid of any air bubbles (we want to
keep the system as closed off from outside
forces as possible).
4. You can now place the slide on the microscope
stage and peer in at a low-power (10x)
magnification. This is probably giving you Biology
class vibes. Remember to look for the spaghetti-
and-meatball-like fungi.

Since it’s a bit difficult to grow Malassezia species, your

tests may come out as false. Your best bet is to add olive
oil (remember Malassezia like fatty acids) to the Littman
agar culture medium. Then, your results will most likely
come out accurately.

We understand that this looks a bit tricky, but it’s the most
accurate test to perform without requiring the services
of a specialist. So, if this looks like your test, have at it!

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2. Conducting Skin Biopsy

This is a bit similar to the skin scrapings
approach. The difference is in skin biopsy, a
dermatologist will administer a local anesthetic
to you and remove a skin lesion. In case you’re
wondering, a lesion is an abnormal change
or damage on your skin; caused by trauma
or disease (like a fungus infection). Your skin
lesion will undergo a microscopic diagnosis by
a pathologist, so he or she can see who these
trespassers are. You should get your results
within 4 to 10 days.

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3. Using Blacklight

This is a pretty easy way to self-diagnose for

Malassezia. All you need is your skin and a
blacklight. If you notice bumps or disruptions
on your skin that fit the Malassezia-related
symptoms, examine your skin up close with
a blacklight. If the irregularities on your skin
light up to a coral-orange-red color, you have
bacterial acne. But, if they light up to a blue-
white-yellow color — weird, we know! — you’ve
got some yeast tenants.

If you would like to really examine these

microorganisms, you can extract a papule
(which is another name for a pimple or zit).

You can extract the pus from your pimple and

observe the content of Malassezia’s little house
under the light. You don’t need to make a
makeshift blacklight for this test. Doctors have
a lamp (Wood’s lamp) similar to the blacklight
device or bulb.

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Causes of Malassezia-
Related Scalp
Conditions
Like we saw earlier, there’s a lot of misconception going
on about Malassezia. But, there are a few factors that
could cause its onset. Let’s take a look at them:

External Factors

This topic has a broader scope, so we’ll be breaking

this down in the “things to avoid” section. But, you
should take note of a few pointers. Excessive occlusion,
which is the closing or blockage of a hollow organ (like
your skin pores) or blood vessels, hot weather, many
skincare products, sweat, and high humidity, can cause
Malassezia-skin conditions to thrive on your skin!

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Internal Factors

As the term “internal” implies, these are factors within your bloodstreams and other
parts of your internal system that cause Malassezia to blossom and shine on your
skin. Sadly, your enemy is operating from your own body. Patients with immunologic
deficiencies, diabetes, neurotransmitter abnormalities, HIV, nutritional disorders,
Hodgkin’s disease, or bone marrow or organ transplant recipients have more incidences
of Malassezia folliculitis.

Did you know pathogenic Malassezia flairs through antibiotics? Especially broad-
spectrum antibiotics, like tetracyclines, taken for prolonged periods. This is due to the
antibiotics attacking and killing your normal skin flora, and exposing more grounds for
Malassezia to build, plant, harvest, and expand!

This news is very frustrating because:

1. Most doctors are quick to prescribe antibiotics.

2. Most people self-prescribe antibiotics and take it for as long or as short as they
please.
3. Malassezia is misdiagnosed on a regular basis.

So, you see why you should only take antibiotics when you should, not when you like.
Also, strictly follow the prescribed dosage. We know how much work it takes to be
regular with medication, but it’s one thing that can help you pull the rug out from under
Malassezia’s ugly feet. Another thing you should do is follow up your antibiotic use with
a high-quality and efficient probiotic! Last but not least is fatigue, stress, obesity, birth
control pills, pregnancy, and steroid use have all led to reported cases of Malassezia
folliculitis!

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What to Avoid if You

have Malassezia
Folliculitis

In this fight against Malassezia, what we want to do

is take it out of its comfort zone, strip it of its powers,
and rule your skin kingdom! As per our not-so-secret
plan, here’s what you should avoid to keep Malassezia
uncomfortable and on edge on your skin.

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Fatty Acids and Oils

Like we saw earlier, Malassezia loves to feed and feast on

long-chain (between 11 and 24) carbon fatty acids. Take a
look at this picture to see how fungi fare and grow with fatty
acids in the vicinity:

VOL. 108 SOURCE: (1968). WILDE, P. F., AND STEWART, P. S. A STUDY OF THE FATTY ACID
METABOLISM OF THE YEAST PITYROSPORUM OVALE. BIOCHEM. J. 108: 225–231. DOI:
10.1042/BJ1080225

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What’s the significance of this? It means that a bulk of hair

care products (we’re talking over 95%) contain variations
of fatty acids that will serve as a sumptuous banquet and
breed more skin and scalp problems.

Remember, oils have some form of fatty acids, usually

in the form of triglycerides. Malassezia prides itself in
showing versatility and strength, so these triglycerides
are no match for it. It has underdogs that help it do the
dirty business of hydrolyzing (this is a chemical reaction
where larger compounds are broken down into smaller
ones when they react with water) triglycerides into the
free fatty acids Malassezia species enjoy.

So, this overzealous group of fungi can break down the

fatty acids present in oils to free fatty acids and use
them to develop, grow, and reproduce. A lot of reputable
studies have proven this to be true. You know, maybe
there’s nothing wrong with this, except they are doing this
process on your face, without pay or approval!

Let’s go over this golden rule again because third time’s

a charm: If you have Malassezia, avoid most fatty acids
and oils the best way you can! Did you get confused at
“most”? Well, we have good news: There are 3 oils you
can safely use with Malassezia. Here’s a comprehensive
list of the main 11-24 carbon chain fatty acids you should
steer clear of, so you get to have them at your fingertips.

TABLE 1 SOURCE: (1975). PORRO, M. N., PASSI, S., CAPRILLI, F., NAZZARO, P., MOR-
PURGO, G. GROWTH REQUIREMENTS AND LIPID METABOLISM OF PITYROSPORUM
ORBICULARE. INSTITUTE OF DERMATOLOGY, ST. GALLICANO, ROME, ITALY.

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Table 1:
Effect of varying fatty acids on growth of
Pityrosporum orbiculare at 10 days

Basal medium Basal medium

Fatty acid supplements
(mg dry weight + 0.2% tRITON
(2 mg/ml)
/ 100 ML) X-100

None 0 0
n-Octanoic 0 0
n-Decanoic 0 0
n- Dodecanoic 8.5 24.4
n-Tetradecanoic 17.2 132.0
n-Hexadecanoic 181.0 318.0
n-Octadecanoic 114.0 281.5
n-Eicosanoic 173.5 186.4
n-Docosanoic 45.5 52.5
n-Tetradecenoic 15.7 22.4
9-Tetradecenoic 29.0 11.4
9-Hexadecenoic 114.0 48.5
9-Octadecenoic 360.0 80.5
trans-9-Octadecenoic 0 0
12 OH-9-Octadecenoic 268.0 31.2
cis-13-Docosenoic 197.3 8.2
cis-15-Tetracosenoic 6.1 2.0

Vit F (linoleic, linolenic,

214.0 67.4
and arachidonic)

Tween 40 195.0 Not done

Tween 60 147.4 Not done
Tween 80 178.5 Not done

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Undecylenic Acid (C11)

Lauric / Dodecanoic (C12)

Tridecylic (C13)
Myristic / Tetradecanoic (C14)
Pentadecanoic (C15)
Palmitic / Hexadecanoic (C16)
Palmitoleic / Hexadecenoic (C16:1)
Margaric (C17)
Stearic / Octadecanoic (C18)
Oleic / Octadecenoic (C18:1)
Linoleic (C18:2)
α-Linolenic (C18:3)
Nonadecylic (C19)
Arachidic / Eicosanoic (C20)
Heneicosylic (C21)
Behenic / Docosanoic (C22)
Tricosylic (C23)
cis-15-Tetracosenoic

Vit F (linoleic, linolenic, and arachidonic)

Note: C24 means the fatty acid has a carbon

chain length of 24 or has 24 carbon atoms.

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For reference purposes, here’s a list of fatty acids with carbon chains of length 4
through 38. Remember, you only need to avoid fatty acids with carbon lengths between
11 and 24.

Lipids: fatty acids

Saturated Propionic (C3) • Butyric (C4) • Valeric (C5) • Caproic (C6) • Enanthic
(C7) Caprylic (C8) • Pelargonic (C9) • Capric (C10) • Undecylic (C11) •
Lauric (C12) • Tridecylic (C13) • Myristic (C14) • Pentadecylic (C15) •
Palmitic (C16) • Margaric (C17) • Stearic (C18) • Nonadecylic (C19) •
Arachidic (C20) Heneicosylic (C21) • Behenic (C22) • Tricosylic (C23) •
Lignoceric (C24) Pentacosylic (C25)Cerotic (C26) • Heptacosylic (C27)
• Montanic (C28)Nonacosylic (C29) • Melissic (C30) • Hentriacontylic
(C31) • Lacceroic (C32) Psyllic (C33) • Geddic (C34) • Ceroplastic (C35) •
Hexatriacontylic (C36) Heptatriacontanoic (C37) • Octatriacontanoic (C38)
• Nonatriacontanoic (C39)Tetracontanoic (C40)

3 Unsaturated Octenoic (8:1) • Decenoic (10:1) • Decadienoic (10:2) • Lauroleic (12:1)

Laurolinoleic (12:2) • Myristovaccenic (14:1) • Myristolinoleic (14:2)
Myristolinolenic (14:3) • Palmitolinolenic (16:3) • Palmitidonic (16:4)
α-Linolenic (18:3) • Stearidonic (18:4) • Dihomo-α-linolenic (20:3)
Eicosatetraenoic (20:4) • Eicosapentaenoic (20:5) • Clupanodonic (22:5)
Docosahexaenoic (22:6) • 9,12,15,18,21-Tetracosapentaenoic (24:5) •
6,9,12,15,18,21-Tetracosahexaenoic (24:6)

6 Unsaturated 8-Tetradecenoic (14:1) • 12-Octadecenoic (18:1) • Linoleic (18:2)

Linolelaidic (trans-18:2) • γ-Linolenic (18:3) • Calendic (18:3) • Pinolenic
(18:3) • Dihomo-linoleic (20:2) • Dihomo-γ-linolenic (20:3) • Arachidonic
(20:4) • Adrenic (22:4) • Osbond (22:5)

7 Unsaturated Palmitoleic (16:1) • Vaccenic (18:1) • Rumenic (18:2) • Paullinic (20:1) •

7,10,13-Eicosatrienoic (20:3)

9 Unsaturated Oleic (18:1) • Elaidic (trans-18:1) • Gondoic (20:1) • Erucic (22:1) • Nervonic
(24:1) • 8,11-Eicosadienoic (20:2) • Mead (20:3)

Cholesterol If you do an extensive patch test and it works fine for you, have at it!

Squalene Squalane (with an “a”) in skincare products is awesome! Squalene (with an

“e”) is Malassezia food.

Amino acids/ Amino acids + pyridoxine (vitamin B6) + thiamine (vitamin B1) + lipids =
Vitamins CATASTROPHE

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The most popular fatty acids included in hair care

products have even-numbered carbon chain lengths,
especially linoleic, palmitic, lauric, oleic, myristic, and
stearic acids. All you need to do to check for these fatty
acids is to scan the ingredient list on the back of your
hair care products.

Unfortunately, some hair care products exclude some

ingredients and write things like “carrier oils” or “30
ayurvedic herbs infused” in the ingredients section,
without stating each product’s composition and laying
it all bare. So, you see why you must buy your products
from trusted and respected brands.

Be especially careful when it comes to oleic and palmitic

acids. They could be referred to as the best Malassezia
fertilizers because they are used to induce the mycelial
phase (the phase with a speedy growth phase) in vitro
and make M. furfur to grow very fast!

Also, we can’t overemphasize how important it is that you

do a patch test for ALL your hair care products for at least
a couple of weeks! We’re sure the last thing you want to
do is use a skin and hair butter or fat-based cream for a
couple of days and continue its use because “your skin
and scalp are glowing and are as fresh as the morning
sun,” only for you, a month later, to look at the angry red
or discolored houses of Malassezia species occupying
your skin and scalp, and you start to wonder:

“What sorcery is this?!?”

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Esters

Ah, esters... Doesn’t this remind you of those forlorn, occasionally blissful
days in high school when you had to memorize at least the first 30
elements and cram up for tests? We’ve had a lot of questions regarding
whether esters can feed Malassezia fungi.

If you can go down memory lane far enough or recall your organic
chemistry, you could remember an equation that looked like this:

Alcohol + Alkanoic acid => Ester

In haircare, esters are a combination of glycerol or alcohol with a fatty

acid. The resulting compound is called a fatty acid ester. For instance,
if you combine palmitic fatty acid with rubbing alcohol (isopropyl
alcohol), you will get isopropyl palmitate — a common ingredient in
many moisturizers, like the popular Aveeno Daily Moisturizing Lotion.

It is super easy to find esters in your hair care products because they
end in the suffix -ATE. Here are some examples: glyceryl stearate,
isopropyl palmitate, and decyl oleate.

Note: This “-ATE rule” is not a hard and fast rule! There are exceptions,
but it’s still a good working rule to go by.

Are you still there? Hopefully, you’ve not given up and left us blabbing to
ourselves. It’s understandable for you to take your time to grasp where
this is going, so here’s a recap to help:

• alcohol + fatty acid = ester.

• glycerin + fatty acid = glyceride, also known as a glycerol ester.
• Esters in your hair care products end in -ATE.

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Are we back on track now?

Excellent!
Now, let’s make this more practical. Grab your lab coats!

It turns out that Malassezia species can make growth-

inducing dishes with esters, depending on which alcohols
and fatty acids are present in those esters.

Need some info on which fatty acids and alcohols in

esters scream, “Fertilizer for Malassezia!”? We’ve got you.
Here’s how it goes in descending order:

Ethanol > Isopropyl alcohol > decyl alcohol

Further explanation: Esters made with ethanol give

Malassezia so much growth and joy. After them, we
have esters made with isopropyl alcohol and then decyl
alcohol.

As a rule of thumb, esters are bad news when

they contain fatty acids with carbon chain lengths
within the range of 11 and 24.

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Malassezia makes sure to take the fatty acids from

ethanol, gobble them up, and even throw large parties
to celebrate. We doubt they had proper home training
too! But, there’s a catch. The second Malassezia takes
the fatty acids out of the ethanol, the octanoate acid
gives it a sinister smile, “I’ve got only 8 carbon atoms.
You’re so going to starve!” *Cue the evil laughter.* And
true to octanoate acid’s words, Malassezia does starve
and die because it only gets sustained by the C11-C24
fatty acids.

According to in vitro studies, here are the esters that

Malassezia can metabolize just fine:

• Ethyl octanoate
• PEG-7 Glyceryl Cocoate [a polyethylene glycol ester
(PEG) that is a product of glycerin and coconut fatty
acids]
• PEG-Glyceryl Stearate (a polyethylene glycol ester
that breaks down into stearic acid)
• Polyethylene Glycol Stearates (a mixture of mono
and distearates with the corresponding free glycols)

So, steer clear of these miscreants to the best of your

ability!

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Ester Take-Away

What should you do with all this information? What does

all this mean for you? It’s simple: Stay clear off ALL esters
unless they originate from caprylic or capric acid. But, if
you can’t figure it out, turn your back on any esters that
come seeking shelter in your hair.

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Polysorbates

The last thing we want is for you to get bored and doze off. So, let’s
keep this one short and sweet, alright? Studies show that M. furfur and
M. sympodialis could make use of ethoxylated sorbitan esters known
as polysorbates (or tweens) as lipid farms and harvest from them at
will! These unique esters have a suffix number (e.g., polysorbate 20)
that signifies the fatty acid used as the base during the esterification
process.

Let’s take a look at some of them:

• Polysorbate 20 = lauric acid, C12 (sorbitan monolaurate)

• Polysorbate 40 = palmitic acid, C14 (sorbitan monopalmitate)
• Polysorbate 60 = stearic acid, C18 (sorbitan monostearate)
• Polysorbate 80 = oleic acid, C18:1 (sorbitan monooleate)

All four polysorbates feasted on Malassezia in vitro. Observe their carbon

chains. What did you notice? They’re between 11 and 24, which makes
them Malassezia’s special delicacy.

Cholesterol

Some, not all culture testing showed that cholesterol can encourage
mycelial growth in particular subspecies of M. furfur by only about 20%.
But, we’re a bit skeptical about this study and don’t think cholesterol (a
skin-repairing ingredient) is worth avoiding and deserving of the cold
shoulder.

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Fatty Alcohols

Experts are undecided whether fatty alcohols and which

types make Malassezia worse... So, they may or may not be
safe for you. Unless a particular fatty alcohol is strictly safe
for use, like octyldodecanol, we recommend you avoid it
and everything associated with it like a plague if you’re still
struggling with Malassezia over ownership of your scalp
and skin.

Yeast Ferments

One yeast that is identified as the most common in this line of

fermented yeasts is galactomyces. As Malassezia feeds and
thrives on this fermented fungus, it also increases the activity
of the aryl hydrocarbon receptor (AhR), a protein that is linked
to various skin diseases and infections!

As expected, studies show that people with Malassezia-

related diseases have a whooping 10 to 1000-fold higher AhR-
activating capacity when compared with healthy controls.
What you should take from all this is excess AhR activity is
the bad guy here! (Aside from Malassezia, that is).

Lactobacillus, lactococcus, bifidobacterium, as well as other

lactic-acid producing bacteria, are perfectly okay for use and
won’t affect the Malassezia species.

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Squalene

Let’s get you and squalene acquainted: Squalene is another

regular part of your human sebum that has minor effects on
mycelium induction. Get ready for some more chemical jargon:
Malassezia can induce squalene peroxidation in vitro (=
“studies [which] are performed with microorganisms, cells, or
biological molecules outside their normal biological context”).
Squalene peroxide, as shown by studies, is a potential role
player in dandruff conditions! A simple translation is, squalene
can also serve as a meal during a Malassezian buffet and
further the development of “normal” bacterial acne.

Here’s how: Malassezia interacts with normal squalene and

oxidizes it to squalene peroxide, which results in scalp chaos
— dandruff!

Surprisingly, squalane, spelled with “a”, (a popular ingredient

in most skincare products) is perfectly okay to use. That’s
because it is a more stable form of squalene. We know how
confused you must be now. Don’t you worry, we’ll talk more
about this in the “Oils That Won’t Aggravate Malassezia”
section and clear all your doubts then!

Fun Fact:

On close examination of the skin surface lipids, people with

seborrheic dermatitis are deficient in fatty acids and squalene
but rich in triglycerides and cholesterol when compared to
healthy controls.

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Additional Notes

Amino Acids/Vitamins

We’re not sure how relevant this piece of information is,

but we’re determined to leave no stone unturned! When
you have glycine (an amino acid), asparagine (another
amino acid), pyridoxine (vitamin B6), and thiamine (vitamin
B1) together in the same room with lipids, they form the
perfect Malassezia fertilizer. Now, we’re wondering if
other B-complex vitamins pose the same threat.

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But, what we’re sure of, according to another study, is

amino acids in the presence of other lipids (esters, fatty
acids, fats, oils, etc.) are bad news for you and excellent
for Malassezia. This situation is pretty dicey because we
naturally have fats and oils in our skin, so you should
always take precautionary measures with amino acids.
How? We’re glad you asked. The best way is to test them
in a cautious and controlled setting before you dive into
that product.

In case you’re wondering, arginine is one of the most

common amino acids you’ll see in haircare and skincare
products. You can find it in COSRX BHA, Benton Soothing
Gel, COSRX Snail Mucin Essence, Benton Snail Bee
Essence, and more!

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Ceramides

Ceramides are the main component of the epidermis and

stratum corneum, which are the two outermost layers of the
skin. You have to remember your scalp is part of your skin too.
These layers play a vital role in the barrier and health function
of your skin. To further buttress this point, there’s a link
between skin diseases and specific ceramide deficiencies.

For example, decreased ceramide levels of 1, 3, and 6 leads to

psoriasis, while a deficiency in ceramides 1 through 6 breeds
acneic skin and eczema. You could also think of ceramides as
the bonds that hold your skin’s health and form in good shape!

Now, here’s where things get a bit tricky: Not all ceramides
receive equal treatment. A study even found that dandruff,
which is worsened by Malassezia colonization, has decreased
levels of ceramide 1 (no surprise here) but also has increased
levels of ceramide 6i and 6ii!

Do you know what’s more alarming? It’s this patent about

ceramides in skincare. It states that companies usually
manufacture skincare products with C16-C32 fatty acids! To
worsen this situation, we have enzymes on our skin called
ceramidases. These enzymes help to break the ceramides
down into their respective parts (free sphingosines and fatty
acids), which are suitable Malassezia food. According to
studies, glucosyl-ceramide can feed other yeasts like candida!

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Now more than ever, you see why you should

do a patch test if you’re trying out products
with ceramides. Some people reported that
ceramides did not cause them breakouts, while
others said they did. Overall, remember you’re
different from the next person, and as they
say, your mileage may vary (YMMV).

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Coconut Oil

We’ve heard how people “professionally” throw around the

idea of using coconut oil because it’s an “antifungal.” DO NOT
TRY THIS. Although they have a valid reason for saying this,
it’s not substantial enough. This reason is that coconut oil
contains octanoic acid, which is antifungal in nature. Does the
duel between octanoate and Malassezia ring a bell?

Unfortunately, this reason is not substantial enough because

octanoic acid only makes up about 7.1% of coconut oil’s fatty
acid composition. This low percentage is not the only strike
for coconut oil; we’ve got more issues coming. Another reason
to rule out coconut oil as safe and even “curative” to use is
it contains a fatty acid with a carbon chain length of 12 —
lauric acid. Lastly, it makes up a whopping 47% of coconut
oil! Worse still, this fatty acid is one of Malassezia’s favorites.

Try to stay clear of coconut oil; it does much more bad than
good for you and your skin. Here’s a fun and colorful picture
showing the composition of coconut oil.

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Composition of a coconut

47.10%
39.30%

0.50%
7.10%
6.0%

Lauric Acid (C-12)

Capric Acid (C-10)

Caprylic Acid (C-8)

Caproic Acid (C-6)

Long Chain Fats (C-14 to C-20)

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Glycerin

Here’s one you might like to hear: Glycerin DOES NOT

feed Malassezia or pay it any mind! But, if you add a lipid
to the mix, all hell will break loose. So, the lipid, not the
glycerin, is the problem (no surprise here, right?)

Neem Oil

There were a few natural remedies tested to

determine which had the best inhibitory action against
Malassezia. Out of lemon juice extract, rice water
extract, and our favorite, cow’s urine, neem extract
was the natural remedy with the least stabilizing
functions. So, that’s a no-no for neem extract. But,
there’s one remedy that was marginally the best:
Let’s give it up for cow’s urine!

Note: Notwithstanding this, we can’t in good conscience

recommend that you drench your face and other parts
of your skin (especially your scalp) in cow’s urine. The
good news is there are other excellent alternatives to help
you get rid of Malassezia. You’ll see these in the “Natural
Treatment” section below. Stay tuned!

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Sugars

M. pachydermatis is the only Malassezia

species that can grow in the presence of
carbohydrates or sugars; it can excellently
synthesize or ferment sorbitol and mannitol.
For other Malassezia species, sugars or
carbohydrates are unfit for Malassezia’s
mycelial and general growth.

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Warm Weather
and Sweating

The perfect temperature for Malassezia to have optimal

growth is 32°C - 37°C (89.6°C - 98.6°C). We all know
this is around the standard temperature of the human
body. You can’t increase the heat and burn them off your
face, so your best bet is to freeze them off your face! We
recommend taking a trip to Antarctica.

It makes sense if Malassezia grows in a warmer climate

because you’re more likely to sweat when it’s hot outside.
And you see sweat? Malassezia loves that stuff! It
(sweat) comprises materials like lactic acid and salt in the
presence of lipids. It s a game-changer for Malassezia. It
causes them to grow, reproduce, and have a jolly good
time on your face.

We know what you’re thinking: This means being a

couch potato is better for your health, while exercise
is detrimental! Don’t smirk yet. Regular exercise is so
relevant for your health. It opens up your pores for toxins
to leave your body and expels even more toxins when you
exhale during your workout. From one group of couch
potatoes to another, you need to EXERCISE!

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To avoid the proliferation of Malassezia while

you’re trying to keep fit, here are a few lifestyle
adjustments in this regard:

• Shower immediately after your workout

sessions
• Avoid steaming, saunas, and sun exposure
(especially without sunscreen!)
• Change your sweaty workout clothes right
after your workout
• Wear loose-fitting clothes; you need all
that air to cool your body temperature and
irritate Malassezia off your skin

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pH

Malassezia enjoys the pH range from 5.5 to 7.5, which is

at the higher or more acidic end of the acid mantle. An
acid mantle is our booty kicker! It is a protective layer on
our skin that comprises dead skin cells, sweat, and skin
oils.

This acid mantle keeps your skin protected from

environmental pollutants, bacteria, viruses, and fungi.
It also keeps your skin soft and supple; it’s our skins’
sidekick and does everything to keep us from breaking
out.

Malassezia also finds joy in wallowing in areas with a pH

of 4.7, which is the pH of healthy human skin. No surprise
there.

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According to a study, the release of M. sympodialis

allergens takes place at significantly higher rates at pH
6. This study also discovered that people with eczema
tend to have a higher skin pH when compared to healthy
controls. What does this mean? It means the skin’s acid
mantle’s pH was altered and can’t protect the skin as it
should.

When the pH in this study was outside the range of

4.5 to 8.0, there was no observed growth in vitro. So, a
highly alkaline or acidic environment will probably kill and
obliterate the Malassezia community. Nonetheless, we
recommend you stick to products with a lower pH, like
chemical exfoliants, because alkaline substances (e.g.,
lye and baking soda) are detrimental to your skin’s health
and our good old friend — the acid mantle.

Remember, sensitization (sensitivity or the act of reacting

to certain stimuli) to Malassezia most likely comprises
of environmental factors, a dysfunctional skin barrier,
and your genetic background., Even so, your best bet
is to care for your hair and scalp properly with your pH-
appropriate products handy.

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Summary
Take note of all you should avoid like a plague and watch
how you’ll cure yourself. It’s crazy how much you need to
avoid to prevent the growth of Malassezia.

In essence, avoid anything that contains fatty acids with

dangerous carbon chain lengths of 11-24. A rundown of
these problematic fatty acids includes:

oils, polysorbates, esters, and fatty acids themselves.

Keep in mind that some fatty acids are safe to use and
will not feed this demon yeast.

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Remember squalene? It might give you problems with

Malassezia, as would phospholipids and cholesterol,
but that’s debatable. The same applies to ceramides.
Although this wasn’t in the chart above, do your best to
avoid fermented products, especially GALACTOMYCES.
Given the current research available, we’re not so sure
if this rule applies to saccharomyces as well. Always
remember to do a patch test, so you know what works
and doesn’t work for you and your Malassezia.

Lactic-acid-producing bacteria, like lactobacillus, are

perfectly fine to use. There may be a lot to avoid, but
not to worry, there’s still awesome stuff you can use.
Take silicones, for instance; they are the definition of
perfect for treating Malassezia! Use them generously. We
especially love some dimethicone. It makes your skin look
and feel supple, smooth, and protected.

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Substance Action

Fatty acids ‫ݾ‬ Flee from those with carbon chain

lengths between 11 and 24. Especially
avoid them and oils, polysorbates,
and esters.

Esters ‫ݾ‬ Avoid any hair care product with

ingredients ending in -ATE. Although
this isn’t a hard and fast rule, it works
to a substantial degree.

Polysorbates ‫ݾ‬ Keep these out of your skin and hair!

Fatty ‫ݾ‬ If it’s not octyldodecanol, or a product

Alcohol containing octyldodecanol, it’s an
impostor. Stay clear from it the best
way you can.

Yeast ‫ݾ‬ These are evil. Better alternatives

Ferments are lactobacillus, lactococcus,
bifidobacterium, and other lactic-acid
producing bacteria.

Cholesterol ‫ݽ‬ If you do an extensive patch test and

it works fine for you, have at it!

Squalene ‫ݽ‬ Squalane (with an “a”) in skincare

products is awesome! Squalene (with
an “e”) is Malassezia food.

Amino acids/ ‫ݾ‬ Amino acids + pyridoxine (vitamin

Vitamins B6) + thiamine (vitamin B1) + lipids =
CATASTROPHE

Ceramides ܻ Do an extensive patch test with

products containing ceramides.

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Substance Action

Coconut oil ‫ݾ‬ This is a danger zone. Abort any

missions involving coconut oil!

Glycerin ‫ݾ‬ Glycerin + Lipid = Premium

Malassezia food. Keep this mix out of
your hair’s reach.

Neem oil ‫ݾ‬ Steer clear from this.

Sugars ܻ Apart from M. pachydermatis, other

Malassezia species are at a loss for
what to do with sugars. But, to be
on the safe side, avoid sugars. If you
must use them, do an extensive patch
test.

Warm The following are fantastic tips to

Weather prevent Malassezia growth. Always
and Sweat remember these points:

‫ݽ‬ Shower immediately after your

workout sessions.
‫ݾ‬ Avoid steaming, saunas, and sun
exposure (especially without
sunscreen!).
‫ݽ‬ Change your sweaty workout clothes
right after your workout.
‫ݽ‬ Wear loose-fitting clothes; you
need all that air to cool your body
temperature and irritate Malassezia
off your skin.

pH ܻ Avoid any product with a pH range of

5.5 to 7.5

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Oils That Won’t Aggravate

Malassezia
There are only three oils that are safe to use with Malassezia!

Mineral oil

MCT oil

Squalene oil

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1. MCT Oil

MCT or Medium-chain triglyceride is a triglyceride with

a combination of two or three fatty acids having a carbon
chain length of 6-12! Now, it makes sense why they’re called
medium-chain triglycerides. They are also called medium-
chain fatty acids.

MCT oil is either a combination of the friendly caprylic/capric

triglycerides or used separately. Coconut and palm kernel oils
are rich food sources for MCT oil commercial extraction. So,
this is coconut oil without the dreaded lauric fatty acid. As a
result, the oil will remain liquid, instead of the usual solid, at
room temperature.

Here’s why MCT oil won’t cause you any problems: It comprises
capric (decanoic) acid and caprylic (octanoic) acid (C 10
and 8, respectively). These two fatty acids are outside the
red-marked C11-C24 range we’re trying to avoid.

If you’re wondering what to use for your oil cleanse, we’ve got
just the product for you. We recommend pure caprylic acid
oil (see on Amazon) or MCT oil because, according to culture
testing, MCT oil’s fatty acid inhibits the growth of Malassezia
the most.

We’ll break this down in the “Malassezia Natural Treatment”

section. If you’re going to use MCT oil, make sure it only
contains capric/caprylic triglycerides and absolutely NO lauric
acid!

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2. Mineral Oil

Also known as baby oil without fragrance. This oil is an

inert substance with no fatty acids. In other words, it’s
not something Malassezia would feast on because there’s
nothing for your skin to hydrolyze.

But, here’s the thing; it may cause you problems as a

result of potential impurities and its slight occlusiveness!
So, it can contaminate your skin with impurities and still
go on ahead to prevent moisture from leaving your skin
by clogging your pores (occlusiveness).

Remember that you should open up your pores to release

impurities and manage your Malassezia better. So, we’ll
give mineral oil a “mostly safe” badge on a count of these
drawbacks, especially if you’re using it as an oil cleanser
and washing it off right after.

If we had to choose between MCT and mineral oils, we’d

go for MCT oil in a heartbeat!

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3. Squalene Oil

Like crude oils (e.g., mineral oils), squalene oil is a

hydrocarbon originating from the hydrogenation of pure
squalene. This hydrogenation makes squalene oil less
susceptible to oxidation by eliminating double bonds, so it
has a longer shelf life than the original and pure squalene.

So, what’s all the fuss about squalene? First, squalene is a

natural part of your skin and will not irritate your skin even
at 100% concentration! Second, people with seborrheic
dermatitis (which Malassezia causes) have skin surface
lipids deficient in squalene when compared to healthy
controls.

Third, it’s best to treat skin conditions by providing what

the skin is deficient in.

Finally, squalene (like sunscreen) protects you from

UV radiation-induced oxidative stress or sun damage.
Squalene may have antifungal and antibacterial
properties, is an anti-carcinogen, and is such a good
moisturizer!

Remember, squalene can serve as Malassezia food. But,

there’s good news: the skincare derived version (squalane
oil) doesn’t share the same fate! So, go ahead; try it out,
and see how well it treats you!

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Malassezia
Treatment
Now you know what to avoid when you have
Malassezia; let’s discuss treatment options!
When you use products compatible with
Malassezia-related skin conditions, they will
stop it from getting worse and/or slowly heal
your active lesions.

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If you’re all for speed and immediate results, we’ve got

some professionals you need to meet: Antifungals.
When it comes to Malassezia, you should understand it
as a fungal overload and skin allergy. With an antifungal
product, you can control the fungal overload. Then,
using an oil (or a hair care product) that can’t serve as
Malassezian food, you can keep the condition under
control.

When treating acne, you get tons of options to choose

from, right? For Malassezia, we have tons of options
available, and we’ll be discussing each in-depth. After,
we’re sure you’ll be making the most informed decision
possible in regards to your Malassezia. So, you just relax,
get ready, draw the curtains, and fasten your seatbelts.
We’re on our way to the land of Antifungals.

Before we get into this, there’s something you should

know. Synthetic antifungals are pretty harsh substances.
They get the job (removing fungus) done, well and good,
but that’s it. They don’t care about your hair’s health; all
their after is the blood of fungi dripping from the sides of
their mouths. Graphic, we know, but we’re sure you get
the point. *wink*

So, we’re starting with heartless antifungals first, but

we’d prefer that you get into the more natural and loving
antifungals. Have fun!
There are six types of Antifungals. Here’s a rundown:

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Types of Antifungals

1. Allylamines (Terbinafine)
Allylamine works against the fungal activities of molds,
dimorphic fungi, dermatophytes, and many forms of fungi. It
disrupts fungal sterol biosynthesis (a process in which fungi
feeds and nourishes its cell’s components) to prevent the
fungi from accumulating squalene. When you orally ingest
allylamine, your sebum transports it to reach sites like your
nails, stratum corneum (your epidermis), and hair!

2. Azoles
(Bifonazole, Itraconazole, and
Ketoconazole)
These are the largest group of antifungals. They aim to disrupt
the fungal cell membrane or dissolve the cell wall of the
fungus. You might be wondering what this disruption does.
Well, without a “healthy” cell wall, fungi find it hard to function
and grow properly.

Azoles snatch the shelter from the rigidity of fungi and

watch them die off. *cue the sinister look* Azoles are easy
to tolerate, have anti-inflammatory properties, and have high
efficacy rates, especially when you orally ingest them.

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3. Benzylamines (Butenafine)
When you apply benzylamine directly to your skin, the residual
fungicidal (killing fungi broadly) concentrations remain on your
skin for up to 3 days! Benzylamines have anti-inflammatory
properties and reduce the red marks caused by the sun,
otherwise known as UVB-induced erythema.

4. Hydroxypyridones
(Ciclopirox)
These are synthetic antifungals that also possess anti-
inflammatory and antibacterial properties. It’s a 2-in-1 fungal
and bacterial serial killer!

5. Immunomodulators
(Pimecrolimus, Tacrolimus)
Immunomodulators work by weakening the activity of the
fungal immune system.

6. Other
Last but certainly not least, we have other types of antifungals
like zinc pyrithione. This antifungal has keratolytic properties,
which helps shed fungus off your skin!

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Ketoconazole

Many studies have shown that ketoconazole obliterates

all species of Malassezia. As a result, ketoconazole is the
first stop for most people. If you’re keen on organization
and orderliness, ketoconazole has you covered, and your
Malassezia cornered! Unlike other antifungals, this one stacks
up pretty well!

According to studies, complete cure rates with ketoconazole

occurred when they paired oral antifungals with topical
ketoconazole. The reason behind this is maintenance
regimens must be in place to curb Malassezia’s activities.

What’s a maintenance regimen? A maintenance regimen

is a process of using topical ketoconazole once a week
after your scalp is Malassezia-free. But this isn’t always
necessary. According to a leading group of dermatologists
and microbiologists, keratolytic agents can control Malassezia
folliculitis after the initial clearing with antifungals.
This method is your best bet. In other words, use your favorite
antifungal till your lesions clear, then follow it up with a
keratolytic agent non-stop. So you won’t have to worry about
antifungal resistance along the way, surprise Malassezia with
this keratolytic agent.

We think the most effective keratolytic agents for Malassezia

are benzoyl peroxide, sulfur, and urea. Are you looking for
other excellent options to consider? Retinoids like adapalene
(Differin) or tretinoin will do the job.

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Warning:
If you’re looking to take an oral antifungal,
we’d like you to know that there was a recent
FDA report on the off-label oral ketoconazole.
There’s now a death risk attached to this
antifungal. As a result, we recommend
consulting your physician about using either
fluconazole or itraconazole instead. So far,
these antifungals have fewer relapse rates and
are safer to use.

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How to Use Ketoconazole

2X A WEEK FOR 4 WEEKS

The popular recommendation is to use ketoconazole 2%

shampoo twice a week and for a month (4 weeks). Once
you notice you’re free of lesions, use the ketoconazole 2%
shampoo once a week. This intermittent use is effective
in preventing Malassezia WW2 (relapse)

3-5 MINUTES

Also, we recommend you leave the solution on your skin

for around three to five minutes. According to studies, the
5-minute treatment is far more effective than applying
and rinsing it off right after.

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Climbazole

Ketoconazole and Climbazole have slightly similar in vitro

activity against M. furfur. From this study alone, it’s hard
to say which “azole” is better. According to our sources,
they are yet to conduct tests on the rest of the Malassezia
siblings.

A recent study showed that 2% climbazole shampoo

was very effective at assassinating Malassezia and thus,
reducing its population sizes on dog’s skin. In case you’re
worried, don’t be. It works just fine for human skin too.

Zinc Pyrithione

Zinc pyrithione is a keratolytic and antifungal agent. It

is generally less efficient than our star ketoconazole.
Gladly, it makes up for this in its own unique way. How?
Zinc pyrithione works to increase ceramide, triglyceride,
and cholesterol levels in the shampoo-treated scalp
of dandruff patients. As a result, zinc pyrithione also
improves your skin’s natural protective function.

We hope you’re ready for some more good news!

With zinc pyrithione, you don’t have to fear antifungal
resistance.

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Ciclopirox Olamine

Ciclopirox Olamine is a triple-action Malassezia treatment.

It has anti-inflammatory, antifungal, and antibacterial
properties. Extensive tests show that it deals ruthlessly
with these species of fungi:

• Penicillium and Aspergillus

• Candida
• Trichophyton
• Saccharomyces Cerevisiae
• Epidermophyton and Microsporum
• Cryptococcus neoformans
• And the ever-annoying Malassezia, along with its
chief isolates or species. (M. restricta, M. furfur, M.
obtusa, M. pachydermatis, M. globosa, M. slooffiae,
and M. sympodialis)

This treatment works faster to inhibit Malassezia than

ketoconazole! It even has a uniform activity (wipes all
at once) against lots of microorganisms and a broader
spectrum when compared to other topical antifungals.
So, we have a new star/atomic bomb for all the nasty
microbes.

If you want to treat scalp seborrheic dermatitis, tinea

pedis, and tinea corporis, use Ciclopirox Olamine twice
a day for a month. Another exciting thing about Ciclopirox
Olamine is it doesn’t create bacterial or fungal resistance!
What’s more? A lot of people tolerate this very well! Talk
about an All-star treatment!

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Butenafine Hydrochloride

There’s only been one in vivo study on this antifungal, but

it has a lot of potential. We know you want all the juicy
deets. Here’s what happened:

Ten Caucasian women with post-adolescent acne,

seborrheic dermatitis, and oily skin applied 1% butenafine
HCl cream twice a day. After a week, M. Furfur tried to
raise a peace flag, but butenafine hydrochloride didn’t
want any of it. It ruthlessly pushed M. Furfur to the cold
earth at gunpoint.

By the time the next week came by, M. Furfur got

obliterated from the battlefield! Then, the third week
came, and six out of the ten women bid their seborrheic
dermatitis farewell. As for the other four, they had mild
improvement.

If you’re trying to get rid of your dandruff and ketoconazole

doesn’t work, don’t fret. Butenafine hydrochloride is
probably a better option. Here’s the case study if you
want some motivation.

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Selenium Sulfide

According to an in vitro study, selenium sulfide can

inhibit the growth of pityrosporum pachydermatis
and pityrosporum ovale, but it’s not as effective as
ketoconazole.

Another issue with this antifungal is the topic of toxicity,

especially with treatment on large areas or prolonged use.
According to in vivo studies, 24 patients used selenium
sulfide shampoo and left it on for 30 minutes to do its
thing. They repeated this process for three consecutive
days, with a follow-up treatment once a week.

At the end of two months, 22 patients were free of the

fungi. Unfortunately, they relapsed when the treatment
didn’t continue intermittently. The other two did have
significant improvements. But, they got completely cured
with the use of 200 mg of ketoconazole once a day for
a month.

There was also a case where a 21-year old female with

Malassezia folliculitis. She managed to cure herself after
ten days of applying 2.5% selenium sulfide cream for 10
minutes. She also did not experience a relapse during a
3-month follow-up.

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What should you grab from all this? You should

understand you are unique and might have a
different route that will work just fine for you
and won’t for the next person. Find that unique
route, probably with the help of a physician,
and cure your Malassezia!

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Malassezia Natural
Treatment Options
We understand that not everyone would entertain the
idea of using antifungals for the long-term, so let’s look
at some more comfortable natural treatment options. Do
you want in on a secret? We feel that when compared
to antifungals, natural versions work just as well, if not
better!

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Azelaic Acid

Here’s a fun fact: Malassezia is azelaic acid’s father.

Unbelievable, we know, but the fact remains that azelaic
acid is a byproduct of Malassezia.

No, you shouldn’t scream and run in terror when you see
azelaic acid. Its origin doesn’t make it evil. A study in vitro
even showed that azelaic acid (1%) inhibited the growth
of P. ovale.

Who’s the new guy? Well, P. Ovale is one of the two

subspecies of yeast that comprise M. Furfur. If that didn’t
convince you, we’ve got more evidence to prove azelaic
acid’s innocence.

Azelaic acid creams generally come in 10%-20%. If 1%

can inhibit growth, imagine what 10-20 times that can
do! When it comes to acne and seborrheic dermatitis,
you can put azelaic acid on the job. Even then, we can’t
stress this enough: Always do a patch test first!

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Benzoyl peroxide

Benzoyl peroxide has comedolytic (i.e., prevents the

formation of comedones. Remember comedones?) and
antibacterial properties. As a result, it’s one of the most
recommended treatments for acne.

This antifungal is not really what you would call natural.

But, it is very effective in treating ingrown hairs,
seborrheic dermatitis, folliculitis, acne, and more. We’re
sure you’d love a benzoyl peroxide wash, especially if you
have seborrheic dermatitis in your face and trunk!

To use this wash (containing 2.5%, 5%, or 10% benzoyl

peroxide), apply it to your face and body for 5-10 minutes.
Then, rise it off. You’ll experience a reduction in erythema
and scaling.

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Caprylic Acid Oil

Remember that MCT oil comprises C8 and C10 fatty acids,

and as a result, MCT oil won’t worsen your Malassezia.
Capric and caprylic acid are both safe fatty acids. Let’s
juggle your memory a bit:

• Capric (Decanoic acid) has a carbon chain length of 10

• Caprylic (Octanoic acid) has a carbon chain length of 8

Caprylic acid, in particular, has the most efficient

antifungal properties. You can use this to your advantage.
Use the pure caprylic acid oil for your oil cleanse, or add
a few drops into your favorite moisturizer.

Cinnamic Acid

This acid is an extract from balsams like shea butter or

storax and cinnamon oil. It has antifungal activity against
Malassezia species.

Cow’s Urine

Ready to get the shock of a lifetime? You can get cow’s

urine from Amazon just search for “Pure Cow Urine” and
hold your breath.

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Green Tea Extract

Need to get rid of eczema and M. sympodialis? Use

5% green tea extract in your bath for 30 minutes,
three times a week (for M. sympodialis) and for four
weeks (for eczema).

Probiotics

According to different studies, supplementing

Lactobacillus Paracasei ST11 reduces the population
of Malassezia.

Propylene Glycol

Propylene glycol is not really “natural,” but a couple

of studies show that it can inhibit the growth and
functioning of Malassezia.

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Honey and Propolis Extract

Everyone knows honey has powerful antimicrobial effects against nasty

vermins that cause skin disorders. According to studies, some variations
of our wonder honey (like tualang, manuka, and Scottish heather) hinder
the growth of the pathogens Staphylococcus aureus, escherichia coli,
and Pseudomonas aeruginosa!

What good news, especially if you have eczema! Why? Staphylococcus

aureus is one of the underdogs helping eczema proliferate. Honey’s
effects on Malassezia are still a bit murky, but studies show that it deals
with dandruff and seborrheic dermatitis. Remember, these two have a
link with Malassezia.

Here’s how one study went:

Thirty patients with seborrheic dermatitis (SD) applied a honey

mixture (90% raw honey and 10% water) on the affected areas for
three hours bidiurnal-ly (every other day). After a month, all patients
made improvements, while some ultimately healed their lesions.

We recommend you follow this up every week with a honey application

for many months to prevent a possible relapse.

So, while you enjoy your delicious jar of honey, let your face have some
of that magic! If you’re not too keen on putting raw honey on your face,
there are products with propolis and honey extract you can try out.

Why propolis? According to recent in vitro studies, propolis extract

displays antimicrobial activity against candida, M. pachydermatis,
staphylococcus, and more! Now, will you try it out?

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Salicylic Acid (BHA)

Salicylic acid is another triple-threat antifungal. It

is a keratolytic agent and has anti-bacterial, anti-
inflammatory, and antifungal properties.

Salicylic acid is an oil-soluble hydroxy acid (i.e., it helps

dissolve all the mess in clogged pores). It doesn’t cause
sun sensitivity, unlike glycolic acid.

Unfortunately, most salicylic acid products use

polysorbate 20 as a stabilizer! Remember how much
Malassezia loves polysorbates. Bummer. But, you see a
safe salicylic acid treatment? It can do wonders!

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Sulfur

Sulfur is a popular antifungal. Lots of people have used

it and experienced great results. Let’s share a testimony.
Someone finally defeated Tinea Versicolor (M. globosa)
after 14 years! What did he do? He took sulfur baths a
few times a week and finally got rid of Tinea Versicolor.

Sulfur is a keratolytic agent that aids in the shedding

of fungus from your epidermis. Want to know what
else sulfur can do? It produces pentathionic acid (fungi
poison!) It’s likely to directly inhibit Malassezia, even.

For many years, sulfur has helped cure and relieve warts,
acne, scabies, rosacea, and folliculitis. We have more
exciting news: It cures and relieves Malassezia-related
conditions too! Some of them are eczema, seborrheic
dermatitis, psoriasis, dandruff, and pityriasis Versicolor.

That leaves nothing out. Sulfur is such a versatile

antifungal, and it deserves all the accolades. The only
drawback i is its rotten egg smell. But, as the saying goes,
no pain, no gain.

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Sun Exposure

Vitamin D is a vital vitamin that can help you win the

war against Malassezia. With modest amounts of sun
exposure, you’re good to go! This amount equates to 15
minutes of sun exposure a day when the UV index is 3
or more.

15 MINUTES WHEN UV INDEX IS 3 OR MORE

What’s exciting about this is sun exposure improves

several skin conditions like eczema, seborrheic
dermatitis, rosacea, and acne. The icing on the cake,
some studies showed that sun exposure or UV light can
curb Malassezia’s growth.

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Tea tree oil

According to some in vitro studies, tea tree oil has potent
antimicrobial properties against Malassezia. Tea tree oil’s
inhibitory or assassinating action against Malassezia
ranges from 0.12%-1.0% depending on the species
involved. No, this doesn’t mean you should slather your
skin with this oil, especially at 100% concentration!

Always make sure you dilute the oil at 1% concentration

or less. It will do its work just fine, even then. If you can,
get the “Melaleuca alternifolia” variety of tea tree oil. It
was the variety used in the studies above.

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Diet and Malassezia

Certain foods will help with Malassezia. They are:

Foods low in refined carbs,

without sugar

No processed stuff

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Low inflammatory
food

Probiotics

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Final Words

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Now you have the weapons and armor to go into battle with
Malassezia, dandruff, and other skin and scalp conditions; we
wish you victory!

Always remember all you should have handy, what you should
do, eat, etc., and regain ownership of your scalp and skin! As
you begin this life-changing journey, we wish you nothing but
good luck.

All the best!

Sincerely,

The Hairqare Lab Team

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or Dry Scalp
ADVANCED CARE

GUIDE

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