Combination of Salicylic Acid Peel and Active Zinc Shows 95 Percent Efficacy Against Malassezia Folliculitis: Study

To assess therapeutic efficiency, tolerability, and relapse prevention properties of supramolecular keratolytic and anti-inflammatory therapy in a systematic way, scientists performed a randomized 12-week study with a single arm. In total, 240 adult patients suffered from moderate to severe (grades 2–3) Malassezia folliculitis. During an 8-week active therapy period, participants received once-a-week in-office topical peeling with 30% SSA (supramolecular salicylic acid) in combination with daily home treatment using 1% SAZ (supramolecular active zinc).

In addition to this, there was a 4-week washout period without therapy application. The primary endpoint is the overall efficacy at week 8 in the full analysis set (FAS; n = 240) and per-protocol set (PPS; n = 212), defined as the reduction of inflammatory skin manifestations and direct microscopic fungus elimination. In addition, some predefined secondary endpoints are: the specific manifestation resolution rates (pruritus, scaling, erythema, skin greasiness), post-treatment recurrence, patients’ satisfaction, and dermatological QoL.

Key findings:

• Evaluation through statistical analysis based on the entire analysis set (n = 240) and per-protocol group (n = 212) supported the results on fast symptom relief, high levels of fungal eradication, and good tolerability.
• Clinical efficacy in the overall population at week 8 was at 95.42% (95% CI, 91.95%-97.69%) in the total analysis set (n = 240) and 99.52% (95% CI, 97.35%-99.99%) in the per-protocol group (n = 212).
• Clinically significant improvement in terms of the disease symptoms was found in 69.17% of patients by week 2.
• The high response rate in the combined therapy at week 8 was observed for all the symptoms under investigation: skin greasiness (95.24%), erythema (94.76%), pruritus (90.95%), and scaling (86.67%).
• In the treatment-free follow-up period of 4 weeks, the disease recurred in 2 out of 237 patients in the FAS recurrence analysis (0.84%).
• The adverse effects were observed in 2.92% of patients.

Results of the 12-week, multicenter clinical trial have proved that a combination of weekly treatments with 30% supramolecular salicylic acid peeling and daily application of supramolecular active zinc leads to a fast and efficient clinical effect along with extremely low rates of recurrence in patients with moderate-to-severe Malassezia folliculitis.

Reference:

Liu, Y., Zhang, J., Lai, W. et al. Supramolecular Salicylic Acid Chemical Peeling Combined with Supramolecular Active Zinc for Malassezia Folliculitis: Efficacy and Safety from a Multicenter, Single-Arm Trial. Dermatol Ther (Heidelb) 16, 5555–5566 (2026). https://doi.org/10.1007/s13555-026-01915-7