You’ve probably heard the term fungal acne popping up more frequently these days, especially on social media or health blogs. While it might seem like just another type of acne, fungal acne, or Malassezia folliculitis, is actually very different from the regular spots most people are familiar with. It’s not your typical pimple or blemish, and it behaves in a unique way. In fact, many people misdiagnose themselves with fungal acne, which can often lead to ineffective treatments, worsening the condition, and more frustration.
Unlike regular acne, which is caused by clogged pores due to excess oil, dirt, and bacteria, fungal acne is triggered by an overgrowth of yeast (Malassezia) that naturally exists on the skin. This subtle but crucial difference means that typical acne medications, which focus on killing bacteria or reducing oil production, may actually aggravate fungal acne and make it worse.
Many individuals find themselves using standard acne treatments, such as benzoyl peroxide or salicylic acid, only to see their skin worsen. This is because these treatments don’t target the underlying cause of fungal acne yeast overgrowth. Misunderstanding the condition can lead to frustration and a cycle of unsuccessful treatments.
In this article, I’ll help you understand what fungal acne is, how it differs from regular acne, and why using typical acne treatments could make it worse. I’ll also explain what dermatologists recommend for accurate diagnosis and effective treatment, so you can finally address the issue correctly and avoid unnecessary skin damage.
What Exactly is Fungal Acne?
Fungal acne, also known as Malassezia folliculitis, is a skin condition caused by an overgrowth of yeast, not bacteria. The yeast responsible for fungal acne, Malassezia, naturally lives on the skin as part of the skin’s microbiome. In most cases, it doesn’t cause any problems. However, under certain conditions, such as excess sweating, humid weather, or the use of certain skin care products, this yeast can grow excessively. This overgrowth leads to clogged hair follicles, causing inflammation and the formation of red, itchy bumps on the skin.
These bumps often resemble the pimples seen in regular acne, but the two are fundamentally different. Unlike typical acne, which is usually triggered by factors like excess oil, clogged pores, bacteria, or hormonal fluctuations, fungal acne is primarily a reaction to an overgrowth of Malassezia yeast.
Key Symptoms of Fungal Acne:
- Small, uniform, itchy bumps: These bumps often appear in clusters, and they tend to feel itchy or irritated, which distinguishes them from regular acne.
- Bumps that appear in clusters or groups: Unlike typical acne, which may appear sporadically, fungal acne often appears in groups, especially around the same area of skin.
- Inflammation around the follicles: The skin surrounding the affected area may appear red and inflamed, especially around the hair follicles.
- Commonly appears on the chest, back, shoulders, and face: Although fungal acne can show up anywhere on the body, it’s most often found on areas where sweat accumulates, such as the back, chest, shoulders, and sometimes the face.
If you’re experiencing these symptoms, there’s a chance it could be fungal acne rather than regular acne. However, proper diagnosis by a dermatologist is crucial, as treatments for fungal acne and regular acne are vastly different.
How Does Fungal Acne Differ from Regular Acne?
Understanding the differences between fungal acne and regular acne can be tricky because their appearances can be quite similar. Both conditions can cause red, inflamed bumps on the skin, which is why many people often confuse the two. However, they are fundamentally caused by different factors, and knowing these differences is key for proper treatment.
While fungal acne and regular acne share some visual characteristics, they are the result of distinct processes and require different approaches to treatment. Below, we’ll break down the key differences:
1. Causes:
- Fungal Acne:
Fungal acne is caused by the overgrowth of Malassezia yeast, a type of fungus that naturally resides on the skin. When certain factors like sweating, humidity, oily skin, or even certain skincare products disrupt the balance of this yeast, it can multiply and invade the hair follicles. This leads to inflammation and the formation of red, itchy bumps. Factors such as wearing tight clothing or makeup that traps moisture can contribute to fungal acne, as these create the ideal environment for yeast to thrive. - Regular Acne:
Regular acne, also known as acne vulgaris, is caused by the clogging of hair follicles with excess sebum (skin oil), dead skin cells, and sometimes bacteria. This results in the formation of pimples, blackheads, and whiteheads. While hormonal changes (such as during puberty, menstruation, or stress) are common triggers, diet and environmental factors can also contribute to clogged pores, leading to the development of acne.
2. Appearance:
- Fungal Acne:
The bumps caused by fungal acne are usually small, uniform in size, and can range from red to skin-colored. These bumps tend to appear in clusters and often cause an itchy sensation. Unlike regular acne, fungal acne usually doesn’t form whiteheads or blackheads and may appear as a rash-like cluster on the skin. The bumps may also have a slightly raised, pimple-like appearance but lack the pus-filled center typical of regular acne. - Regular Acne:
Regular acne often presents as larger, more inflamed spots that may include whiteheads, blackheads, pustules, cysts, and pimples. These spots can become painful and are typically filled with pus, which is the result of bacterial infection. Acne can also lead to scarring or discoloration if left untreated. The redness around regular acne is often more pronounced, and the pimples may become swollen or tender.
3. Location:
- Fungal Acne:
Fungal acne commonly appears on the chest, back, shoulders, and forehead, though it can also affect the face. It is often seen in areas where sweat and moisture tend to accumulate, such as the upper back and the shoulders. It may not always appear in the traditional T-zone (forehead, nose, chin), which is a characteristic feature of regular acne. However, it can still appear on the face, particularly in areas prone to sweat. - Regular Acne:
Regular acne is typically most prominent on the face, especially in the T-zone (the forehead, nose, and chin), which is where the skin tends to produce the most oil. Acne can also affect the chest, back, and shoulders, particularly in cases of hormonal imbalances or stress-related breakouts. In severe cases, acne can spread to other areas of the body.
4. Treatment:
- Fungal Acne:
The treatment for fungal acne focuses on reducing the overgrowth of yeast. Antifungal treatments, such as topical or oral antifungal medications, are usually the most effective solutions. Common antifungal treatments include ketoconazole creams, clotrimazole, and oral antifungals like fluconazole. In addition, avoiding skincare products that exacerbate the condition, like those containing oils or heavy moisturizers, can help. Fungal acne may also benefit from using lightweight, oil-free skincare products that don’t contribute to yeast growth. - Regular Acne:
Regular acne is typically treated with a combination of topical treatments (like benzoyl peroxide, salicylic acid, and retinoids) and oral medications (like antibiotics or hormonal treatments). In some cases, stronger oral medications, like isotretinoin, may be prescribed for severe cases. Acne treatment usually focuses on controlling oil production, fighting bacteria, and unclogging pores. Non-comedogenic products are recommended for acne-prone skin to prevent further breakouts.
Why Do Acne Treatments Make Fungal Acne Worse?
It’s a common mistake for individuals with fungal acne to reach for traditional acne treatments, such as benzoyl peroxide, salicylic acid, or even topical steroids. While these treatments are widely recommended for bacterial acne, they are often ineffective, and in some cases, they can actually make fungal acne worse. This is because these products are designed to target the causes of regular acne, like clogged pores, excess sebum, and bacteria. However, fungal acne is a completely different condition that is caused by an overgrowth of Malassezia yeast, not bacteria.
Many of the active ingredients in conventional acne treatments do not address the root cause of fungal acne the overgrowth of yeast and may inadvertently contribute to its worsening. The use of harsh medications that dry out the skin can disrupt the skin’s natural balance, leading to an environment that is more hospitable for yeast to thrive. This creates a cycle where the fungal acne becomes harder to manage, leading to frustration and worsening of the skin condition.
In addition, these treatments often do not account for the delicate balance of the skin’s microbiome, which includes beneficial microorganisms alongside potentially harmful ones. When this balance is disrupted, yeast overgrowth can intensify, leading to more visible and persistent symptoms. Below, we’ll take a closer look at why some common acne treatments might make fungal acne worse:
Common Acne Treatments That May Exacerbate Fungal Acne:
- Benzoyl Peroxide:
Benzoyl peroxide is a go-to solution for many people suffering from bacterial acne because it’s effective at killing acne-causing bacteria and reducing inflammation. However, for fungal acne, it may do more harm than good. While it doesn’t directly encourage yeast growth, its drying effect on the skin can disturb the skin’s natural moisture balance, creating an environment where Malassezia yeast can thrive. This can lead to more breakouts and worsen the condition. - Salicylic Acid:
Salicylic acid is commonly used to exfoliate the skin, unclog pores, and treat regular acne. It works well for removing dead skin cells, but in the case of fungal acne, it may cause further irritation. By stripping the skin of its protective layer, salicylic acid can weaken the skin’s natural barrier, making it more prone to yeast infections. This disruption can encourage the growth of Malassezia and exacerbate fungal acne symptoms, such as itching and redness. - Topical Steroids:
Topical steroids, often prescribed to reduce inflammation in various skin conditions, can offer short-term relief for fungal acne by temporarily reducing redness and swelling. However, over time, they can actually make the problem worse. Steroids can suppress the immune response in the skin, allowing the yeast responsible for fungal acne to multiply unchecked. Long-term use of topical steroids can also thin the skin, making it more vulnerable to infection and irritation. - Other Harsh Acne Treatments:
In addition to the above treatments, other common acne medications such as retinoids and oral antibiotics can also disrupt the skin’s balance in different ways. While these may work well for bacterial acne, they are often not effective for fungal acne, and in some cases, they may worsen symptoms by altering the skin’s natural protective mechanisms.
The Importance of Correctly Treating Fungal Acne:
To effectively manage fungal acne, it’s crucial to understand that the treatment needs to target the overgrowth of yeast rather than focusing on the bacteria or oil production associated with regular acne. Fungal acne requires antifungal treatments that directly address the root cause. This includes antifungal creams, such as those containing ketoconazole or clotrimazole, and in some cases, oral antifungal medications prescribed by a dermatologist. By using antifungal treatments, you can restore the balance of your skin’s microbiome, reduce inflammation, and effectively clear the yeast overgrowth causing the acne.
What Dermatologists Recommend for Fungal Acne Treatment
If you suspect you have fungal acne, it’s essential to visit a dermatologist for an accurate diagnosis and an appropriate treatment plan. Since fungal acne is caused by yeast overgrowth, it requires a different approach than regular acne, which is often treated with antibacterial or oil-reducing treatments. A dermatologist can provide a tailored plan that targets the root cause of the problem: the Malassezia yeast. Below are the common treatments and recommendations dermatologists may provide to manage fungal acne:
1. Topical Antifungal Creams:
For most cases of fungal acne, dermatologists will recommend topical antifungal creams, which are designed to kill the yeast responsible for the infection. These creams are applied directly to the affected area and are often effective in treating mild to moderate cases of fungal acne. Common antifungal creams include:
- Clotrimazole: This is a popular antifungal treatment that works by inhibiting the growth of Malassezia yeast. It’s available over the counter in many countries and is often the first-line treatment recommended by dermatologists.
- Ketoconazole: Another antifungal cream, ketoconazole works similarly to clotrimazole but is often more potent. It is also available in shampoo form and can be used for fungal acne that appears on the scalp or other areas with hair follicles.
2. Oral Antifungal Medications:
In cases of more severe fungal acne or when topical treatments are not effective, dermatologists may prescribe oral antifungal medications. These drugs work systemically to target yeast overgrowth throughout the body and can be particularly useful for widespread or persistent fungal acne. Common oral antifungal medications include:
- Fluconazole: This is a widely used oral antifungal medication that is typically prescribed for more severe cases. It helps to reduce the Malassezia yeast population and clear up the infection.
- Itraconazole: Another option, itraconazole is often prescribed when fluconazole is not effective. It works in a similar way to fluconazole but can be more powerful in cases of persistent fungal acne.
Oral antifungals are typically prescribed for a limited period, as prolonged use can lead to side effects, so it’s important to follow the dermatologist’s dosage instructions carefully.
3. Shampoos with Antifungal Properties:
If fungal acne appears on the scalp or hairline, antifungal shampoos can be a helpful treatment. Shampoos containing active antifungal ingredients can treat both the scalp and areas of the skin around the hair follicles. Common antifungal shampoos recommended by dermatologists include:
- Ketoconazole shampoo: This is often prescribed for fungal acne on the scalp, as ketoconazole is effective in reducing yeast overgrowth. Regular use can help reduce flare-ups and keep the scalp clear.
- Selenium sulfide shampoo: Another option, this type of shampoo can be used to treat fungal acne on the scalp and other areas with similar conditions.
Using these shampoos regularly can help reduce fungal infections on the scalp, preventing flare-ups that may spread to other parts of the body.
4. Lifestyle Changes:
In addition to medications, dermatologists will often recommend certain lifestyle changes to help prevent flare-ups of fungal acne. These changes can also complement treatment and help maintain clearer skin long-term:
- Keep the skin clean and dry: Fungal acne thrives in warm, moist environments, so it’s essential to keep affected areas clean and dry. Showering regularly, especially after sweating, and patting the skin dry with a clean towel can help prevent yeast overgrowth.
- Avoid heavy or oily skincare products: Some skincare products, especially those that contain oils or heavy moisturizers, can make fungal acne worse by providing a breeding ground for yeast. Dermatologists often recommend using lightweight, oil-free products that won’t exacerbate the condition.
- Wear breathable fabrics: Clothing made from synthetic fabrics can trap heat and moisture against the skin, which can encourage yeast growth. Dermatologists recommend wearing breathable, loose-fitting clothing made from natural fabrics like cotton to allow air circulation and prevent sweat accumulation.
- Shower after exercise: It’s crucial to shower soon after exercising or sweating to wash away any sweat that can contribute to yeast buildup on the skin.
Final Thought: Why Accurate Diagnosis and Treatment Matter
Fungal acne might look similar to regular acne, but the treatments couldn’t be more different. While bacterial acne responds to traditional treatments like benzoyl peroxide and salicylic acid, fungal acne needs antifungal treatment to get better.
If you’re unsure whether you have fungal acne or regular acne, it’s always best to consult a dermatologist. You can get in touch with our acne clinic to book a consultation with one of our expert dermatologists, who can provide an accurate diagnosis and treatment tailored to your needs.
References:
- Zaidi, S., & Faiz, A. (2020). Malassezia folliculitis: Diagnosis and management. Journal of Clinical and Aesthetic Dermatology, 13(5), 10-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237725/
- Williams, H.C., & Hanke, W. (2016). The role of Malassezia in acne-like conditions. Journal of Dermatology, 43(3), 208-213. https://pubmed.ncbi.nlm.nih.gov/26521187/
- Cheong, K.Y., & Tan, W.L. (2018). Fungal acne: A clinical review of Malassezia folliculitis. Mycoses, 61(3), 185-191. https://onlinelibrary.wiley.com/doi/full/10.1111/myc.12755
- Sharma, S., & Kaur, M. (2017). Clinical insights on Malassezia folliculitis: Treatment protocols. Dermatology Research and Practice, 2017, 1-5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691072/
- Tey, H.L., & Lee, S.P. (2019). Management of Malassezia folliculitis in dermatological practice. International Journal of Dermatology, 58(2), 157-163. https://pubmed.ncbi.nlm.nih.gov/30536568/