Fungal Acne: Could This Be Causing Your Persistent Pimples?

If you’ve tried what seems like everything to get rid of persistent acne that won’t go away, no matter which treatments or skin care you use, it is possible that you might not be dealing with acne at all, but a condition caused by a yeast overgrowth known as fungal acne. This condition, scientifically known as Malassezia folliculitis or Pityrosporum folliculitis, is characterized by a fungal infection of hair follicles, which can look a lot like acne on the surface.

Here, I’ll explain more about what fungal acne is and how it is different from other true types of acne and what you can do to finally get rid of it. 

Fungal acne is an inflammatory skin condition that happens when an overgrowth of a specific type of yeast called Malassezia causes a fungal infection inside the hair follicles, or pores, in your skin. This causes red, inflamed pustules or papules that resemble acne, as well as itching. Because it so closely resembles acne vulgaris, however, fungal acne is often misdiagnosed and incorrectly treated, making it a persistent, frustrating problem.

Fungal acne occurs when there’s an imbalance in your skin’s natural microbiome, allowing Malassezia yeast to multiply. There are several triggers that can contribute to this overgrowth:

• Excessive sweating. Working out or being in humid environments can create a warm, moist environment where yeast thrives. This is made worse when you wear tight, non-breathable fabrics that trap moisture and allow yeast to thrive.

• Hormonal imbalances. Some hormone-related conditions like PCOS (polycystic ovary syndrome) or insulin-resistance may make you more susceptible to fungal acne (3).

• Medications. Antibiotics used to treat bacterial acne can sometimes disrupt the skin’s microbiome, promoting yeast growth.

• Diet. Yeast thrives in a high-sugar environment, so eating lots of sugary foods or simple carbohydrates can contribute to fungal acne.
  
• Certain skin care ingredients. Some oils, fatty acids, esters, and polysorbates in skin care can help yeast thrive on the skin. 
• Climate. Yeast thrive in warm humid environments so this is more common in the summer in humid climates.

Fungal acne usually appears as small, uniform pustules or papules that are often itchy and tend to form in clusters. These bumps tend to show up on areas that are prone to sweating, like the forehead, chest, back, and upper arms, although they can show up anywhere on the face or body. They may look like tiny pimples, but they don’t have blackheads or whiteheads. The skin can feel irritated or itchy, and the breakouts may worsen in hot, humid conditions.

While fungal acne is caused by yeast overgrowth, acne vulgaris (the typical type of acne that most people are familiar with) is caused by a bacterial overgrowth. These two conditions can look similar and can be tricky to tell apart, but there are a few key differences.

One of the most important distinctions is that fungal acne, unlike acne vulgaris, typically does not involve comedones (clogged pores like blackheads or whiteheads). Instead, fungal acne typically shows up as a uniform cluster of red, itchy bumps. Acne vulgaris, on the other hand, often includes a mix of comedones, cysts, and pustules.

Hormonal acne tends to occur deeper in the skin, forming painful cysts that often pop up in the same areas each month, especially around the chin and jawline. In contrast, fungal acne is more superficial and usually feels itchy. While hormonal acne is driven by fluctuations in hormones like estrogen and testosterone, fungal acne is triggered by an overgrowth of yeast.

Typical treatments for regular acne will not work for fungal acne, which is why this condition can be so frustrating if it is misdiagnosed. Fungal acne is treated in the same way as other conditions involving yeast overgrowth, such as tinea versicolor. The most effective treatments include:

• Antifungal shampoos. Shampoos that contain antifungal ingredients like ketoconazole, selenium sulfide, or zinc pyrithione can be used on the scalp or body to kill the yeast.

• Antifungal creams. Topical antifungal medications like clotrimazole or terbinafine can also be applied to the affected areas to get rid of the yeast.  

• Sulfur. Washes like Derma Made Medi Wash that contain sulfur – which has antimicrobial and antifungal properties – can help to reduce the amount of yeast on the skin that is causing fungal acne.

• Oral antifungal medications. In more severe cases, your dermatologist might prescribe an oral antifungal medication like fluconazole to treat fungal acne that doesn’t respond to other treatments.

There are steps you can take to keep fungal acne at bay once you’ve successfully treated it using the methods listed above.

• Shower and immediately change out of workout clothes after sweating in them.

• Use a dandruff shampoo or sulfur-containing wash to kill yeast and keep the population from overgrowing on your skin.

• Talk to your doctor about any hormonal concerns such as PCOS that may be linked with an increase in susceptibility to recurring yeast infections.

If you’ve been battling persistent breakouts that don’t respond to regular acne treatments, you might be dealing with fungal acne. This skin condition is caused by yeast overgrowth and can be treated with antifungal products like sulfur washes and medicated shampoos. If you are unsure about whether your breakouts are caused by true acne or a fungal infection, see your dermatologist for an accurate diagnosis so you know you are using the correct treatments for your skin condition and type.

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