Fungal acne is a type of infection in your skin’s hair follicles. It most commonly appears as small pimples that don’t vary much in shape or size, followed by itching.
Fungal acne can cause whiteheads and skin irritation. It’s often confused with acne vulgaris. This is the type of acne most commonly associated with blackheads and whiteheads.
But fungal acne and acne vulgaris are two different conditions caused by two different things. They won’t respond to the same treatment. If you keep using anti-acne treatments, you can make fungal acne even worse.
That’s why it’s important to understand what fungal acne looks like and how it develops. Read on to learn the symptoms and signs of fungal acne and what you can do to treat and prevent breakouts.
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What are the causes of fungal acne?
Fungal acne is a bit of a misnomer. Unlike acne, fungal acne isn’t caused primarily by oil and bacteria in pores, although oil and sebum production is a big part of helping feed the bacteria that cause fungal acne.
Instead, the pimple-like bumps and irritated skin associated with fungal acne are caused by an overgrowth of yeast, a type of fungus.
That’s why it’s sometimes called fungal acne. It’s also referred to as Pityrosporum folliculitis or Malassezia folliculitis.
The yeast responsible for fungal acne is always present on your skin. Typically, your body is able to balance the yeast, other fungi, and bacteria that are also a part of your skin.
But if that natural balance is upset, an overgrowth can occur. That’s when the infection of hair follicles develops and acne-like symptoms show up.
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Conditions that can upset this balance of bacteria and fungi include:
Heat and humidity: Fungal acne is closely related to hotter climates. According to Zeichner, it’s relatively uncommon in the United States and is seen at much higher rates in areas of the world where the weather is always warm, such as the Philippines. This is because the yeast that causes fungal acne thrives in moist environments with excessive sweat and heat.
Sweat: You probably already know that it’s best to shower as soon as your exercise is over and that it’s not ideal to sit around in sweaty, clingy clothes (ahem, yoga pants), but this can do more than just make for an uncomfortable fit. To avoid sweat-induced fungal acne, it is advised to choose loose clothing with natural fabrics, avoid spandex, and change clothing often after exercise or excessive sweating. This can be helpful particularly in hot weather when it can flare up.
Overuse of antibiotics: The yeasts on our skin are part of our microbiome, and they’re not a problem when they’re not in excess. However, in certain circumstances—such as long-term use of topical and/or oral acne antibiotics—the normal skin flora is wiped out by the antibiotics, and so the yeast flourishes, causing inflammation and fungal acne. If you have acne that’s not responding to normal treatments and a history of regular antibiotic use, you may have found your culprit.
Contact with others: Fungal acne might be contagious (after all, yeast is known for spreading). If you’ve had bodily contact with someone who has fungal acne, it may be your cause of yours.
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What are the symptoms of fungal acne?
One of the reasons fungal acne can last for so long is because fungal acne looks similar to acne vulgaris, or bacterial acne.
People with fungal acne, not knowing the difference, may treat it with regular acne skin care options. These treatments don’t work, and they can make the infection worse.
Here’s how to tell the difference between fungal acne and bacterial acne:
Size. Pus-filled bumps caused by fungal acne tend to be near all the same size. Bacterial acne can cause pimples and whiteheads of varying sizes.
Location. Fungal acne often shows up on the arms, chest, and back. It can also be on the face, where bacterial acne is most common.
Itching. Fungal acne often causes itchiness. Bacterial acne rarely does.
Clusters. Fungal acne often appears in clusters of small whiteheads. Bacterial acne is less clustered and more sparse.
Fungal acne is the result of yeast growth, so you may experience other yeast-related conditions, like psoriasis and dandruff. This can help you determine whether your breakouts are from yeast or another cause.
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How is fungal acne diagnosed?
If you believe you have symptoms of fungal acne, you may want to see a dermatologist. Dermatologists specialize in diagnosing and treating conditions that affect the skin.
To determine if your symptoms are a result of fungal acne, a dermatologist will ask you about the symptoms you’re experiencing. This will likely include:
- how long you’ve had the breakout
- what you’ve used to treat it
- what symptoms you’re experiencing
- In some cases, the provider may also want to do one of the following:
They may do a simple, painless skin scraping and examine the scraping under a microscope to look for any yeast responsible for fungal acne.
They may take a skin sample or biopsy. This is a simple process done in the office. The sample will be sent to a lab where it can be tested to confirm the fungal acne diagnosis.
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How is fungal acne treated?
Fungal acne is often treated improperly because it looks a lot like regular acne. Many people use everyday anti-acne treatments against it, but those won’t work.
To properly treat the fungal infection, you need to restore the balance between yeast and bacteria on the skin. Several treatment options can help do this.
Shower more regularly
If you regularly work out or have a job that causes you to sweat, try showering and changing clothes right after the gym or work.
This can help wash away excess yeast that may have started growing in the warm, moist environments that develop in sweaty clothes.
Wear looser clothes
If you frequently wear tight clothes, friction and low airflow can encourage yeast growth on the skin.
Opt for loose, breathable fabrics more regularly to help your skin get proper circulation and encourage balanced bacterial and fungal growth.
Try a body wash
Dandruff shampoos made with pyrithione zinc or selenium sulfide can be used as body washes. This is an off-label use of these shampoos, but it can be effective.
Rinse your skin several times a week with these dandruff shampoos while you’re having a breakout.
You may also consider using it regularly, about once a week, to help maintain a healthy balance of yeast and bacteria on your skin. Let the shampoo sit on your skin for several minutes before rinsing, for best results.
Use over-the-counter (OTC) antifungal treatments
A variety of OTC antifungal creams and ointments are available, such as medications for athlete’s foot and jock itch.
Look for products with ketoconazole, butenafine, or clotrimazole cream.
Try prescription oral antifungal medicine
If home treatments don’t help eliminate the breakout, consider making an appointment with your dermatologist.
Your dermatologist can prescribe an oral medication, such as itraconazole or fluconazole, to target the hair follicles and eliminate the infection.
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How can I prevent fungal acne?
While fungal acne can’t be prevented completely, these steps may help reduce the chances of a return infection:
- Use a dandruff shampoo regularly. This regular rinse may help maintain a healthy balance of yeast on your skin. Once the breakout is gone, you can cut back on how often you use the shampoo as a body wash to as little as once a week.
- Wear breathable fabrics. Breathable fabrics allow for airflow, which can cut down on warm, moist environments that encourage fungus growth. If changing your clothing options helps treat fungal acne, consider wearing similar types of clothing.
- Shower after sweating. A quick rinse after a workout or a sweaty day at work can help prevent yeast growth issues.
- Eat a balanced diet. Fungi like yeast thrive on sugary carbohydrates, so balance your diet with fruits, vegetables, and proteins to help discourage overgrowth.