Girl with acne breakout

Fungal Acne: Do You Have it and How Do You Treat It?

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Acne — the scourge of countless teens. But this skin condition also affects people well into their 30s, and some into their late 40s. Although not serious, the permanent scars it leaves cause emotional distress. It’s especially distressing if the treatments you’ve been doing have not been effective.

Your acne treatments may not be working because you don’t have acne but a different skin condition called fungal acne.

What Does Fungal Acne Look Like?

girl with fungal acne
Fungal acne appears more commonly on the upper chest and back instead of on your face. When it does, it usually turns on the sides of your face or on your chin. Photo by SharonMcCutcheon on Pixabay

When you have fungal acne, you’ll experience itching, irritation and breakouts. The primary difference between acne vulgaris and fungal is the intense itch and the appearance of whiteheads and blackheads.

The good news is the fungal kind is typically seen on the upper chest and back whereas vulgaris commonly shows up on the face and neck. The condition may still appear on your face, but not as prominently placed as acne. So with the former, you may not have to worry about buying makeup to conceal bad skin.

The bad news is fungal acne rarely improves with a round of antibiotics, but vulgaris can be controlled with that acne medication.

So how do you tell if you have fungal acne?

You’ll know when you answer “yes” to the following:

  • Is it itchy as hell? Common acne shouldn’t itch. If yours feel like you have an uncontrollable urge to scratch your skin, it’s fungal.
  • Do you sometimes feel a stinging sensation?
  • Do you have small, red bumps on your back, chest and shoulders instead of your face?
  • Do the acneiform (appears to be acne but isn’t) on your face show up on the sides or your chin?
  • Do your breakouts look uniform and in the shape of pinheads?

Of course, go in for a consultation with a licensed dermatologist before making any moves to remedy your skin condition. A dermatologist who has treated fungal acne will use multiple diagnostics tools to confirm if you do have the skin condition and not another.

Among them:

  1. Skin biopsy – taking out and examining a part of your skin, which will include the infected follicle, to determine the presence of malassezia.
  2. Skin scrapingscraping hair, skin and nail tissue as part of fungal testing. Like the skin biopsy, samples for this lab test will be viewed under a microscope with chemicals. Your dermatologist may also prescribe scraping from pustules and papules to see if there is a secondary bacterial infection.

Now if fungal acne isn’t acne, what is it?

What is Fungal Acne?

Malassezia folliculitis
Malassezia folliculitis or fungal acne is not acne. Photo by Anna Nekrashevich on Pexels

Fungal acne is a chronic condition in which an overgrowth of the malassezia yeast in the hair follicle causes irritation, acneiform breakouts and intense itching. Unlike acne, fungal acne or malassezia folliculitis is a fungus.

So typical acne medications and treatments will not work for this skin condition that afflicts mostly young people. Acne treatments may even make it worse.

Some people have to deal with both conditions, making treatment a bigger challenge. Compounding this problem is the cost of a wrong diagnosis, which can leave many hopeless about their condition. People could endure malassezia for years if it’s misdiagnosed as acne.

Clearly, when you’re looking up dermatologists, choose professionals who’ve dealt with this tricky condition. This way, you’ll be taking the right step toward managing fungal acne, which typically develops in warm weather.

What Causes Fungal Acne?

girl stretching on a bench
Workout clothes hug the body close, and for good reason. But tight-fitting clothes don’t let your skin breathe, and sweat can cause fungal acne. Photo by Julia Ballew on Unsplash

Malassezia grows in specific conditions, as in the “setting” has to be just right for this yeast to multiply in rapid succession. When it does, expect irritation and infection to follow. Everyone has yeast (and bacteria) on their body. But this type of yeast only starts to give you problems if you live in a warm climate. So you’re likely to develop fungal acne than those who live in cold climates.

Warm environment

People with fungal acne may not appreciate living in a tropical paradise. Blistering temperatures and high humidity aren’t just uncomfortable. They’re also the right conditions for the overgrowth of malassezia. A study of 68 cases in the Philippines even found 56 percent of the subjects had acne vulgaris and fungal acne. The country typically has high temperatures, high humidity and, on certain months, heavy rainfall.

Tight clothes

Sometimes it’s not just the temperature that causes malassezia folliculitis. Sometimes it’s what you wear that could be the culprit. Tight-fitting clothes can mean sweating, and when your outfit doesn’t let your skin breathe, it triggers malassezia. This is why you need to get out of those sweaty workout clothes and not walk around them after a fitness class or a run in preparation for a marathon.

Diet

In the same way as some food products cause acne, certain diets may also lead to excessive yeast growth. What sort of diet? One where you consistently grab sweets on grocery shelves and eating too much carbs. Yeast feeds on sugar and carbohydrates. Eat too much of both and you’re likely to get those acneiform breakouts on your chest, back or chin.

Antibiotics

What is meant to control acne vulgaris may worsen fungal acne. This happens because some antibiotics can kill good bacteria. And good bacteria are meant to control yeast growth on skin. Some medications also weaken your immune system, leaving your body at the mercy of malassezia.

Sebum

Sebum is that waxy or oily substance hair follicles produce, thanks to the sebaceous gland (not to be mistaken for sebaceous filaments). Much like sugar and carbs, sebum is a yeast favorite. It thrives on this lipid source, which contains fatty acids, cholesterol and triglycerides, among other lipids.

Since you can’t use medication prescribed for acne vulgaris, what products can you use for fungal acne? Some people swear by Selsun Blue shampoo as an effective treatment to this fungal breakout. And some board-certified dermatologists do agree.

An antidandruff shampoo for fungal acne on your face?

How Do You Treat Fungal Acne?

Girl treating her fungal acne
Treatments for fungal acne typically include a prescription of lotions or cream products with ketoconazole, selenium sulfide or econozole. Photo by Polina Tankilevitch on Pexels

Fungal acne treatment does include the application of anti-dandruff shampoo, like Selsun or Nizoral. Studies have shown that fungal therapy, not corticosteroid, is better at controlling the growth of malassezia. And Selsun Blue’s active ingredient, selenium sulfide, is a recommended antifungal treatment.

Your dermatologist may prescribe topical lotions or cream products with the following ingredients:

  • 1% Clotrimazole – Canesten antifungal cream may help with fungal infections; it comes in spray form, too.
  • 2% Ketoconazole – Nizoral may reduce the growth of fungus, treat infection and prevent fungal acne
  • 1% Econozole nirate cream – Spectazole is the brand name for econozole, which prevents the growth of fungus to treat infections.

But topical applications alone will not be effective. Your dermatologist may also put you on antifungal pills. Pills are able to reach deep into the hair follicle to control yeast growth.

Anyone who’s gone to a dermatology clinic knows that treatments for skin conditions don’t stop at oral and topical medication. If you’ll go back to the causes behind malassezia folliculitis, you’ll know some lifestyle adjustments have to be made to keep breakouts at bay.

That means:

  • Wear loose clothing more often; if doable, go for natural, breathable fabrics or moisture-wicking clothes
  • After working out or training for any sports event, shower so that the sweat doesn’t linger on your body
  • Try not to consume too much sugar or carbs

Any skin condition is never easy at any age. With fungal acne, the first step is getting an accurate diagnosis. Once your dermatologist confirms that your breakouts are fungal and not common acne, then you can begin the right treatment. And eventually, you’ll be able to see your skin clear up.

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