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Fungal acne is one of those tricky, lesser known skin conditions that is very common but often mistaken for common acne. If you’re struggling with small, red, bumps on your face and traditional acne treatments aren’t working, it might be time to consider fungal acne as the culprit. Fungal acne, also known as Malassezia folliculitis, has similar symptoms to common acne, making it crucial to differentiate between the two, but requires vastly different treatments. Below, we delve into the causes and identifying factors of fungal acne, and explore different treatments and ingredients to help you manage this treatable condition.

Understanding Fungal Acne

Malassezia folliculitis, commonly referred to as “fungal acne,” is a widespread skin condition often mistaken for or inaccurately treated as common acne (acne vulgaris). Unlike common acne, which occurs due to excess sebum and dead skin cells clogging hair follicles, fungal acne is triggered by the overgrowth of a specific yeast known as Malassezia. Despite its name, fungal acne is not actually acne but a form of folliculitis, which is an infection in the small hair follicles on the face or body.

Fungal acne can appear as small, itchy bumps on the skin that resemble acne lesions. These bumps are typically red or skin-colored and can be found on areas with a high density of hair follicles, such as the face, chest, back, and shoulders. Inflammation, pustules, or papules may also accompany Malassezia folliculitis, which is why it’s often mistaken for common acne.

Spotting the difference between Malassezia folliculitis and common acne can be a challenge as they often look similar. However, common acne and fungal acne require different treatments, and anti-acne treatments like antibiotics can actually make fungal acne worse.

Common Acne vs Fungal Acne Symptoms

As mentioned, Malassezia folliculitis can appear similar to common acne with some subtle differences. Recognizing the symptoms of fungal acne is important to treat it correctly.

Common symptoms of fungal acne to watch out for include:

Small, uniform bumps: Fungal acne typically presents as small, itchy bumps. These bumps are often the same size and shape, ranging from pinhead-sized to slightly larger pustules while common acne may consist of various types of lesions, including blackheads, whiteheads, cysts, or nodules.

Location and pattern: Fungal acne lesions often appear in clusters or specific patterns, following the distribution of hair follicles. Common areas affected include the chest, back, shoulders, and forehead while common acne tends to affect the face more prominently. .

Itching and inflammation: Fungal acne is frequently accompanied by intense itching and discomfort, more so than common acne. The affected areas may appear red and inflamed, indicating an immune response to the overgrowth of yeast.

Response to antibiotics: Fungal acne does not respond well to traditional antibiotic acne treatments because antibiotics do not distinguish between harmful acne-causing bacteria and beneficial yeast-controlling bacteria. This can create an imbalance that allows the yeast to flourish.

Causes of Fungal Acne

Fungal acne occurs when there is an overgrowth of yeast on the skin’s surface. While Malassezia yeast is found on everyone, it becomes problematic when it enters hair follicles and is allowed to overpopulate the skin’s microbiome unchecked. This excessive yeast growth disrupts the natural balance of the skin, leading to the formation of small, itchy bumps that resemble acne. Yeast grows in warm, moist environments, so Malassezia folliculitis tends to flare in the summer months with heat, humidity, and perspiration. It can also arise after treatment with medications such as antibiotics and steroids/prednisone, and in conjunction with other systemic diseases like diabetes.

Disrupted Microbiome

Fungal acne can happen when your skin’s microbiome becomes unbalanced and this disruption can be caused by antibiotics.

Your skin has a delicate balance of microorganisms, including bacteria and fungi, that form the skin’s microbiome. This microbiome plays a crucial role in maintaining a healthy skin barrier, which keeps the skin soft, hydrated, supple, and smooth. When this balance is disrupted, like when you take antibiotics, it can create an environment that promotes the growth of Malassezia yeast, causing fungal acne.

Antibiotics, while commonly prescribed for the treatment of acne, can inadvertently worsen fungal acne as they can eliminate beneficial bacteria that help keep yeast growth in check. To address the disrupted microbiome caused by antibiotics and help manage Malassezia folliculitis, you can consider incorporating probiotics into your skincare routine or diet. Probiotics are beneficial bacteria that can help restore the balance of the skin’s microbiome and support a healthy skin barrier.

Skincare Ingredients

Certain skincare ingredients can exacerbate fungal acne by promoting yeast growth or irritating the skin. It is important to avoid products containing these ingredients if you have fungal acne.

Some of these ingredients include:

Fatty acids: Fatty acids, such as linoleic acid, oleic acid, stearic acid, palmitic acid, myristic acid, and lauric acid, can potentially worsen fungal acne. These fatty acids feed the Malassezia yeast, leading to its overgrowth. Avoid ingredients like coconut oil, which is rich in lauric acid.

Oils: Oils with a high concentration of triglycerides, such as coconut oil, can create a favorable environment for fungal acne. These oils can clog pores and nourish the yeast, exacerbating the condition.

Fermented ingredients: While fermented skincare products have many benefits, they can also exacerbate fungal acne due to the fermentation process that can promote yeast growth. It’s best to stop using any fermented skincare products if you’re experiencing Malassezia folliculitis.

Irritating ingredients: Skin irritants, such as alcohol, fragrance, menthol, and certain essential oils like lavender oil, lemon oil, and eucalyptus oil, can worsen Malassezia folliculitis. These ingredients can disrupt the skin’s barrier function and increase inflammation.

Other Fungal Acne Triggers

High humidity and warm climates promote the growth of Malassezia yeast, increasing the risk of fungal acne. Profuse sweating, tight clothing, and occlusive materials create a moist environment that encourages yeast overgrowth. Choosing loose-fitting, breathable fabrics like cotton can help minimize the risk. Inadequate cleansing and infrequent washing can also contribute to yeast overgrowth. Additionally, stress disrupts the skin’s microbiome balance and weakens the immune system, making it more susceptible to Malassezia folliculitis. Managing stress through exercise, mindfulness, or seeking support can promote healthy skin.

How to Treat Fungal Acne

Unlike typical acne, which often responds to antibiotics, such treatment can exacerbate Malassezia folliculitis. Instead, antifungal medications or skincare products with antifungal properties are recommended.

In addition to antifungal treatments, the best way to treat and prevent Malassezia folliculitis is through proper hygiene and care. Remember to regularly cleanse or sanitize anything that touches your face, including towels, makeup brushes, and pillowcases, and don’t share them with others. After exercise or sweating, promptly wash and dry your face to remove sweat and prevent moisture buildup, which contributes to Malassezia folliculitis. Lastly, incorporating probiotics into your diet and lifestyle can help maintain a healthy balance of bacteria on the skin and throughout the body.

Topical Antifungal Ingredients

Topical antifungal agents are commonly used to treat fungal acne. These products contain ingredients that specifically target and prevent the growth of the Malassezia yeast. Over-the-counter antifungal creams, lotions, and shampoos can be effective in treating mild to moderate cases of fungal acne. These products, such as anti-dandruff shampoo and creams used to treat athletes’ foot, can be directly applied to the affected areas.

Some key ingredients to look for in antifungal treatments include:

  • Azoles: Azole antifungals, such as clotrimazole, ketoconazole, and miconazole, are commonly used in topical treatments for Malassezia folliculitis. They work by disrupting the cell membranes of the yeast, preventing their growth and reproduction.
  • Selenium sulfide: Selenium sulfide has antifungal properties and is often found in medicated shampoos used to treat fungal conditions, including Malassezia folliculitis.
  • Pyrithione zinc: Pyrithione zinc is an antifungal agent that can help control the growth of the Malassezia yeast and is commonly found in dandruff shampoos.

In addition to the above antifungal ingredients, there are several other common skincare ingredients that may be beneficial in managing fungal acne:

Oral Antifungal Medications

In more severe or persistent cases of Malassezia folliculitis where topical treatments aren’t working, oral antifungal medications may be prescribed, such as itraconazole or fluconazole, to be taken over a specific period. These medications work systemically to target the underlying fungal infection and can be highly effective in resolving stubborn cases of fungal acne.

Skincare Routine to Prevent Fungal Acne

Cleanse your skin twice a day using a mild, non-comedogenic, pH-neutral cleanser. This helps remove excess oil, sweat, and impurities without stripping the skin’s natural oils. Look for serums and toners with probiotics, which can help balance the skin’s microbiome, and natural anti-fungal ingredients like tea tree oil, known for its antimicrobial properties.

Choose moisturizers and sunscreens that are oil-free or non-comedogenic to avoid clogging pores and aggravating Malassezia folliculitis. Look for lightweight and non-greasy formulas that are specifically labeled as “non-comedogenic” or “oil-free.” Consider using physical sunscreens containing zinc oxide or titanium dioxide, as they are less likely to cause irritation.

Gentle exfoliation can help remove dead skin cells, but it should be done with care for individuals with Malassezia folliculitis. Look for chemical exfoliants containing AHAs or BHAs, as they can effectively unclog pores without excessive irritation. Avoid using harsh scrubs or brushes that can cause micro-tears in the skin, making it more vulnerable to infections.

Best Products to Treat Fungal Acne

Malassezia folliculitis can often be treated with over the counter antifungal treatments, including anti-dandruff shampoos or creams to treat athletes’ foot. These topical products are formulated with ingredients specifically designed to target and inhibit the growth of the Malassezia yeast, which is the primary cause of fungal acne. Available in the form of creams, lotions, and shampoos, these treatments can effectively address mild to moderate cases of fungal acne.

It’s important to remember that these products are not intended for the face. However, many individuals have found success using it for Malassezia folliculitis treatment. Results may vary, and if you have concerns or if your condition persists or worsens, consult a dermatologist for a personalized evaluation and guidance.

Nizoral Anti-Dandruff Shampoo

Antifungal Ingredient: ketoconazole

Nizoral Anti-Dandruff Shampoo, which contains the antifungal ingredient ketoconazole, is a popular and accessible treatment for fungal acne. Its effectiveness lies in its ability to target the underlying cause of the condition: the overgrowth of Malassezia yeast. By inhibiting the yeast’s growth, ketoconazole reduces inflammation and prevents acne breakouts.

To use Nizoral Anti-Dandruff Shampoo for Malassezia folliculitis, start by wetting your face with lukewarm water. Apply a small amount of the shampoo to the affected areas and gently massage it into the skin. Leave it on for a minute or two and then thoroughly rinse it off. Follow up with a gentle cleanser and moisturizer suitable for your skin type.

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Head and Shoulders Clinical Strength Dandruff and Seborrheic Dermatitis Shampoo

Antifungal Ingredient: selenium sulfide

Head and Shoulders Clinical Strength Dandruff and Seborrheic Dermatitis Shampoo, with selenium sulfide, is a recommended treatment for Malassezia folliculitis due to its ability to address the underlying causes of the condition. Selenium sulfide is an effective antifungal agent that specifically targets the Malassezia yeast to reduce fungal acne breakouts. The shampoo is available in pharmacies and stores. To use this shampoo for fungal acne, wet your face with lukewarm water, apply it to the affected areas, and gently massage it in. Leave it on for a few minutes before rinsing and follow up with a gentle cleanser and moisturizer.

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Lotrimin Athletes’ Foot Antifungal Cream

Antifungal Ingredient: clotrimazole

Lotrimin Athletes’ Foot Antifungal Cream with clotrimazole is a viable option for treating fungal acne. Clotrimazole effectively targets the Malassezia yeast responsible for fungal acne, reducing its growth and preventing breakouts. The cream is gentle on the skin and suitable for facial application. To use, wash your face, pat dry, and apply a thin layer of the cream to affected areas twice daily, morning and night, or as directed by your healthcare provider.

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