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What is fungal acne? Experts explain

This type of acne requires a different kind of treatment—so it’s important to identify it correctly.

Curology Team Avatar
by Curology Team
Updated on Jan 24, 2024 • 9 min read
Medically reviewed by Donna McIntyre, NP-BC
Fungal Acne
Curology Team Avatar
by Curology Team
Updated on Jan 24, 2024 • 9 min read
Medically reviewed by Donna McIntyre, NP-BC
We’re here to share what we know — but don’t take it as medical advice. Talk to your medical provider if you have questions.

In this article

What is fungal acne? 
More

Summary

  • Fungal acne, or Malassezia folliculitis, is often confused with regular acne but is caused by an overgrowth of yeast, not bacteria.

  • It presents as small, itchy bumps (papules and pustules) and typically appears on the chest, back, and arms, differing in appearance and location from traditional acne.

  • The condition requires a unique treatment approach, including oral antifungal medications like itraconazole and fluconazole, and topical antifungals like ketoconazole cream or shampoo.

  • Fungal acne thrives in oily environments and may be more common in humid climates, during puberty, and in people with certain medical conditions or using specific medications.

  • Understanding the difference between fungal acne and other types like hormonal acne is crucial for effective treatment, as standard acne treatments can worsen fungal acne.

If you’re dealing with stubborn, itchy breakouts that just won’t quit, you might be dealing with fungal acne—known in the medical world as Malassezia folliculitis. It’s a curveball in the skincare game that’s very different from traditional acne. 

We asked Curology’s team of dermatology providers to unveil the mysteries of fungal acne. We’ll explore everything from its unique causes and symptoms to the most effective treatment strategies. By understanding how fungal acne differs from regular acne, you’ll discover the best practices for managing and preventing these frustrating skin flare-ups. 

What is fungal acne? 

Curious about fungal acne? This interesting skin condition goes by the scientific name Malassezia (Pityrosporum) folliculitis. It often gets mistaken for regular acne vulgaris, but they’re not the same thing. Bacteria and excess oil usually cause traditional acne, while fungal acne is caused by an overgrowth of yeast on your skin.¹

This sneaky condition can stick around for years and doesn’t respond well to standard acne treatments.² It usually shows up as small, itchy papules and pustules, about 1-2mm big, and can sometimes come with a burning sensation. This type of acne is not just found on the face—fungal acne can also appear on your chest, back, arms, and face.³

Figuring out if your blemishes are fungal acne usually involves a doctor’s visit; sometimes, they might do a biopsy.⁴ They are fungal acne, your provider may give you oral antifungals, which can work wonders quickly. And, if you have a mix of fungal acne and more typical acne presentation, a combo of antifungal and acne meds might be the way to go.⁵

What causes fungal acne?

Fungal acne is a bit of a troublemaker and often gets mixed up with regular acne because they look so similar. But the culprit here is quite different from the traditional acne bacteria—it’s yeast, specifically the Malassezia yeast that usually lives on your skin.⁶ Fungal acne pops up when this yeast grows more than it should. This can happen if your skin pores get clogged, or there’s a disturbance in the natural balance of organisms on your skin.⁷

The yeast’s favorite snack? Sebum—that oily stuff your skin makes to stay moisturized. Sebum is abundant in areas where you have hair, and that’s where this yeast thrives.⁸

A few other things that make fungal acne more likely: It’s a frequent guest during your teenage years when your oil glands are usually in overdrive.⁹ Hot and humid weather? That’s like a tropical vacation for fungal acne. And if you’re sweating a lot, that may also cause yeast breakouts. Interestingly, it’s more common in males, but anyone can get it.¹⁰

Fungal acne is a tricky condition that needs a different approach than regular acne.¹¹ So, if you’ve been battling with traditional acne treatments and aren’t seeing much change, it might be worth considering if fungal acne is the real party crasher here.

Treatments for fungal acne 

Dealing with fungal acne can feel like a tricky battle, but with the right treatments, victory is within reach. From medications to supportive therapies, there are plenty of options available. 

Here’s a breakdown of the most effective approaches to treating fungal acne:¹²

  • Oral antifungal medications: Oral antifungals are a common fungal acne treatment. Itraconazole and fluconazole are the usual go-to’s; think of them as your first line of defense.

  • Topical antifungals: Ketoconazole in cream or shampoo form is a common topical antifungal. Sometimes, fungal acne needs a double hit. Combining oral and topical antifungals can really ramp up the effectiveness.

  • Topical tretinoin: Here’s an exciting ally—topical tretinoin. Not just for its anti-inflammatory and keratolytic superpowers but also because it’s handy when fungal acne is accompanied by regular acne.

  • Alternative treatments: In some rare cases, like when oral antifungals aren’t the right fit, treatments like photodynamic therapy (PDT) come into play. PDT uses light-sensitive compounds and light exposure to target the affected areas.

Fungal acne sometimes likes to hang out with other skin conditions, like seborrheic dermatitis or acne vulgaris.¹³ This can mean adding more treatments to your regimen. But watch out— antibiotics, while great for regular acne, can actually make fungal acne worse.¹⁴

Remember, it’s always best to speak with your dermatology provider first. They’ll give you a personalized game plan that’s just right for your skin.

Connect with a dermatology professional 

Dealing with fungal acne can feel confusing. That’s why the best move is to connect with a dermatology professional. They’re the ones who can give you the most accurate diagnosis and tailor an acne treatment plan that suits your skin’s unique needs. You don’t have to figure out everything on your own!

Reach out to a dermatology provider for guidance and get set on the path to clearer, happier skin. After all, your skin deserves the best care, and there’s no one better to provide it than a professional. Ready to take that step? Here’s your cue to make the call and start your journey to better skin health.

Getting a custom acne formula with Curology

Tackling fungal acne, or Malassezia folliculitis, can be a bit of a journey. Understanding your specific risk factors and symptoms is the first step. From there, choosing the right treatment, whether it’s oral antifungals, topical solutions, or a combination of both, is crucial. Remember, what works for one person may not work for another, so showing your condition to a medical provider in person for personalization is key.

Get your personalized skincare routine with Curology

Get your personalized skincare routine with Curology

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curology bottle

And speaking of personalization, at Curology, we believe that your skincare should be as unique as you are. While we don’t specifically treat fungal acne, we specialize in custom-formulated acne treatments that are tailored to your individual skin needs for traditional acne. Our team of experts is here to work with you, creating a personalized plan that addresses your unique skin concerns. If you’re ready to take the next step in your skin health journey with a formula that’s made just for you, Curology is here to help.

Start your journey* towards clearer, healthier skin!

FAQs

How do you know if you have fungal acne?

You can identify fungal acne, known as Malassezia folliculitis, by its appearance and location. It usually presents as small, itchy bumps (papules and pustules) commonly found on your chest, back, and arms. This condition differs from traditional acne in that an overgrowth of yeast causes it and doesn’t respond well to standard acne treatments. A physical examination or a biopsy by a healthcare professional can help confirm the diagnosis.

How do I get rid of fungal acne?

To treat fungal acne effectively, you may be prescribed oral antifungal medications like itraconazole and fluconazole, which target the yeast deep within your hair follicles. Alongside, topical antifungals like ketoconazole cream or shampoo are used with oral medications or as maintenance therapy. In some cases, treatments like photodynamic therapy (PDT) might be effective, especially when oral antifungals are unsuitable. Remember, it’s crucial to consult a dermatologist to get a personalized treatment plan.

What is the difference between hormonal acne and fungal acne?

It’s important for you to understand the difference between hormonal acne and fungal acne, as they require different treatment approaches. Hormonal acne typically stems from imbalances in your hormones, often involving androgens. This leads to increased oil production in your skin, resulting in inflammatory lesions that usually appear on your lower face.¹⁵

Fungal acne is a completely different story. It’s caused by an overgrowth of Malassezia yeast on your skin. This condition manifests as small, itchy bumps, which you’ll often find on your chest, back, and shoulders. While hormonal acne might respond well to hormone-regulating medications and topical treatments, fungal acne calls for a different strategy. You’ll likely need antifungal medications to tackle it effectively. Regular acne treatments, especially antibiotics, may actually make fungal acne worse, so choosing the right treatment is crucial.

Who is more at risk for getting fungal acne?

Certain conditions and factors can increase your chances of developing fungal acne including:¹⁶

  • People with suppressed immune function

  • Diabetics 

  • People using broad-spectrum antibiotics or taking steroids

  • Adolescents going through puberty 

  • Pregnancy 

Even skincare products you use, like cosmetics, lotions, sunscreens, or emollients may create a friendly environment for fungal acne.¹⁷ Being aware of these risk factors can help you take steps to prevent it.

What is the best acne treatment?

Figuring out the best treatment for your acne boils down to what type of acne you have and its severity. Topical therapies are usually the first line of defense for mild to moderate cases.¹⁸ This includes retinoids and antimicrobials like benzoyl peroxide and sometimes antibiotics. These treatments are great for nipping new lesions in the bud, but you might need to wait 6-8 weeks to start seeing a difference.¹⁹

If you’re dealing with more severe acne, the approach might need to be a bit more aggressive. This is where systemic therapies come into play. These include oral antibiotics, hormonal treatments, or even isotretinoin. Sometimes, using a combination of both topical and oral treatments works best.²⁰

But remember, acne is as unique as you are, so what works for one person might not be the answer for you. That’s why it’s important to speak with a healthcare professional. They’ll help you determine the treatment plan that fits your acne situation like a glove.

• • •

P.S. We did the homework so you don’t have to:

  1. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. (March 2014).

  2. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  3. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  4. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  5. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  6. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  7. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  8. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  9. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  10. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  11. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  12. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  13. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  14. Rubenstein, R.M. and Malerich, S.A. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. Ibid.

  15. Bagatin, E., et al. Adult female acne: a guide to clinical practice. An Bras Dermatol. (January-February 2019).

  16. Thayikkannu, A.B., et al. Malassezia-Can it be Ignored? Indian J Dermatol. (July-August 2015).

  17. Thayikkannu, A.B., et al. Malassezia-Can it be Ignored? Indian J Dermatol. Ibid.

  18. Kraft, J. and Freiman, A. Management of acne. CMAJ. (2011, April 19).

  19. Kraft, J. and Freiman, A. Management of acne. CMAJ. Ibid.

  20. Kraft, J. and Freiman, A. Management of acne. CMAJ. Ibid.

Donna McIntyre is a board-certified nurse practitioner at Curology. She obtained her Master of Science in Nursing at MGH Institute of Health Professions in Boston, MA.

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• • •
Our medical review process:We’re here to tell you what we know. That’s why our information is evidence-based and fact-checked by medical experts. Still, everyone’s skin is unique—the best way to get advice is to talk to your healthcare provider.
Curology Team Avatar

Curology Team

Donna McIntyre, NP-BC

Donna McIntyre, NP-BC

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