All About Fungal Acne: How to Identify and Treat

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 are 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.

Several conditions or events can upset this balance of bacteria and fungi, including:

• Trapped moisture. Wearing sweaty workout clothes for too long can encourage yeast growth. Rewearing workout clothes without washing them may also expose your skin to fungi that have grown in the clothes.
• Medication. If you take antibiotics, the bacteria on your skin can be reduced. That can allow for the overgrowth of a fungus.
• Suppressed immune system. People with compromised immune systems may be more likely to develop fungal acne.
• Diet changes. Fungi and yeast feed on carbohydrates, so balancing your intake of sweets and carb-rich foods may help slow fungal growth.
• Wearing tight clothes. Regularly wearing nonbreathable clothes can encourage extra sweat and moisture. This can foster a skin environment ripe for yeast growth.
• Warm, moist environments. People living in hot climates, where sweating is more likely, may experience fungal acne more frequently.

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 nearly 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.

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.

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.

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 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.

If you’ve attempted to treat your suspected fungal acne at home and the breakout persists for more than 3 weeks, call your dermatologist.

A prescription antifungal medication may be more effective at eliminating the infection than topical treatments.

And if the symptoms return shortly after you thought they were resolved, consider making another appointment with your dermatologist.

You may be able to find a treatment that’ll help stop the recurrence and prevent possible long-term issues. You can also discuss preventive options with your doctor.

Fungal acne is a type of infection in hair follicles caused by an overgrowth of yeast. Despite the name, it’s not like the acne that causes whiteheads and blackheads.

Typical anti-acne treatments won’t work for fungal acne. Instead, you need to identify this type of infection accurately in order to properly treat it.

Learning how to identify this specific type of skin infection can also help you prevent future breakouts.