What Is Fungal Acne?

Bumps and irritation on the skin caused by yeast overgrowth

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Fungal acne, also known as pityrosporum folliculitis or malassezia folliculitis, is caused by an overgrowth of yeast in the hair follicle, leading to breakouts, itching, and irritation on the skin’s surface. It can be quite distressing due to its discomfort and cosmetic concerns. It’s treated differently than other types of acne. It can often be controlled or prevented.

Close up of Asian woman worry about her face when she saw the problem of acne and scar by the mini mirror. - stock photo


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Symptoms

Fungal acne, also referred to as fungal folliculitis, occurs when yeast enters the hair follicle and multiplies, causing acne-like breakouts on the skin’s surface. The tiny round papules are often pink and occasionally have a whitehead. Yeast is a type of fungus, and that's why this skin condition is called fungal acne.

Fungal acne is usually accompanied by the following: 

  • Swelling and redness
  • Irritation of the hair follicle
  • Itching
  • Acne-like breakouts 
  • Occasional stinging sensation

Fungal Acne vs. Acne Vulgaris

Fungal acne is often confused with acne vulgaris because they look similar. Vulgaris is the medical term for "common," and it's used in "acne vulgaris" to distinguish it from other types of acne.

The causes, symptoms, and treatments of fungal acne and acne vulgaris are different, however:

Fungal Acne
  • Caused by a yeast infection in the hair follicle

  • Most common on the upper back, chest, and forehead

  • Breakouts are pinhead-sized and uniform

  • Does not improve (or even worsens) with antibiotics

  • Intense itching

Acne Vulgaris
  • Caused by oil and bacteria clogging the pores

  • Most common on the face, neck, and chest

  • Breakouts usually have blackheads or whiteheads

  • Sometimes treated with antibiotics

  • Does not cause itching

Causes

Malassezia, a type of yeast, is common on the skin. It usually doesn't cause any skin problems, but under specific conditions, it can lead to infection and irritation in the form of fungal acne. 

While doctors do not fully understand what causes the yeast to invade hair follicles, it's known that yeast multiplies quickly in hot, sweaty places. Individuals who live in hot, humid climates are therefore more likely to experience fungal acne.

Wearing clothing that does not breathe well, such as synthetic fabrics, and sweaty clothing for too long or re-wearing workout gear can make you more likely to develop fungal acne as well, so is wearing tight or restrictive clothing.

This type of yeast feeds off of skin oil, also known as sebum. Having oily skin or adding extra oil to your skin in the form of sunscreen or lotion can put you at higher risk of fungal acne. Adolescents are therefore more likely to be diagnosed with fungal acne because hormonal changes during puberty can increase sebum production in the body. Men are more susceptible to fungal acne than women. 

Medications

While uncommon, certain medications can put you at higher risk for developing fungal acne. Oral antibiotics, sometimes prescribed for common acne, can make fungal acne worse because the antibiotic reduces your skin’s good bacteria, which help to regulate the amount of yeast on your skin. Without the good bacteria to balance it out, yeast can multiply quickly.

Oral steroids like prednisone dampen your body’s immune response, which means you won’t be able to control yeast overgrowth as effectively. For women, oral contraceptives can increase the level of estrogen in the body, which affects skin oil production, making them more susceptible to yeast overgrowth.  

Underlying Conditions

Any medical condition that causes immunosuppression like HIV infection could put you at higher risk of fungal acne because your body is unable to control yeast overgrowth. If you are immunocompromised and start to notice red, itchy bumps, consult your doctor. 

How to Prevent Fungal Acne

The best way to prevent fungal acne is to avoid conditions that help yeast grow. Yeast needs hot, humid conditions to thrive, so be sure to wear breathable fabric on your skin, especially when working out. Once you finish exercising, shower and dry off right away. Yeast also loves feeding off of carbohydrates, so limiting sugar in your diet could help to prevent overgrowth. 

If you have a history of fungal acne, washing the affected area with an anti-dandruff shampoo in the shower could help to prevent yeast overgrowth. 


Diagnosis

Usually your dermatologist will be able to diagnose fungal acne after a brief physical exam. They will look for uniform, pinhead-sized red pustules on the hair follicles on the upper chest and back. Bumps caused by yeast are typically of the same size, and whiteheads are generally not seen with fungal acne.

Your dermatologist may ask you a few questions during the exam, such as:

  • How long have you been experiencing these bumps?
  • Are they itchy?
  • Do they seem to get worse in the heat?
  • Have you started any new medications lately?

They may recommend doing a skin scraping to look at your skin cells under a microscope and detect the yeast responsible for fungal acne. This method is not always definitive because most people normally have this yeast on their skin. A Wood's lamp exam, which involves using ultraviolet light to look at the skin closely, may also be performed. If you have fungal acne, a yellow-green fluorescence will be seen.

Fungal Acne Is Commonly Misdiagnosed

Fungal acne is commonly misdiagnosed as common acne. Differentiating the two is important since antibiotic treatment may make the problem worse. When left untreated, fungal acne may persist for many years. This condition should be considered especially in people who fail to respond to typical acne medications, have itchy skin, and bumps of around the same size.

Treatment

Treatment for fungal acne has two goals: to treat the yeast overgrowth and to address the underlying cause. If the yeast overgrowth alone is treated, the fungal acne will most likely recur.

Fungal acne is often treated with both antifungals and acne medications. 

Oral Treatment

Oral treatment is usually the most effective option, especially for controlling the initial symptoms. The most common oral antifungal medications prescribed is Sporanox (itraconazole). For tough-to-treat cases, Accutane may be considered. 

The length of treatment depends on how widespread the fungal acne is and how it is responding to the medication. Once the outbreaks and itching are under control, your doctor will help you develop a plan to slowly wean off of the antifungal medications. This process can take months. 

Adverse Side Effects

While oral antifungals are highly effective at treating fungal acne, it’s important to weigh their benefits with the potential adverse side effects and interactions with other medications. The most common side effects include:

If you are experiencing any of these side effects from your fungal acne treatment, talk with your doctor about the next steps. 

Topical Treatments 

While oral treatments are more effective, topical ones can be helpful for maintenance and even prevention of future episodes of fungal folliculitis. Topical treatments usually come in the form of an anti-dandruff shampoo and are to be used every day for a week. The most common treatments are Nizoral or Selsun. They can be applied in the shower and left on for 10 minutes before rinsing off.

Prognosis

Studies show that fungal acne is very treatable. However, it does have a high incidence of recurrence. Once your fungal folliculitis has been treated and is completely gone, talk with your doctor about preventive measures you can take to keep your skin clear and healthy. For those who are prone to fungal acne, periodic re-evaluation of predisposing factors is recommended. 

Coping

Because fungal acne is caused by yeast entering the hair follicle, you can help prevent it by keeping your skin as clean as possible. Wash your skin daily and try not to shave every day since this could be irritating to the hair follicle. Other preventive measures involve removing the conditions in which yeast thrive, such as wearing breathable fabric that wicks away sweat when you exercise or spend time outdoors. Don't re-wear sweaty fitness gear, and avoid oily lotions and creams since yeast feeds off of excess skin oils.

If you’re concerned that your fungal folliculitis is returning, see your doctor right away. The sooner you catch it, the easier it is to treat. 

Word From Verywell

While the irritation and appearance of fungal acne can be bothersome, the cause is usually easily treated and even preventable with a regular skin care routine and avoiding skin care products that will lead to excess sebum. It's important to note that fungal folliculitis will not respond to typical acne medication, and the use of these drugs may make it worse. If you suspect you have fungal acne, talk with your dermatologist or primary doctor about what to do.

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Article Sources
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