Fungal Acne: Causes, Symptoms, Treatment

Fungal acne, also known as pityrosporum folliculitis or malassezia folliculitis, is caused by an overgrowth of yeast in the hair follicle. This leads to breakouts, itching, and irritation on the skin’s surface. The condition can be quite distressing due to its discomfort and cosmetic concerns.

Fungal acne treated differently than other types of acne. It can often be controlled or prevented.

This article will go over fungal acne causes, what these breakouts look like, how it the condition is diagnosed, what options you have in terms of fungal acne treatment, and tips for preventing it.

Fungal Acne 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 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 healthcare providers 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. Wearing tight or restrictive clothing can also increase your risk.

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 a 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 a higher risk of 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. 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 healthcare provider. 

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 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 on the test.

Fungal Acne Treatment

Treatment for fungal acne has two goals: to treat the yeast overgrowth and to address the underlying cause of it. 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 for treating fungal acne, especially for controlling the initial symptoms. The most common prescription oral antifungal medication is Sporanox (itraconazole). For tough-to-treat cases, Accutane may be considered. 

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

Over-the-Counter Fungal Acne Products

While oral treatments are more effective, topical fungal acne treatments can be helpful for the 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, available in drugstores and online. They can be applied in the shower and left on for 10 minutes before rinsing off.

Prevention

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 healthcare provider 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. 

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 healthcare provider right away. The sooner you catch it, the easier it is to treat. 

Summary

Fungal acne is common and usually easy to treat as long as it's correctly diagnosed. Since fungal acne is caused by an overgrowth of yeast on the skin, managing it is a bit different than managing typical acne. Fungal acne can often be prevented by taking personal care steps to prevent yeast growth.

A 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 skincare 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 healthcare provider about what to do.