Everything You Need to Know About Fungal Acne, Including How to Treat It

Sometimes, what you think is acne—you know, those angry bumps speckling your skin—might actually be something entirely different. Fungal acne is one such impostor and a very sneaky one at that.

In fact, fungal acne isn’t really a term dermatologists use, according to board-certified dermatologist Ife J. Rodney, M.D.¹, founding director of Eternal Dermatology + Aesthetics and professor of dermatology at Howard University and George Washington University. “It is often confused with acne², but what’s actually happening is an overgrowth of pityrosporum yeast that lives in our hair follicles,” Dr. Rodney tells SELF. “Sometimes, the overgrowth causes an infection, resulting in little bumps on the chest, back, and face that will look like acne.”

Surviving life as a teenager has taught you how to respond when pimples strike: You go at them with a slew of products designed to obliterate them—but the acne treatments you’ve relied on for years will have zero effect on fungal acne. Here’s why and what you can do to actually get rid of it.

What is fungal acne? | Fungal acne causes | Fungal acne symptoms | Fungal acne duration | Fungal acne triggers | Fungal acne treatment | Seeing a dermatologist

Folliculitis is a common skin infection that develops in the hair follicles, according to the American Academy of Dermatology (AAD)³. It can show up anywhere on your skin, except for the palms of your hands and the soles of your feet.

“By definition, folliculitis means an infection of the hair follicles, usually from bacteria,” Dr. Rodney explains. “However, when there is excess pityrosporum yeast within the hair follicles, we call it fungal folliculitis which is sometimes referred to as fungal acne.”

Basically, fungal acne is just one form of folliculitis. So, despite its resemblance to bacterial acne, fungal acne occurs when yeast (yes, a fungus) inflames the hair follicles on your skin and causes pimple-like bumps. Fungal acne is technically referred to as pityrosporum folliculitis or malassezia folliculitis for the specific type of fungus (malassezia is the more updated term⁴, but your dermatologist may still call it pityrosporum).

For the record, it’s normal for this type of fungus to be living on your skin. But when it gets out of control, it can lead to fungal acne breakouts or other skin conditions, like seborrheic dermatitis.

Under normal conditions, there will be a balance between the bacteria and fungus on our skin, Hye Jin Chung, M.D.⁵, assistant professor of dermatology at Boston University School of Medicine, tells SELF. But if something happens to wipe out the bacteria (say, you take antibiotics)⁶, there won’t be anything to keep the fungus in check. As a result, an overgrowth of fungus can develop, which in turn can lead to skin irritation, inflammation, and fungal acne.

Antibiotics aren’t the only factor in developing fungal acne—sometimes our own habits are the culprits. For instance, wearing tight, nonbreathable clothes often contributes to breakouts on your chest, back, or other parts of your body that are prone to breakouts, Dr. Chung says. More specifically, wearing sweaty workout clothes for too long or rewearing fitness gear without washing it can create a very hospitable (read: moist) environment for fungi to grow, Emily C. McKenzie, M.D.⁷, clinical instructor in the department of dermatology at the University of Utah, tells SELF.

Unfortunately, some people are just genetically predisposed to overgrowths of yeast and, therefore, experience fungal acne more frequently, Dr. McKenzie adds. Having chronic conditions that affect your immune system, like diabetes and HIV, can also predispose you to fungal acne.

The bacterial or hormonal acne you’re probably used to typically consists of pus-filled bumps or cysts. Regular (bacterial) acne breakouts vary in size and also tend to feature blackheads or whiteheads on the face, Dr. Chung says.

But what does fungal acne look like? You’ll usually notice the following symptoms, Dr. Rodney says:

• Small, even-shaped bumps
• Reddened skin
• Tenderness or swelling of surrounding skin
• Itchiness
• Bumps that usually appear on the forehead or on the upper portion of the back

Dr. McKenzie emphasizes that fungal acne will usually appear as uniform inflamed or reddened bumps and pustules on the chest, upper arms, and back—rarely the face, but sometimes the forehead. Also, the bumps that result from malassezia don’t usually come to heads. And, perhaps most noticeably, she adds that fungal acne breakouts will be itchy. Typical bacterial acne can be itchy sometimes, she says, “but not that much.”

Like any other annoying skin issue (including typical bacterial acne), it’s hard to set a timeline for how long fungal acne can last. “If left untreated, the time it takes fungal acne to resolve depends on the individual,” Dr. Rodney says. “If it’s triggered by seasonal changes or stressful life events, it can take several weeks to months to show improvement.”

But the right treatment can dramatically cut down on that recovery time. “When you treat the condition with antifungal washes or creams, you’ll begin to see improvement in about two to four weeks,” Dr. Rodney says.

First, prevention is key. There are a few things you can try to avoid triggering or exacerbating a fungal acne breakout. The AAD suggests trying these lifestyle tweaks to keep your skin happy:

• Wear loose, breathable clothes (think cotton) when it’s hot and humid outside.
• Change out of your sweaty clothes after you work out and shower as soon as you can.
• Wash your bathing suit or wetsuit after each use and let it dry before wearing it again.

Still, since the fungus that causes fungal acne naturally lives around your hair follicles, Dr. Rodney says, there’s only so much you can do to prevent it. She suggests washing your face twice a day with a gentle cleanser to remove oil, dirt, and other build-up on the skin, exfoliating with a product that contains alpha- or beta-hydroxy acids weekly, and applying a lightweight moisturizer morning and night to reinforce your protective skin barrier.

If lifestyle changes don’t help, your next step for a mild case of fungal acne should be trying an over-the-counter topical treatment. For example, Dr. McKenzie says Selsun Blue ($9, Amazon), despite being marketed as a dandruff shampoo, also works as an antifungal body wash, thanks to its active ingredients (some Selsun Blue products contain pyrithione zinc, while others contain selenium sulfide, but either one will do the trick). Other similar products containing those active ingredients might also perform well. And the key with all of them is to let the product sit on your skin for about five minutes before rinsing, she says. That way, the active fungus-fighting ingredient has time to get the job done.

Other recommended topical treatments include creams containing 2% ketoconazole, econozole nitrate, or 1% clotrimazole cream, all of which are often used to treat athlete’s foot.

If your symptoms still persist after about three weeks, it’s time to see a dermatologist. They’ll be able to confirm your diagnosis and may prescribe an oral antifungal medication, which will work faster to treat the breakouts than a cream or shampoo because topical treatments may have a harder time getting into the follicle⁸.

Unfortunately, there’s always a risk of recurrence with fungal acne after it’s treated—especially right after it clears up, Dr. Chung says. It’s not totally understood why, but drug resistance, switching seasons, and changing lifestyle habits are all thought to play a role in the recurrence of it.

As a preventive measure, she tells her patients who deal with fungal acne to use an antifungal product in place of normal body wash as often as once a week, though she adds that there’s “no magic number” for how often to work it into your routine. Once your system has recovered, you can ease off on the antifungal wash, but stopping it altogether might put you at risk for a recurrence.

Antifungal products are touted as being “safe” for use when you have fungal acne, but that doesn’t mean other products are full of yeast. Dr. Chung explains that labeling just means that those products won’t contribute to the growth of fungus. As long as you’re doing other things to keep the growth of that fungus in check, you shouldn’t feel pressured to seek them out.

Ultimately, the biggest mistake you can make when dealing with fungal acne is simply mistaking it for regular acne. Conventional acne products, especially antibiotics, won’t help and might even make your symptoms worse. So, if your breakouts itch and are concentrated on your upper arms, chest, and back (your “trunk,” as Dr. Chung puts it), you might be dealing with fungal acne symptoms. And, if you simply aren’t sure, you can always check with your derm before trying any treatment. When it comes to fungal acne, Dr. Chung says it’s better to “see a dermatologist sooner rather than later.”

Sources:

1. Eternal Dermatology + Aesthetics, Ife J. Rodney, M.D.
2. Journal of the American Academy of Dermatology, Pityrosporum Folliculitis: A Retrospective Review of 110 Cases
3. American Academy of Dermatology, Acne-Like Breakouts Could Be Folliculitis
4. Indian Journal of Dermatology, Venerology and Leprology, The Genus Malassezia and Human Disease
5. Boston University School of Medicine, Hye Jin Chung, M.D.
6. Diagnostic Microbiology and Infectious Disease, Epidemiological Characteristics of Malassezia Folliculitis and Use of the May-Grünwald-Giemsa Stain to Diagnose the Infection
7. University of Utah, Emily C. McKenzie, M.D.
8. The Journal of Clinical and Aesthetic Dermatology, Malassezia (Pityrosporum) Folliculitis

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