Fungal Acne

A woman in a white towel and long red/orange hair with fungal acne.
  • Fungal acne is a skin condition that develops when an overgrowth of yeast occurs on the skin and infects the hair follicles.
  • This overgrowth is usually the result of an imbalance between naturally occurring fungi and bacteria on the skin. This can be caused by a number of lifestyle and medical factors.
  • A fungal acne infection causes clusters of pus-filled blemishes to appear, commonly on the arms, back, and chest. These blemishes can be painful and itchy.
  • Treatment options for fungal acne include topical products, antifungal oral medications, and lifestyle changes that help restore balance to the skin bacteria and fungi.

Fungal acne is a common skin condition that affects 27% of Americans in their lifetimes.

It’s usually caused by an imbalance in the layer of the skin that contains millions of bacteria and fungi, also known as the microbiome.

When the microbiome is out of balance, harmful organisms can start to develop that may damage and infect the hair follicles.

Infections like fungal acne can be unsightly and difficult to deal with, especially if misdiagnosed and treated incorrectly.

In this article, we’ll take a closer look at the causes, symptoms, and treatment options for fungal acne to help you manage the effects of this condition.

What is Fungal Acne?

Fungal acne (Malassezia folliculitis) is a skin condition that develops when the hair follicles become infected with a yeast fungus.

This condition causes clusters of pus-filled blemishes to appear all over the body.

It can have a similar appearance to regular acne. However, a fungal acne breakout is often itchy, whereas common acne is not.

A fungal acne infection can last for months at a time if it’s not treated correctly, and since it’s often misdiagnosed as common acne, prolonged breakouts are common.

Fungal acne can affect anyone at any age, but it is most common in adolescents and people with oily skin where yeast thrives.

This condition might also be common under people who:

  • Use certain medications

  • Frequently use oil-based moisturizers and sunscreens

  • Sweat a lot

  • Have weakened immune systems

  • Suffer from other fungal infections like dermatitis

  • Live in a hot and humid climate

What Causes Fungal Acne?

Fungal acne is caused by a naturally occurring yeast fungus called Malassezia. Although many people live with these fungi on their skin, it doesn’t always cause problems.

However, when Malassezia starts to overproduce, it can damage and clog the hair follicles, causing an infection.

This usually happens as a result of an imbalance of bacteria and fungi on the skin, and can be triggered by the following:

  • Trapped moisture caused by wearing sweaty clothes for too long or wearing workout clothes without washing them between sessions.

  • Certain antibiotics can cause an overgrowth of bacteria.

  • Diets that are rich in carbohydrates — a food group that fungi feed on.

  • Leaving skin hot and damp, creating a perfect environment for fungi to grow.

Fungal Acne Symptoms

The symptoms of fungal acne are often confused with those of regular acne. Here's how you can tell the difference:

Symptom: Size of blemishes Fungal Acne: Pus-filled bumps of similar size. Regular Acne: Variation in blemishes and their sizes. Large cysts can develop in severe cases.

Symptom: Clusters Fungal Acne: Often appear in small clusters of whiteheads. Regular Acne: Appears sporadically across the face.

Symptom: Location Fungal Acne: Can show up anywhere on the body. Commonly occurs on the arms, chest, and back. Regular Acne: Usually occurs on the face.

Symptom: Itchiness Fungal Acne: Usually itches. Regular Acne: Rarely itches.

Since fungal acne is caused by an overgrowth of yeast, you may also experience other fungi-related symptoms like dandruff and psoriasis. The breakout might also cause a painful burning sensation.

These additional symptoms can also help you to make sense of the type of breakout you may be experiencing.

How is fungal acne diagnosed?

A fungal acne breakout should be diagnosed by a licensed dermatologist. These healthcare providers specialize in diagnosing and treating various skin conditions.

During your appointment, the dermatologist might ask you about your symptoms, including:

  • How long you’ve had the breakout

  • Which treatment options you’ve been using

They might also perform a skin scrape and examine the collected particles under a microscope. This can help them to determine if yeast is responsible for the breakout.

Your dermatologist might also advise a deeper skin biopsy. The sample taken will be sent to a pathology lab for further testing.

Key Point: How Does a Skin Scrape Test Work?

A doctor may perform a scrape test if they want to look at particles of the skin in more detail, or send it to a laboratory for further analysis.

Your healthcare provider will use a scalpel or needle to carefully remove pieces of the affected skin. Although this sounds painful, the scraping usually doesn’t hurt much.

Signs of irritation or a small rash may appear on the skin once the scraping is done.

Fungal Acne Treatment

Because fungal acne has a similar appearance to and shares some symptoms with regular acne, it’s common to think they can be treated the same way.

However, this is not the case, and failing to treat fungal acne correctly can prolong the duration of the breakout.

In fact, trying to treat fungal acne with regular skin care products may worsen the infection and make it more severe.

Let’s take a closer look at the right treatment options for fungal acne.

Topical Fungal Acne treatments

Your healthcare provider may prescribe a topical regime to help you treat and heal a fungal acne infection. Topical treatments are applied directly to the affected area of the skin.

When topical antifungal treatments are applied to the skin, they attack the membranes of the fungi and start to break them down.

Once the membrane is damaged, the fungal cell bursts open and the organism eventually dies.

A Fungal Acne treatment may include antifungal creams and ointments. It’s recommended to look for products containing the following ingredients:

  • Ketoconazole

  • Butenafine

  • Clotrimazole

  • Econazole

A cream or ointment being squeezed out of a white tube onto a woman's finger for fungal acne treatment.

Oral Fungal Acne Treatment

If your Fungal Acne infection is more severe or doesn’t respond well to topical treatments, your doctor may recommend using oral medication.

These medications work to decrease the amount of yeast on the skin to bring it back to normal levels. This then starts to restore a healthy balance to the skin.

The most effective oral Fungal Acne medications are:

  • Fluconazole

  • Itraconazole

Key Point: Do Oral Fungal Acne Treatments Cause Side-Effects?

Oral treatments for fungal acne are often potent and can cause negative side effects to develop.

These may include:

  • Diarrhea
  • Nausea
  • Vomiting
  • Liver damage
  • Stomach pain

These medications should only be taken when prescribed by a licensed health professional, and dosage instructions should be followed closely.

If these negative symptoms persist or become more severe, it’s recommended that you seek medical attention as soon as possible.

Fungal Acne Treatment at Home - Lifestyle Changes

Fungal acne can also be managed by making a number of lifestyle changes at home that can help restore the balance between bacteria and fungi on the skin.

At home Fungal Acne treatments may include:

  • Showering more regularly to avoid trapping moisture and sweat on the skin.

  • Wearing looser clothing that encourages airflow and prevents yeast from growing.

  • Using anti-dandruff shampoos to alleviate the other side effects of fungal acne.

You can also apply a warm compress to the affected area a few times per day to help alleviate pain.

It’s always recommended to first speak to your doctor before making any lifestyle changes. They will also be able to advise you on which ones would work best for your specific condition.

Can You Get Fungal Acne More Than Once?

Fungal Acne treatments are usually effective enough to prevent future breakouts. However, an infection can re-occur even after successful treatment.

This is usually the result of recurring improper hygiene habits and other lifestyle factors.

That’s why it’s often advisable to try and incorporate any recommended at home and lifestyle changes into your routine permanently.

You can also start using weekly antifungal treatments to keep an overgrowth of fungi at bay.

When Should You See a Doctor About a Fungal Acne Breakout?

If you’ve been treating fungal acne correctly without seeing any improvement in three weeks, follow it up with your dermatologist.

You should also see your doctor if your infection resolves but then returns shortly thereafter.

Persistent breakouts might require stronger medication or will respond better to combination therapy.

Your doctor will be able to recommend a Fungal Acne treatment that can stop recurring breakouts and offer a more long-term solution.

Where Can You Learn More About Fungal Acne?

If you’re experiencing or are worried about any of the symptoms covered in this article, you can speak to a board-certified doctor or nurse practitioner online from your computer or smartphone. Head over to LifeMD to make a video appointment.

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This article is intended for informational purposes only and should not be considered medical advice. Consult a healthcare professional or call a doctor in the case of a medical emergency.

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