If your skin is suffering from an acne breakout, it might be a different variety called fungal acne. It does not respond to normal treatment, and differs from bacterial acne. Here’s how to identify and treat this condition.
What is fungal acne and how is it different from bacterial acne?
So-called fungal acne isn't really acne(1) at all, although it does look similar to acne vulgaris (hence its nickname), and causes skin inflammation, redness and pustular lumps.
It's actually a type of fungal (yeast) or bacterial infection in the hair follicle called folliculitis (or malassezia folliculitis when referring to the yeast infection).
A healthy amount of fungi or bacteria on the skin is normal, but when the microbiome is unbalanced it can cause a folliculitis infection
Dr. Nina Roos, Dermatologist
It also causes swelling and the spread of liquid-filled bumps(2), known as papules or pustules, over the skin.
“A healthy amount of fungi or bacteria on the skin is normal, but when the microbiome is unbalanced it can cause a folliculitis infection”, explains dermatologist Dr. Nina Roos.
On the other hand, the reasons behind acne vulgaris developing are complex, but it is linked specifically with p.acnes bacteria(3). It is important to correctly diagnose your condition because folliculitis does not respond to traditional medications for acne vulgaris, such as topical antibiotics and benzoyl peroxide.
How to treat folliculitis: dos and don'ts
DO cleanse your skin
Washing your skin will help remove excess sebum and bacteria that could aggravate the infection.
Using harsh products or scrubbing can result in your skin producing more oil as overcompensation.
DO keep skin dry and clean
Especially during workouts, and remember to wash clothes after exercising. “Yeast loves a wet environment. So in the summer, remember to always change your swimsuits”, recommends Dr. Roos.
DON'T squeeze the pimples
You risk spreading the infection.
DON'T increase your regular acne treatment until you have a diagnosis
Remember that acne vulgaris and folliculitis are not treated the same, and you could worsen the condition.
DO ask a professional
Malassezia folliculitis is a skin condition that can be treated using topical antifungal treatment, which only a dermatologist can prescribe. “It usually takes 15 days to work”, says Dr. Roos.
Signs you may have fungal acne
The most effective way to diagnose what kind of skin concern you have is to see a professional dermatologist. Here are some of the red flags that might suggest a fungal acne infection:
- Folliculitis has a more "rash-like" appearance than acne vulgaris, and the spots are usually smaller, more uniform in size and filled with a more watery liquid than acne. “It looks like a red pimple with a whitehead in the center”, describes Dr. Roos.
- Fungal acne spots often have a very small hair inside, as they develop inside the follicle and around the hair shaft. On men, this is sometimes around the beard and neck areas, and is known as "barber's itch".
- Many sufferers of folliculitis complain of itchiness, and remark that it often develops in areas on the body that experience rubbing or irritation, like the underarms, scalp, chest and back. Dr. Roos explains further: “while bacterial acne stays in the same place, fungal acne usually spreads in the body. But it’s important to note that it is not contagious”.
- Experiencing a breakout after sweating or being in a hot, humid environment can also be a tell-tale sign. “That’s why it’s so important to keep your skin dry”, recommends the dermatologist.
- Because malassezia folliculitis is a yeast infection, it usually develops suddenly, compared to acne vulgaris which tends to build up over time.
- Malassezia folliculitis can spread after long-term antibiotic use has destroyed bacteria on the skin and allowed it to proliferate. If you've been taking medication and the condition has worsened, this could be an indication you're suffering from a fungal infection.
1. Rubenstein, R. et al, 'Malassezia (Pityrosporum)Folliculitis' in The Journal of Clinical and Aesthetic Dermatology (2014) 7.3: pp. 37–41. [Accessible at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970831/]
2. Song, H. et al, 'Comparison between Malassezia Folliculitis and Non-Malassezia Folliculitis' in Annals of Dermatology (2014) 26.5: 598–602. [Accessible at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198587/]
3. Webster, G. et al, 'Acne vulgaris' in BMJ (2002) Aug 31; 325(7362): pp. 475–479.[Accessible at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123998/]
4. Suzuki C. et al, 'Treatment Outcomes for Malassezia Folliculitis in the Dermatology Department of a University Hospital in Japan' in Med Mycol J. (2016) 57(3):E63-6. doi: 10.3314/mmj.16-00003.[Accessible at: https://www.ncbi.nlm.nih.gov/pubmed/27581777]