What is Fungal Acne?
Fungal acne, also referred to as Malassezia folliculitis or Pityrosprum folliculitis, is caused by a naturally occurring yeast present on the skin’s surface. When these yeast organisms overgrow, they may burrow into the hair follicles and oil glands, where they can feed on the oil and cause fungal acne.1
Fungal Acne vs Bacterial Acne
What does fungal acne look like? Fungal acne is difficult to discern from traditional acne. Here’s how you can tell the difference between fungal acne and bacterial acne.
While fungal acne can potentially happen anywhere on the body, the easiest way to tell the difference between fungal acne and traditional bacterial acne is the location. Traditional acne occurs mainly on the cheeks, jawline, and T-zone (comprising the forehead and nose). Acne along the hairline or on your upper back, shoulders, and upper chest is more commonly associated with fungal acne.
Fungal acne appears as small, uniform red bumps filled with pus. By comparison, traditional acne comedones will progress at different rates and vary in severity and size.
Read next: Yes, Acne Supplements Work. Here's How.
Fungal Acne Symptoms
Fungal acne is characteristically itchier than traditional acne. It is especially worse on hot summer days.
Who Gets Fungal Acne?
While fungal acne can potentially affect anyone, it can be more common among certain populations.
Newborns will sometimes develop small pimples on their cheeks and face. This is a form of fungal acne that comes as a result of the baby’s immune system and skin flora still developing. While this this is common, there’s generally no need for treatment. As the baby’s immune system matures, the acne typically goes away on its own without leaving scars.
2. People with Suppressed Immune Systems
Those who have a condition that suppresses the immune system and those who take immunosuppressant medication may also be vulnerable to fungal acne. A suppressed immune system prevents proper regulation of Malassezia, allowing the yeast to grow freely.
3. Those Who Have Used of Antibiotics
Healthy individuals with traditional acne are often treated with a course of oral or topical antibiotics, which work to reduce inflammation while regulating P. acnes bacteria on the skin. However, antibiotics may alter the skin flora, allowing Malassezia yeasts to grow unchecked. On top of that, people with traditional acne tend to produce more oil in their sebaceous glands. More oil means more food for the fungi, which encourages their growth and results in more bumps.
4. Those Who Have Used Birth Control
Hormonal birth control has a combination of estrogen and progestin. Taking these hormones can disrupt the body’s natural hormonal balance and can help yeast to grow.
5. Menopausal Women
While fungal acne can affect men and women of any age, menopausal women may be more prone. Menopause is characterized by hormonal fluctuations as the ovaries stop producing estrogen and progestin while androgen hormones remain relatively unchanged. This results in hormonal imbalances that may contribute to overactive sebaceous glands. While more sebum can contribute to non-fungal acne, Malasezzia feed on sebum, which is why the yeast tends to congregate more around areas with high sebaceous gland concentrations.16
6. Those with Oilier Skin
As mentioned, the Malasezzia yeast thrives on sebum. If your skin tends toward the oilier side, you may already be more prone to bacterial acne, but you should also be concerned with fungal acne. More oil on your skin inevitably means more food for the Malasezzia, which increases the risk of fungal acne.17
How to Get Rid of Fungal Acne with Natural Remedies
The most common treatment for fungal acne is oral antifungal medication. While this medication is effective, it’s important to understand that Malassezia is a natural part of skin flora and cannot be eliminated completely. Stopping antifungal medication may lead to the yeast flaring up again. However, there are other treatments for fungal acne that may help to treat and manage symptoms.
1. Topical Washes with Anti-fungal Ingredients
Sulfur masks and other washes containing sulfur are highly recommended. Sulfur is naturally antibacterial and antifungal, allowing it to regulate Malassezia production and remove it from within your pores.2 However, avoid products containing fragrances, which can irritate the skin and exacerbate certain issues like rosacea.
The most commonly prescribed topical treatment for fungal acne is dandruff shampoos. These shampoos contain antifungal ingredients, like sulfur and ketoconazole, and can be used as body or face washes. These shampoos should be lathered onto the skin, left to sit for 10 seconds, then rinsed off.3
Honey and propolis (a compound produced by bees) act as powerful antimicrobial agents. Studies show that honey presents an antifungal effect against Candida, another common species of fungi.4 Applying raw honey to your skin may help to regulate Malassezia levels and reduce acne in general.
3. Salicylic Acid
Salicylic acid is a common treatment for both acne and dandruff.5 It is antifungal, antibacterial, and anti-inflammatory, making it an effective tool for reducing acne. Salicylic acid also acts as a desmolytic agent, which means that it helps to unclog pores and encourage the removal of dead skin cells and debris in the skin.6
4. Azelaic Acid
Azelaic acid is another common treatment for traditional acne as well as rosacea. It may help with fungal acne by regulating the fatty acid content in your skin, a common mechanism used by antifungals. As Malassezia survive on the fatty acids and oils in the skin, reducing the free fatty acid content may help to reduce the yeast population.7
5. Caprylic Acid Oil
Caprylic acid has powerful antifungal properties that have been shown in studies to inhibit several Malassezia species.8
6. Cinnamic Acid
Derived from cinnamon oil, cinnamic acid has been shown to possess antifungal activity against Malassezia species.9
7. Green Tea Extract
In a study, subjects with atopic dermatitis associated with Malassezia sympodialis underwent a bath therapy using green tea extracts three times a week over a period of four weeks. Results showed that all subjects experienced significant improvement in all metrics.10
Studies show that oral supplementation with a probiotic containing Lactobacillus improved dandruff caused by Malassezia yeasts. This suggests that Lactobacilli may be effective in regulating Malasezzia levels.11
9. Propylene Glycol
In a double-blind study, propylene glycol was found to be effective in reducing symptoms of seborrheic dermatitis on the scalp. This suggests that propylene glycol may help to inhibit Malassezia.12
10. Tea Tree Oil
Tea tree oil, which is derived from the Melaleuca alternifolia plant, is known to have powerful antimicrobial properties. In vitro studies show that it may be effective in inhibiting several species of Malassezia.13
11. Urea Cream
Similar to salicylic acid, urea helps to exfoliate the skin, removing dead skin cells and debris that could clog pores. It also acts as an effective moisturizer. Studies show that urea acts as an effective treatment for seborrheic dermatitis, atopic dermatitis, and other skin conditions commonly associated with Malassezia.14
Fungal Acne Treatment | Skincare Routine
Part of reducing your fungal acne comes down to maintaining a regular skincare routine can help to control the oil and fungal populations on your skin while incorporating some of the above ingredients to reduce the amount of yeast on your skin.18 Perform this skincare routine twice per day, morning and night.
Use a gentle facial cleanser to wash away any dirt, sweat, and debris that has collected on your skin. Cleansing also helps to control sebum production and fungal populations, but considering cleanser does not spend a long time on your skin, this step is mostly to prepare your face for the other products.
Toner helps to remove anything that your cleanser may have missed while also actively treating your fungal acne. Once your skin has dried, use a light, fragrance-free toner that contains one of the active antifungal ingredients above such as green tea extract.
This is the crux of your skincare routine’s effectiveness. Apply a serum containing salicylic acid or azelaic acid to your skin, focusing on areas affected by fungal acne.
Moisturizer is an essential step in your skincare process. It protects and nourishes your face to provide more supple, smooth skin. While moisturizer makes sense for dry skin, it’s also essential for oily skin. Excess oil is often your face overcompensating for dry skin. Using moisturizer prevents that overcompensation and may help to balance the oil production.
Always end your morning routine by applying sunscreen. Most active ingredients will increase your skin’s sensitivity to UV rays, which can contribute to inflammation and increase your risk of skin cancer. Use a non-greasy sunscreen, even if you don’t plan to go outside. Sunlight can still come in through windows. Read our blog on safe and effective sunscreen ingredients to learn more.
Extra Step: Exfoliate
About once or twice per week, apply a chemical exfoliant (AHA or BHA) after using your toner. This can help to promote the shed of dead skin cells to make way for fresh skin cells. This helps to prevent clogged pores while further regulating oil production. However, exfoliating too much can be potentially irritating, which is why you should limit it to no more than twice per week.
Recommended Products for Fungal Acne
If you are not sure where to start, here are some products that we recommend for fungal acne.
- Colorescience Unforgettable Mineral SPF 30
- Nizoral A-D Anti Dandruff Shampoo
- Head and Shoulders Classic Clean Dandruff Shampoo (Zinc Pyrithione)
- Hegor Shampoo (1.5% Climbazole)
- DrFormulas™ HairOmega® Shampoo (1% Ketoconazole)
- Selsun Blue Medicated Dandruff (Selenium sulfide)
How to Prevent Fungal Acne
Along with fungal acne treatments, you can take a proactive step to prevent the growth of fungal acne.
1. Wear breathable fabrics
Species of Malassezia thrive in warm, humid environments, making them more likely to grow when you are sweaty and hot. Wear breathable fabrics to reduce sweat and body heat, and remember to rinse and bathe immediately after workouts to reduce the chance of overgrown yeasts.
2. Avoid most face oils
As mentioned, Malassezia feed primarily on oils and fatty acids, so it’s a good idea to avoid most face oils and fatty acids. Avoid most products using esters, which comprise a fatty acid combined with a glycerol or alcohol, aside from capric and caprylic acid.7 Other oils to avoid include:
- Squalene (a component of human sebum)
Face oils that are safe to use include:
- MCT oil (capric/caprylic triglycerides)
- Mineral oil (naturally free of fatty acids)
- Squalane (not to be confused with squalene)
Exfoliating breaks down dead skin cells and debris to prevent clogged pores, while also regulating skin oils and dirt that may promote the growth of yeast cells.3 Use a gentle chemical exfoliator, and avoid harsh scrubs as they may irritate the skin and create microtears.
4. See a dermatologist
The worst thing you can do is treat your fungal acne like traditional acne. Aside from not helping your condition, certain traditional acne treatments may exacerbate the symptoms of fungal acne. Unfortunately, it’s far too easy to mistake the two. The best way to know for sure is to see your dermatologist.15
Fungal acne presents symptoms that are distinct from conventional acne, but with the right treatments and preventive measures, you can reduce your fungal acne and maintain clear, healthy skin.