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
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. Fungal acne is characteristically itchier, especially in hot summer days, and 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.
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Because fungal acne feeds off of oils produced by the skin, it tends to be more prominent in areas of high sebaceous gland density, which includes the:
- Back and chest
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.
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.
Use 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.
Use of 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
How to Treat Fungal Acne
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.
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.
Salcylic 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
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
Caprylic Acid Oil
Caprylic acid has powerful antifungal properties that have been shown in studies to inhibit several Malassezia species.8
Derived from cinnamon oil, cinnamic acid has been shown to possess antifungal activity against Malassezia species.9
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
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
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
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
How to Prevent Fungal Acne
Along with fungal acne treatments, you can take a proactive step to prevent the growth of fungal acne.
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.
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.
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.