Fungal Acne

What is fungal acne?

Fungal acne is a common skin condition that occurs when hair follicles become infected with a fungus called Malassezia yeast. The condition is also called Malassezia folliculitis or Pityrosporum folliculitis.

Fungal acne causes clusters of small, itchy, red bumps (papules) on your skin. Sometimes, the bumps get a bit larger and turn into whiteheads, small pockets of white or yellow pus (pustules).

What’s the difference between fungal acne and regular acne?

Fungal acne is often confused with acne vulgaris (“vulgaris” is Latin for “common”). Both cause pimples. Common acne happens when hair follicles get blocked with bacteria, oil and dead skin. Fungal acne is a fungal infection in hair follicles. The main difference is that fungal acne can be itchy and acne vulgaris isn’t.

It’s important to distinguish between fungal and common acne because the treatments are different. Yet the two types of acne can happen at the same time.

Who might get fungal acne?

Anyone can get fungal acne. It’s most common in adolescents and young adult males, who tend to have oily skin where yeast thrive. The yeast also grows quickly on hot, damp or sweaty skin.

The condition is also more likely to occur in people who:

• Live in a hot, humid climate.
• Have a weakened immune system.
• Have other fungal infections, such as seborrheic dermatitis or tinea versicolor.
• Sweat a lot (hyperhidrosis).
• Use a lot of oil-based moisturizers and sunscreens.
• Use antibiotics.

What causes fungal acne?

Almost everyone has Malassezia yeast on their skin naturally. But the fungus can cause a problem when hair follicles become damaged or blocked and yeast gets inside.

Follicles may become damaged as a result of:

• Having skin rub against skin too much.
• Leaving skin hot and damp.
• Shaving, plucking or waxing hair.
• Touching or rubbing skin frequently.
• Using a hot tub or whirlpool.
• Wearing tight clothes.

Taking antibiotics can also cause fungal acne or make it worse. Bacteria and yeast both live on skin. But antibiotics can decrease the amount of good bacteria present and cause an overgrowth of yeast that may cause fungal acne.

Medical conditions or medications that suppress your immune system make it harder for your body to control the growth of yeast. These factors increase the risk of getting fungal acne.

What are the symptoms of fungal acne?

Fungal acne causes a sudden breakout of small pimples that may seem like a rash. The bumps form in clusters and look similar in size and appearance. Each pimple might have a red border or ring around it.

Your skin may feel:

• Burning.
• Itchy.
• Painful.

The blemishes can happen anywhere on your skin, but they’re most common on the:

• Chin.
• Chest.
• Forehead.
• Neck.
• Upper arms.
• Shoulders.
• Upper back.

How is fungal acne diagnosed?

A primary care physician or dermatologist (skin specialist) can diagnose Pityrosporum folliculitis by:

• Asking you about your symptoms and how long you’ve had them.
• Examining your skin.
• Taking a sample of your skin and looking at it under a microscope.
• Using Wood’s lamp, a small black light, to search your skin for areas that look fluorescent yellow or green.

How is fungal acne treated?

Healthcare providers typically treat Malassezia folliculitis by prescribing oral or topical antifungal medications.

The most effective treatments are oral antifungal medications, such as:

• Fluconazole.
• Itraconazole.

Topical treatments include antifungal creams or shampoos. You can buy the shampoo at a store, or your healthcare provider can prescribe a stronger version. Your provider may recommend topical treatments before deciding whether you need oral treatments. Examples include:

• Econazole.
• Ketoconazole.
• Selenium sulfide shampoo (also used to prevent and treat dandruff).

Some studies are testing photodynamic therapy (PDT) for fungal acne that doesn’t respond well to other treatments. PDT combines light and a drug (a photosensitizer) to destroy unhealthy cells.

Are there any side effects of fungal acne treatment?

Oral antifungal medications may cause:

• Diarrhea.
• Nausea and vomiting.
• Stomach pain.
• Liver damage.

How can I prevent fungal acne?

You can decrease the chance of getting Pityrosporum folliculitis by:

• Showering and changing your clothes immediately after working out.
• Using care when shaving, plucking or waxing.
• Using only well-maintained and clean hot tubs.
• Washing your bathing suit and letting it dry between each use.
• Wearing loose clothing, especially when it’s hot and humid or when you’re exercising.

If you have repeated fungal acne breakouts, your healthcare provider might recommend long-term use of antifungal medications.

Can fungal acne come back?

Topical and oral antifungal treatments are usually effective. But even after successful treatment, fungal acne can come back.

Making hygiene changes and using topical solutions weekly, like an antifungal shampoo, may help stop fungal acne from recurring.

How can I relieve the symptoms of fungal acne?

Some home remedies may help relieve the symptoms of fungal acne and clear the blemishes, such as:

• Putting warm compresses on the area a few times per day.
• Stopping whatever’s causing damage to your hair follicles for about a month (for example, take a break from shaving or wearing tight-fitting clothing).

You should talk to a physician before trying these home remedies.

A note from Cleveland Clinic

Fungal acne, or Malassezia folliculitis, is an infection in your hair follicles that’s often confused with common acne. It causes clusters of small, itchy, red bumps on your skin. Talk to your healthcare provider if you have any itchy breakouts that don’t go away. Antifungal treatments and hygiene changes can help.