Medically reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Last updated 3/15/2021
Acne is acne, right? Like, how different can two pimples be?
Actually, believe it or not, that spot on your face may or may not be a pimple, and that acne, well, may not be acne.
“Fungal acne” is a common term for a condition that actually isn’t acne at all. But it may resemble acne to the untrained eye.
Treat fungal acne with regular acne medication and you’ll get nowhere, though.
Understanding the difference between common comedonal and fungal acnes can ensure you get the treatment most likely to clear your skin.
When people refer to comedonal acne, they’re generally talking about acne caused by comedones, a very specific kind of acne lesion, or pimple. Yep, in case you didn’t know, there are several different types of zits.
Comedones further come in two types: open comedones (or blackheads), and closed comedones (or whiteheads).
Contrary to popular opinion, blackheads aren’t black because they’re dirty. Instead, the black appearance is caused by oxidation of the debris that’s clogging your pores. Oxidation occurs because the lesion is open to the air.
About half of women with clinical acne have comedonal acne, and the other half have inflammatory acne, or the kind that causes acne cysts and nodules, which are other types of pimples. Also worth noting: women with inflammatory acne tend to be younger than those with comedonal acne.
The good news about comedonal acne, if there is any, is that it’s generally considered a mild form of acne, whereas having inflammatory acne or a combination of comedonal and inflammatory lesions leans towards moderate-to-severe acne.
But wait, how does fungal acne fit into all of this?
What’s commonly referred to as fungal acne isn’t acne at all. Mind blown, right?
While not a true form of acne, this name is so widely used and accepted, much of the literature you find about it mentions the misnomer.
What we know as fungal acne is actually malassezia, or pityrosporum folliculitis.
Whereas clinical acne is caused by a combination of bacteria, sebum and shedding skin cells, malassezia folliculitis is caused by an overgrowth of yeast.
This yeast is found naturally on your skin, but when it causes acne-like breakouts, there is an overgrowth occurring in the hair follicles.
So how do you know the difference?
Fungal acne typically looks like small red bumps, and is found in rows on the forehead and cheeks or, less commonly, on the upper back and chest.
Where comedonal acne causes blackheads and whiteheads, and inflammatory acne causes acne cysts and nodules, fungal acne is marked by small red bumps.
If there’s any question about the type of acne you have, or if it’s acne at all, chatting with a dermatology practitioner is a good place to start.
Because comedonal and fungal acne are entirely different, their treatments are entirely different. If you mistake malassezia folliculitis for regular acne and use regular acne treatments, it likely won’t get you very far.
Comedonal acne can be successfully treated with topical retinoids and drying agents like benzoyl peroxide.
In more severe cases, such as comedonal acne with inflammatory lesions, systemic antibiotics or hormonal treatments (including oral contraceptives) may be prescribed.
On the other hand, fungal acne must be treated with an antifungal medication. Your healthcare provider can recommend a topical antifungal for mild cases or an oral antifungal treatment if your case is more severe, or doesn’t respond to topical solutions.
Comedonal and fungal acne are not two sides of the same coin.
As we’ve already covered, fungal acne isn’t acne at all, in the clinical sense.
Malassezia, or pityrosporum folliculitis, is a fungal infection of the hair follicles, where comedonal acne is caused by a combination of oil, clogged pores and bacteria.
As such, the treatments for these two skin conditions are very different.
Parsing out which condition you might have can be difficult, but consulting with a healthcare professional or dermatology practitioner can lead to proper diagnosis and the most effective treatment.