Medically reviewed by Vicky Davis, FNP
Written by Our Editorial Team
Last updated 5/6/2021
Maybe you’ve heard the term “fungal acne” making the rounds on TikTok or IG, and you’ve found yourself suddenly simultaneously curious and freaked out. Fungus causing acne?! Don’t worry, we’re here to give you the scoop.
In this article, we’ll explain what fungal acne is, how fungal acne is caused and treatment options if you suspect your breakouts are being caused by more than forgetting to wash your face at night.
First things first: there is no such thing as fungal acne. There are many types of acne, however, fungal acne isn’t a clinical term. But it has been gaining popularity on social media, so let us explain. “Fungal acne” is just the colloquial term for a skin condition called Malassezia folliculitis.
Malassezia folliculitis looks like acne — which is why so many people are eager to call it acne — but it’s actually something else entirely. It is not true acne, and you can have both regular acne breakouts and Malassezia folliculitis breakouts at the same time.
Malassezia folliculitis is caused by an overgrowth of the Malassezia yeast that lives on our skin. Sounds gross, but yeast is a fungus that is part of our regular skin flora, along with other bacteria. Malassezia relies on sebum, which is why it’s typically more concentrated on oilier areas of the body, like the scalp, face, back, etc.
We begin to see breakouts when there is an overgrowth of Malassezia on the skin. The yeast invades hair follicles and causes inflammation, which can then lead to acne-like breakouts.
Some top culprits for Malassezia overgrowth include:
Antibiotic use. The delicate balance of flora on the skin can be disrupted by taking or using antibiotics, causing yeast to take over. The sad irony is that many times, antibiotics are prescribed to treat other forms of acne but can make fungal acne worse.
Warm, humid climates. High temps and humidity can encourage the growth of yeast on the skin.
Oily skin. Since Malassezia feeds off of sebum, oily skin can be a breeding ground for an overgrowth of yeast.
Trapped moisture. Sweaty, moist skin can also be a breeding ground for yeast. Staying in sweaty workout clothes or wearing tight clothing can trap moisture and lead to fungal acne.
Decreased immune system function. Certain medications and health conditions can lead to an overgrowth of the yeast on your skin. Steroids taken both by mouth and applied topically to the skin, diabetes and HIV, can decrease your immune system function and your body can no longer keep Malassezia growth in check.
Regular acne is typically scattered on the face and comprises several different types of lesions, including blackheads, whiteheads, papules, pustules and more.
Fungal acne presents a bit differently, with small bumps, papules and pustules of a similar size and shape. Malassezia folliculitis also typically affects younger people, especially people who live in a warm, tropical humid climate.
Breakouts typically appear on the back, chest and shoulders rather than on the face. If breakouts do occur on the face, they are usually on the chin or sides, rather than concentrated in the center.
Further, fungal acne has a symptom that regular acne does not: it’s itchy. According to a recent study, almost 80 percent of people with fungal acne have this symptom.
If you found yourself nodding along while reading, you might be suffering from fungal acne. Don’t worry — fungal acne is treatable. Here’s the rub: fungal acne often goes misdiagnosed. It’s often confused with regular acne (such as acne vulgaris) and treated as such.
Typical treatments for regular acne include oral antibiotics, prescription acne cream, and other treatments that won’t work on fungal acne.
Oral antifungals are the most effective treatment for fungal acne, and you’ll most likely see improvement very quickly.
As we mentioned earlier, however, traditional acne treatments may actually make fungal acne worse. That’s why it’s important to get an accurate diagnosis of fungal acne from your dermatologist or healthcare provider.
Below are several treatment options that can work to clear up fungal acne breakouts.
Both over-the-counter creams and prescription oral antifungals can be effective treatment options for Malassezia folliculitis.
OTC antifungal medication you can pick up at a drugstore includes:
Ketoconazole lotion 2%
Econazole nitrate cream 1%
Clotrimazole cream 1%
Selenium sulfide 1% dandruff shampoo/body wash
Other antifungal medications (which you’ll need a prescription for) include:
2.5% selenium sulfide lotion used as shampoo/body wash (used for maintenance as needed)
Ketoconazole shampoo 2% (used for maintenance as needed)
Several lifestyle habits can also help keep fungal acne away:
After working out, make sure to change out of sweaty clothing immediately and take a shower if you can.
Avoid wearing tight-fitting clothing made out of synthetic materials, and instead wear loose, breathable fabrics.
Choose skincare products that are oil-free and non-comedogenic.
Talk with your healthcare provider about your concerns when going on antibiotics, whether topical or oral.
“Fungal acne” is simply a term some people use to describe the skin condition known as Malassezia folliculitis. While the breakouts may look like acne, fungal acne isn’t really a form of acne at all.
If you are struggling with fungal acne, there’s no shame or embarrassment in seeking treatment. Talk with your dermatologist or healthcare provider about treatment options that may be right for you.
If you’ve tried everything and your acne still won’t quit, check out our blog post Why Won’t My Acne Go Away?.