What Is Fungal Acne And How Do You Know If You Have It?

Have you ever wondered if those pesky pimples that just won’t go away no matter what you do could be fungal? While fungal acne is a hot topic that has gained increasing attention over the past few years, it was barely on the radar before 2017.  Take a look at this snapshot from Google Trends:

Data source: Google Trends (https://www.google.com/trends)

I first stumbled upon the concept of fungal acne about a year ago on Reddit’s r/skincareaddiction. I had never heard about it, but the more I looked into it, the more convinced I became that I had it. Interestingly, it seems to be a relatively new and still little-understood topic in the medical world. About half a year ago, I suggested to a dermatologist during a checkup that I had fungal acne, but he had no idea what I was talking about. I told him that I used to have horrific ‘bacne’ (acne occurring along your back and shoulders) and that using an anti-dandruff shampoo on my back was the only thing that helped.

 

“You could continue with that if it’s working,” he said.

 

Thanks, I thought, that’s really helpful.

 

I guess I wanted someone to explain to me why exactly the anti-dandruff shampoo was working — preferably someone with a medical degree – so that I wouldn’t feel completely bananas for putting shampoo on my back. Yet I left the appointment empty-handed and even more confused than before.

 

After that experience, I realized that figuring out exactly why it was working was something I was going to have to do myself. As an experiment, I stopped using the anti-dandruff shampoo on my back. Lo and behold, the bacne was back within a week.

 

Now, I just use it every 2-3 days to keep those pesky pimples at bay. In the meantime, I have spent hours and hours looking into fungal acne. I wanted to find out why an anti-dandruff shampoo had finally solved my acne issue when nothing else could touch it. It must be noted that I am not a doctor nor any other medical professional. These are just some of my own thoughts and experiences that I want to share to (hopefully) help other people. Let’s start with the most basic question, which is…

What is Fungal Acne?

Fungal acne, also known as Malassezia folliculitis (MF) or Pityrosporum folliculitis (PF), is a common inflammatory skin disorder that can mimic acne vulgaris (common acne).

Fungal acne = Malassezia folliculitis = Pityrosporum folliculitis

Fungal acne usually manifests as papules or pustules on the face, back, chest, upper arms or neck. It is caused by an overgrowth of yeast (I know… yikes!) on the skin, which disrupts the natural skin flora. It can look almost identical to bacterial acne, but the most common difference is that fungal acne is itchy and uniform in size and rarely includes comedones (bumps).

 

However, as fungal acne and regular acne can coexist, it is entirely possible to have both at the same time. So, how can you tell if you have fungal acne? In the following, we’ll go through some of the symptoms, how to diagnose it, and the causes and risk factors associated with it.

Fungal Acne Symptoms

  1. Acne which does not respond to regular acne treatment
    The primary reason why I suspected I had fungal acne was that my acne was simply not responding to regular acne treatments. I had tried every possible topical (benzoyl peroxide, salicylic acid, tretinoin, etc.) and oral (antibiotics and Accutane) solution at this point, but my skin was still not clearing up.

  1. Itchiness
    I had this symptom big time, especially on my face. I remember feeling my pimples sometimes, and wanting to scratch them more than anything. This was the first symptom to go away once I started using an anti-fungal shampoo on my face. Apparently, the itchiness makes it much worse as it causes the skin to lose its defense mechanism, allowing the Malassezia yeast to penetrate further.
  1. Uniform appearance
    As mentioned above, fungal acne is usually uniform in size and does not include comedones. But, to be honest, this isn’t always necessarily the case. Remember how I said that bacterial acne and fungal acne can coexist? This means it’s hard to know if you have fungal acne judging by appearance alone.

How to diagnose fungal acne

So, you have all the symptoms and you think you have fungal acne, but you want to know for sure and are ready to have it diagnosed properly. Generally, a diagnosis by a medical professional involves a physical examination, a determination of the risk factors and symptoms, and one or all of the following tests:

  1. Wood’s lamp skin examination
    The skin is examined with a Wood’s lamp for a few seconds. This procedure is generally painless and safe. The Wood’s lamp will identify the extent of pigmented or depigmented patches as well as detect fluorescence. If Malassezia folliculitis is present, the hair follicles will fluoresce bluish-white.
  1. Fungal culture or biopsy
    One of the pustules is punctured with a needle and the content is examined under a microscope.
  1. Antifungal treatments or therapy
    This part is annoying because you’d prefer to know for sure that you have fungal acne before spending time and money on treatment. But, unfortunately, the only way to be sure that your acne is indeed fungal is to have anti-fungal treatment or therapy and see if it clears up after that. It should clear up relatively quickly after starting the treatment. (With mine, I knew it was working within 1-2 days.)

What causes fungal acne?

Here’s a list of the main causes and risk factors:

  1. Immunosuppression
    This can be due to drugs taken for certain diseases, such as AIDS or cancer, or it can be deliberately induced in preparation for an organ transplant to prevent the donor tissue from being rejected.
  1. Diabetes
    If your blood sugar spikes to unreasonably high levels, this increase in sugar can cause the yeast to overgrow.
  1. Antibiotics
    It’s been proven that continuous antibiotic usage, whether topical or oral, can cause a disruption to the natural skin flora and result in yeast overgrowth.
  1. Steroids
    Steroid use leads to an increased risk of yeast infections, especially with high doses used over long periods of time. It seems that even low-strength topical steroid creams may make yeast infections more likely by reducing the body’s natural immune defenses.
  1. Non-fungal acne safe products
    Cosmetics, lotions, sunscreens – anything that causes occlusion of the skin. Certain ingredients can cause Malassezia to grow and for your skin to become a breeding ground for this yeast. Choose your products wisely and always check the ingredients. The following are the main ingredients to avoid:
      • Fatty acids
      • Lipids
      • Esters
      • Yeast/fermented oils
  1. Warm/humid weather
    If you’ve ever baked bread, you’ll know that yeast likes a warm and moist environment, so the weather can also affect your likelihood of having fungal acne.
  1. Dandruff
    If you are prone to dandruff, which also has a fungal origin, then there is a good chance you might have fungal acne.
  1. Others
    Puberty, pregnancy, and naturally having oily skin are among the factors that can make you more susceptible to fungal acne.

Still not sure if you’ve got fungal acne? Our checklist can help you out.