It may look like regular acne, but there’s a difference in how you treat it

If you have small, persistent pimples that do not go away no matter what you try, you might have a condition called fungal acne.

Fungal acne is not true acne, but can look very much like traditional acne breakouts. This condition, medically known as malassezia folliculitis or pityrosporum folliculitis, is caused by an overgrowth of malassezia yeast so it needs to be treated with antifungal medications rather than traditional acne treatments.

Common causes of fungal acne

Malassezia yeast naturally lives on the skin, but when it multiplies and overgrows, it can become trapped inside hair follicles, causing fungal acne. Some common reasons why this yeast overgrows include:

• Warm, humid environments
• Excessive sweating
• Hormonal imbalances
• High-glycemic diets
• Certain medications
• Certain skin-care ingredients

What makes fungal acne different?

Fungal acne is different from regular acne breakouts, or acne vulgaris, in several key ways. Fungal acne:

• Is caused by yeast overgrowth, while acne vulgaris is caused by C. acnes bacteria.
• Almost never involves blackheads or whiteheads like bacterial acne.
• Typically appears as a cluster of small red bumps or papules and can be itchy.
• Is common in areas that accumulate sweat, like the back, chest, and shoulders but can also occur on the face. Bacterial acne is most common on the face but can also appear on the body.

Fungal acne treatment and prevention

Fungal acne requires antifungal treatments, so typical treatments that are used for bacterial acne will not work — in fact, some can make fungal acne worse. Antifungal shampoos or washes that contain ketoconazole, selenium sulfide, or zinc pyrithione can be effective for fungal acne. Topical antifungal creams that contain clotrimazole or terbinafine can also work well.

If the red bumps are not going away with topical treatments, talk to your dermatologist about oral antifungal medications.

To prevent fungal acne from coming back:

• Avoid skin care ingredients that feed yeast, including fatty acid esters, fermented ingredients, polysorbates and certain oils like olive, coconut, and avocado oils.
• Always shower or change clothes as soon as possible after exercising or sweating.
• Use an antifungal shampoo or sulfur-containing wash 1 to 2 times per week to keep yeast populations under control.

Bottom line

Breakouts that appear as clusters of itchy, red bumps could be fungal acne instead of bacterial acne and need to be treated with antifungals instead of antibacterial ingredients. If over-the-counter antifungal creams or shampoos do not work, see your dermatologist for a diagnosis and more targeted treatment options.

I’m still on sabbatical and no longer run Baumann Cosmetic Institute, so please follow @SkinTypeSolutions on social media, or visit LeslieBaumannMD.com if you have questions.