What is Fungal Acne? – Causes & Diagnosis, How to Identify and Treat

fungal acne

Do you ever wonder what those small, itchy red spots on your head or skin are?

Well, these itchy blots are called fungal acne.

Although they might not be as big as what you call pimples, they still can lower your self-confidence and may cause depression.

According to the Philippine Dermatological Society, Malassezia, the species responsible for causing fungal acne, is present in 92% of the global population.

So, how can this species cause disturbances when it is considered a part of everyone’s skin flora?

In this article, fungal acne prevalence, its causes and symptoms, how to diagnose Pityrosporum folliculitis, and the best and effective treatment for this infection will be provided.

Fungal Acne 101 – All You Should Know…

Prevalence of Fungal Acne

According to the Cleveland Clinic, fungal acne is very common.

According to a study published in the British Journal of Dermatology, it has a lifetime prevalence of 85% and it usually appears during the adolescent stage (10-19 years old) due to hormonal changes.

It can also occur during adulthood. 

However, women ages 20-29 years old are more prone to experience fungal acne compared to women of ages 40-49 years old.

Furthermore, comparing the prevalence of P. folliculitis between males and females, the latter are having more frequent derma visits, and usually, these female patients are of ages 25 and above.

According to another article published in the Journal of American Academy of Dermatology, this infection is most common in the Philippines.

Causes of Fungal Acne

Typical acne is far different from fungal acne as the former is caused by chronic inflammation of hair follicles alone while the yeast responsible for the latter is caused by the fungus Malassezia folliculitis or Pityrosporum folliculitis.

We all know that too much sebum production can cause breakouts. But, what are the other factors?

1) Hot and humid weather

According to peer-reviewed studies, moist environments such as hot and humid weather can be causal factors for P. folliculitis.

In this study, it was reported that a temperature of 31 to 35°C can increase the risk of P. folliculitis. 

2) Sweating and exercising

Excessive or frequent sweating is also a factor for yeast overgrowth.

This means that it is highly possible for patients with hyperhidrosis health conditions and athletes who regularly do physical activities to develop fungal acne.

3) Diet changes

Cultures of yeast grow when you consume many carbohydrates because you feed on the fungus responsible for fungal infection.

Thus, consuming too many sweets increase the chance for them to grow on your skin.

4) Restrictive clothing (tight clothes)

Wearing tight clothes makes fungal acne worse.

These tight or nonbreathable clothes also include your undergarments.

The principle behind this is that, when you wear tight clothes, you increase your chance to experience sweat retention and foul odors, leading to the possibility of yeast overgrowth.

5) Suppressed immune system

According to the Centers for Disease and Control Prevention, individuals with weak or suppressed immune systems are most at risk of developing fungal acne.

This is because opportunistic organisms such as P. folliculitis may easily enter the immune system of the individual and eventually these yeast thrive over time.

6) Medications

The use of certain medications and supplements are also factors for the appearance of excess yeast growth. Some of these include:

  • Corticosteroids
  • Androgen and anabolic steroid drugs
  • Contraceptives
  • Tricyclic antidepressants
  • Lithium
  • Antiepileptic drugs
  • Aripiprazole
  • Selective Serotonin Reuptake Inhibitors
  • Vitamin B1, B6, and B12
  • Antibiotics such as Dactinomycin

What are the Symptoms of Fungal Acne?

Knowing what causes fungal acne, it is about time to learn the symptoms.

Since this health condition is commonly mistaken with normal pimples or usual breakout, knowing its manifestations aside from causing inflammation is necessary.

  • Intense skin itchiness
  • Burning skin sensation
  • Small red bumps on the skin
  • Treatment-resistant breakout
  • Irritated hair follicles

Take note that, if the small red bumps you see are monomorphic, the skin infection you have is indeed P. folliculitis.

Monomorphic means that they have the same size (around 1-2 mm).

Where Do Fungal Acne Symptoms Manifest?

P. folliculitis can show on different parts of the body.

According to a study published in The Journal of Clinical and Aesthetic Dermatology, the most common body part where P. folliculitis may appear is on the face, with a prevalence rate of 57.1%.

Other parts of the body where acne fungal manifest can be seen in the information below, together with their respective prevalence:

  • Back of the body (53%)
  • Extensor surfaces of the upper arms (38.8%)
  • Upper chest (36.7%)
  • Neck (18.3%)

How to Diagnose Fungal Acne

Diagnosing P. folliculitis comes with a process, and the best thing to do when you think that you have this condition is by consulting a dermatologist.

A dermatologist is the best medical professional who can give medical advice, diagnosis, or treatment for skin-related problems.

During an intervention with a dermatologist, the following information will be collected from you:

  • When did the infection start to show up
  • What were the remedies or treatments you have used
  • Which of the acne-like symptoms are present

According to a clinical review, P. folliculitis is often misdiagnosed with other regular acne such as acne vulgaris.

Thus, diagnosing this skin problem using different diagnosing tools is necessary. Some of these include:

  • Skin scraping – scraping a part of the skin and observing the skin sample under a microscope
  • Examining skin lesions through the use of wood’s light
  • Acne biopsy

Some dermatologists prefer to diagnose P. folliculitis when, during the collection of information process, the patient indicates that the medications being used no longer work for the breakouts.

This is important because the patient might have resistance to the medication or the breakouts are not because of the fungus Malassezia.

How to Treat Fungal Acne

Take note that although these acne-like breakouts are caused by a fungal or yeast infection, it is not a contagious health condition.

Moreover, there are two ways to treat P. folliculitis: the first one is by using medical treatments and the second one is by doing supportive measures.

1) Medical Treatment

The following are some medical techniques for treating P. folliculitis, and if you want to know more about cases like this, you can consider reading this article.

However, if you wish to copy the content, you must have prior written permission before doing so.

a) Oral antifungal medication

Antibiotics will not work for fungal infections.

This means that the only medications you can take are antifungal pills. Some of these pills include itraconazole and fluconazole.

b) Topical treatments

According to dermatologists in San Diego, topical antifungal creams such as miconazole are effective treatments for M. folliculitis.

In this study, it was also reported that a fungal acne-treated skin using topical antifungal causes reduced inflammation.

Lastly, in the same study, applying antifungal shampoo with 2% ketoconazole content once a day to the affected area can help resolve the infection.

c) Isotretinoin

Patients with breakout may also consider using isotretinoin. However, either topical or oral, Isotretinoin must be applied to affected areas regularly for 6 months for it to show its effects.

d) Guava soap

Guava soap has been an effective fungal acne treatment for all ages.

According to a study published in the International Journal of Microbiology, guava leaves can treat and prevent fungal acne from developing in the skin and hair follicles.

Moreover, guava leaves are filled with essential oils which act as inhibitory agents for bacteria and fungus.

2) Supportive Measures

Moving on, the supportive measures below are mostly about lifestyle changes and hygiene care.

1) Healthy hygiene after a workout

Since wearing sweaty workout clothes can increase the risk of fungal infections, after exercising, change your sweaty clothes as soon as possible.

This will allow you to reduce the risk of fungal and bacterial acne formation.

Then, after resting for some time, take a shower and use antibacterial soap.

2) Use looser clothes

During the time you have fungal acne, it is advised to wear loose clothing as this will help you reduce skin irritation.

If you are at home, you can take off some of your undergarments such as a sports bra or bra to give your body breathability.

3) Consider antifungal body wash

Body wash such as dandruff shampoo could also help you prevent the formation of fungal acne. Additionally, a body wash with pyrithione zinc or selenium sulfide is also recommended.

Final Thoughts

Indeed, fungal acne caused by M. folliculitis may cause not just physical health issues but also mental ones.

Since this skin condition can lower self-confidence, it is necessary to diagnose and treat it as soon as possible.

A patient presenting himself or herself for medical treatment may be asked many questions about the history of the condition. Although this may be probing, this could help in treating fungal acne in no time.

There are many antifungal treatments for fungal acne and these include drugs and supplements. 

Lastly, for patients looking for fungal acne home remedies, considering healthy hygiene is a great option as well.

Frequently Asked Questions (FAQs)

Is a clogged hair follicle a cause of fungal acne?

When your hair follicle is clogged, it increases the chance for it to be inflamed. Eventually, when it is inflamed, this could lead to the formation of acne or cyst caused by either fungal or bacterial acne.

What can you use to treat hair follicles with acne?

Seeing a board-certified dermatologist is the best option when it comes to skin and hair problems. A dermatologist can provide medical advice about the infection you have. Also, a board-certified dermatologist would usually prescribe antifungal pills and creams, together with a specific dandruff shampoo.

What are different acne treatments?

Take note that breakout treatments may be medical or supportive. For the medical treatments, antifungals will be given. For the supportive treatment options, lifestyle changes and hygiene improvement will be required.