Fungal acne, symptoms cause and treatment

Fungal acne is actually Malassezia folliculitis, a follicular skin fungal disease caused by Malassezia furfur, which manifests as papules similar to acne.

“While fungal acne can be tricky to diagnose, the good news is that it’s easily treatable with the right approach,” says Robin Gmelek, MD, a board-certified dermatologist in New York City.

What is fungal acne?

The internet may be throwing this term around: What exactly is fungal acne?

“Dermatologists call this fungal folliculitis (Malassezia furfur folliculitis). Folliculitis refers to any type of infection of the hair follicles, and in this case, the infection is caused by a fungus,” Dr. Robin Gmirek stressed.

Essentially, it’s a fungal infection on the skin, and more specifically, it’s Malassezia. It’s usually found in oil glands because it thrives on sebum. Normal levels of Malassezia are not problematic at the least, but when there’s an overgrowth, it can cause an immune response that leads to inflammation and the formation of acne-like papules and pustules.

What causes fungal acne?

Under the influence of triggering factors, Malassezia multiplies in large numbers in the hair follicles. Its lipolytic enzyme converts the triglycerides in the hair follicles into free fatty acids, which stimulates the hair follicle opening to produce a lot of desquamation and causes blockage of the hair follicle duct.

Overgrowth of Malassezia, retention of sebum, accumulation of cellular debris, and stimulation by free fatty acids lead to dilation of blocked hair follicles, which then rupture and release of contents into the tissue, causing inflammation, leading to inflammation and the formation of acne-like papules and pustules.

How does fungal acne differ from regular acne?

Although both bacteria and fungi are microorganisms that live on the skin, they are still two different things. Traditional acne, also known as acne vulgaris, or even hormonal acne, occurs when excess oil and skin cells block the oil glands. This creates a prime breeding ground for bacteria, which subsequently triggers inflammation.

“That’s why so many standard acne treatments, such as benzoyl peroxide, are antibacterial, while others, such as Aveclil and Spironolactone, are designed to minimize excess oil,” explains Dr. Robin Gmirek. But in the case of fungal acne, too much fungus is the problem and what causes the pimple-like bumps.

What does fungal acne look like?

While there are some similarities between fungal acne and the classic type, there are some key differences.

With acne vulgaris, the papules are different sizes and in different stages of development. In fungal acne, the papules all look the same. In other words, someone with acne may have some blackheads, some whiteheads, some fully formed red papules, some papules just under the skin… but fungal acne only appears as small bumps one to two millimeters in size that are very uniform in shape and size.

Dr. Robin Gmirek points out that fungal acne also doesn’t usually peak like regular pimples do, and they can also clump together, creating the appearance of a rash. While traditional acne usually appears on the central face, fungal acne is most likely to appear anywhere on the body, including the back, arms, and chest. It can also occur on the face, usually on the chin and cheeks.

Finally, Dr. Robin Gmirek adds that fungal acne is itchy, but traditional acne is not necessarily.

How is fungal acne diagnose?

Based on the clinical manifestations of Malassezia folliculitis, it can be diagnosed by direct microscopy, staining or fungal culture.

Malassezia folliculitis needs to be differentiated from acne vulgaris skin candidiasis, eosinophilic pustular folliculitis, and trichoderma folliculitis. The clinical manifestations of eosinophilic pustular folliculitis are similar to those of Malassezia folliculitis, and it is more common in young and middle-aged men. There are follicular papules and pustular itching in the seborrheic area. But the eosinophils in the blood are elevate, up to more than 40%. The pus in the hair follicles contains a large number of eosinophils and neutrophils, monocytes and epithelial cells. Glucocorticoids are effective when taken orally or applied topically.

What is the best treatment for fungal acne?

Dr. Robin Gmirek mentioned that traditional acne treatments are usually not effective for acne. When the bacteria are kill by antibacterial acne medications, the fungus can overgrow, causing fungal folliculitis to recur.

In contrast, if you use an antifungal medication in common acne, you kill the fungus and the bacteria overgrow.

Since it is very challenging to correctly diagnose bacteria and fungi. It is recommend that everyone go to a regular hospital to seek treatment from a professional doctor to avoid losing more than they gain.

In clinical medicine, high-strength antifungal creams and/or oral antifungal pills are usually require. OTC options are need to be helpful.

A fungal acne treatment that once went viral on TikTok, using anti-dandruff shampoos can also be effective. Because these formulas contain antifungal ingredients such as zinc pyrithione and selenium sulfide. So they are somewhat effective in treating Malassezia folliculitis.

How long does it take to treat fungal acne?

It usually takes about 20-60 days to treat Malassezia folliculitis. Because each patient has a different physical situation and different conditions of folliculitis, different treatment methods or drugs are use. These factors will lead to large differences in treatment time. Therefore, the treatment time needs to be determine according to the patient’s actual recovery time and cannot be generalize.

In general, the recurrence rate of acne is also high, although the exact cause is still unclear. In addition to using antifungal topical medications, you must maintain good personal hygiene in your daily life. Avoid eating chili peppers and seafood. Not wear sweaty sportswear for a long time, change your pillowcase every day. Try to reduce stress in your life, which can also effectively improve it to a certain extent.