Ask a Dermatologist: How to Identify and Treat Fungal Acne
Fungal acne isn’t hard to treat—once you know that’s what you’re dealing with. The challenge can be in the fact that fungal acne can look pretty much the same as regular acne. In short, the condition we call fungal acne is the result of an overgrowth of yeast, “otherwise known as pityrosporum folliculitis (malassezia folliculitis),” according to board-certified dermatologist Morgan Rabach. In fact, to set the record straight: fungal acne is a total misnomer—”it actually has nothing to do with fungus, nor is it really acne—it’s a folliculitis, or infection of the tiny hair follicles on the face or body,” which leads to “papules, small, raised, solid bumps resembling pimples,” explains board-certified dermatologist Ava Shamban.
We know how difficult it can be to identify and treat this type of acne, so we asked Rabach, Shamban, and board-certified dermatologist Joshua Zeichner to break it all down for you. Below, discover what fungal acne looks like, what can cause it, and of course, fungal acne treatments to be aware of.
What Is Fungal Acne?
“Fungal acne is usually papular acne (red bumps),” explains Rabach. One sign your acne is fungal and not of the acne vulgarism variety (which is what we typically think of as ‘normal acne’) is if it’s itchy. Also, if you spot whiteheads or blackheads that are roughly a millimeter big, chances are it could be fungal. This type of acne usually shows up on the chest, back, or upper arms, but can also occur on the face, just like typical acne can, making it difficult to decipher which you’re experiencing.
Causes and Prevention of Fungal Acne
There are a few reasons you may be getting fungal acne, here’s what they are and how you can mitigate them.
- Heat and humidity: Fungal acne is closely related to hotter climates. According to Zeichner, it’s relatively uncommon in the United States and is seen at much higher rates in areas of the world where the weather is always warm, such as the Philippines. This is because the yeast that causes fungal acne thrives in moist environments with excessive sweat and heat.
- Sweat: You probably already know that it’s best to shower as soon as your exercise is over and that it’s not ideal to sit around in sweaty, clingy clothes (ahem, yoga pants), but this can do more than just make for an uncomfortable fit. To avoid sweat-induced fungal acne, Shamban advises to “Choose loose clothing with natural fabrics, avoid spandex, and change clothing often after exercise or excessive sweating. This can be helpful particularly in hot weather when it can flare up.”
- Overuse of antibiotics: The yeasts on our skin are part of our microbiome, and they’re not a problem when they’re not in excess. However, “in certain circumstances—such as long-term use of topical and/or oral acne antibiotics—the normal skin flora is wiped out by the antibiotics, and so the yeast flourishes, causing inflammation and fungal acne,” Rabach explains. If you have acne that’s not responding to normal treatments and a history of regular antibiotic use, you may have found your culprit.
- Contact with others: Fungal acne might be contagious (after all, yeast is known for spreading). If you’ve had bodily contact with someone who has fungal acne, it may be the cause of yours.
Treatment
The good news is that once you’ve identified fungal acne, it’s not so hard to treat—especially, Shamban notes, because “the cause is one-dimensional.” In fact, according to Zeichner, you can “even try a few over-the-counter tricks before visiting your dermatologist.”
Use an Anti-Dandruff Shampoo
Anti-dandruff shampoos contain an active ingredient called zinc pyrithione, which is antifungal. Needless to say, for fungal acne, these shampoos actually make a good skin cleanser (for face or body—wherever the affected area is). “Apply, let it sit, and lather it up while you sing the alphabet before rinsing it off,” Zeichner says. “The shampoo needs enough contact time on the skin for it to exert its effect.”
Apply an Athlete’s Foot Cream
Another nontraditional treatment lies in athlete’s foot cream. “Athlete’s foot is caused by a similar fungus that causes fungal acne” Zeichner explains. As such, over-the-counter creams can be used. “These contain a potent anti-fungal medication called clotrimazole,” Zeichner notes. He recommends applying it twice daily to affected areas. But if these don’t work, or if your rash is not improving in a week or two, Zeichner recommends visiting a board-certified dermatologist for evaluation.
Get a Prescription for a Topical
If your fungal acne is stubborn—as many cases can be—a prescription-strength treatment may be needed. Rabach notes that she’ll often prescribe “an antifungal cream, like Ketoconazole 2%, twice a day, for two to three weeks to help reduce the yeast on the skin, leading to a significant reduction in the lesions present.”
Exfoliate Excess Dirt and Oil
We know that exfoliating can get rid of dead skin cells, but how does this fare with hose prone to fungal acne? Turns out dead skin cells, excess dirt, and oil might all contribute to the increase of yeast growth. Use a body exfoliator regularly (and especially post-workout) to lessen the chance of getting fungal acne.
Make Body Wipes a Gym Bag Staple
A body wipe-down after a workout session is both refreshing and helpful in fending off breakouts. Keep a stash of body wipes in your gym bag to encourage a habitual routine of wiping away sweat and oil, at least until you can get to a shower. Salicylic acid wipes, in particular, may help reduce the potential of clogged pores and are ideal for acne-prone, sensitive skin types.
Use an Oil-Free Moisturizer
When you have fungal acne, the last thing you’ll want to do is exacerbate it with what it loves most: oil. Especially if you’re treating it with a strong topical (whether prescribed or not), you’ll likely have bouts of dryness and irritation, and will want to reach for a moisturizer. Opt for one that’s oil-free to try to keep fungal acne at bay.
Apply a Topical Tea Tree Oil
Touted for its antiseptic, antifungal properties, tea tree oil is an effective treatment for fungal acne. Dilute one to two drops of tea tree oil with 12 drops of a carrier oil (like olive oil) and apply topically (never orally). Since some with sensitive skin have experienced an allergic reaction to those with sensitive skin, it’s best to do a patch test before applying the concoction all over the affected area.
Use a Blemish Serum
If you’re sporting an acneic skin type, less is more when it comes to your skincare routine. A two-in-one serum that targets active breakouts and works to fade acne spots over time may have some serious benefits for both treating the fungal acne and ensuring it doesn’t leave its trace behind.
Try a Prescription Oral Medication
Though it’s rare, dermatologists sometimes call in an oral antifungal treatment like Fluconazole (if you’ve ever been prescribed medication for a vaginal yeast infection, this is likely what you took). “It works faster than the cream or shampoo,” Rabach says, a pro for her New York City clientele who “need results fast.”
