Fungal Acne, At A Glance
- Best Results1 treatment cycle
- Treatment RecoveryNA
- Procedure TimeNA
- Skin SpecialistMedical dermatologist
- Duration of ResultsMay recur
Fungal acne is actually due to a yeast. The medical name is pityrosporum folliculitis. This form of acne is resistant to normal acne treatments including washes, creams & antibiotics. Unlike normal acne, blackheads are rare with fungal infections. Fortunately, once diagnosed, fungal acne is super easy to treat. Discuss with your family physician how to manage this common condition.
FactsFacts on Fungal Acne
- Fungal acne is a yeast infection
- This form of acne presents as red bumps that frequently itch
- A simple swab or skin scraping can diagnose this condition
- Treatments include anti-dandruff shampoo, fungal creams & tablets
- Recurrence following treatments are common
- Maintenance treatments include pulsed topicals & antifungal tablets
- See a medical dermatologist for diagnosis & management
What is fungal acne?
Fungal acne is due to a yeast called malassezia furfur. This yeast is normally found on the skin in small numbers. Fungal acne occurs when the growth of this yeast goes unchecked & a population boom occurs.
Fungal acne can occur simultaneously with acne, can be mistaken for acne or can flare as a result of acne treatment. Because it’s related to a yeast overgrowth in the hair follicles, it won’t respond to normal acne treatment and requires a different treatment approach.
What are the differences between normal acne & fungal acne?
Picking the difference between normal acne & fungal acne can be tricky, even for dermatologists. The clues lie in signs & symptoms.
Normal acne is associated with blackheads, pustules, inflammatory papules & occasionally cysts. Fungal acne usually presents as tiny red bumps with occasional pustules. Most cases do not have blackheads.
Normal acne also favours the face, whilst fungal acne favours the chest, shoulders & back. Facial involvement, though reported, is rare.
Fungal acne usually has symptoms, primarily itch. Common acne is usually asymptomatic. In some cases, your physician may elect to undertake a swap or in rare cases a biopsy to tell the difference.
Do normal anti-acne treatments cure fungal acne?
No. Normal anti-acne medications including washes, lotions, tablets, diet, phototherapy & anti-hormones do not treat fungal acne. The only exception is old fashioned sulphur.
Fungal acne, as the name suggests, responds to antifungals including shampoos & tablets.
What are the causes of Fungal Acne?
Fungal acne yeasts are ubiquitously found on normal human skin. They multiply with changes in oil production, humidity & sweat.
Trigger factors for fungal acne include:
- Excessive sweating can cause fungal acne. Hence people living in humid climates are more prone to it as the yeast thrives on sweat. Heavy workouts can also cause it.
- Restrictive clothing or sweating under our garments and not showering to wash off the sweat can also be a trigger.
- Antibiotics (topical or oral) and immunosuppressants are also a cause.
- Other rare causes include endocrine disorders such as diabetes.
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Is fungal acne contagious?
Yes, but not as contagious as Covid. If you’ve had bodily contact with someone who has fungal acne, it may be the cause of yours. There are many other factors that determine how this yeast is contracted, including contact time, contact load & your own immune system. Remember, this yeast is present on your skin, even though you may not have symptoms.
How can you prevent fungal acne?
You can take some steps to reduce the chances of getting fungal acne including-
- Frequent & prompt change of clothes after your sweat/working out.
- Don’t share towels
- Keeping cool as possible (that’s a hard one if you live in Brisbane during summer)
- Washing with salicylic acid exfoliants (Cerave or La Roche Effaclar)
If you do get an overgrowth of fungus (correct term yeast AKA m.furfur), you can always treat it with selenium sulfide shampoo. A good way to prevent recurrence is to pulse it- apply for the first 7 days of every month- regardless of signs/symptoms.
What are DIY /home remedies that can cure fungal acne?
Anti-dandruff shampoos have the highest efficacy against fungal acne. They do require repeat treatment, as do these remedies listed below. Topical therapy can treat pityrosporum folliculitis, however oral antifungal tablets have the highest efficacy.
Lactobacillus produces lactic acid which can control the production of the yeast. In theory yoghurt in your diet and you can also take lactobacillus supplements.
Honey has antimicrobial qualities. So apply it on the affected area and keep it on for as long as you can, even for a few hours if possible. IMO you are better off putting honey on your toast rather than on your back.
Tea tree oil is another antimicrobial that can be used. TTO should be diluted as directed. Leave on for 30 minutes before washing off.
Caprylic acid oil is a medium chain triglyceride with antifungal properties. Apply for 30 minutes before washing off.
Sulphur is an oldie but a goodie, used for decades by dermatologists for the management of scabies & acne. Smells like sh*t, but super safe. Formulations range between 2 to 10+ %.
What medical treatments are available?
Fortunately, fungal acne is super easy to treat. Your GP or pharmacist can guide you. A medical dermatologist (not me) can intervene if in doubt.
Selenium sulfide shampoo: apply to affected areas daily for 7 consecutive days of the month. You will need to repeat monthly as recurrence is high (for every treatment). Apply to affected areas, leave on for 15 minutes before washing off.
Pevaryl foaming wash: apply for 15 minutes for 3 consecutive days. Repeat every 1-3 months as required.
Ketoconazole /Econazole cream: apply 5 consecutive days per month then repeat as needed.
Ketoconazole tablets: Pulsed treatments by doctors, keeping pulses to less than 10 days.
Itraconazole tablets: Pulsed treatments, 7 days per month. Repeated as required.
*Note- fungal acne is resistant to retinoids, & antibiotics. In fact, prolonged use of antibiotics can make this condition worse.
Will my infection be recurrent?
Yup, probably. Think of this as a yeast infection of your body, much akin to yeast & mould on the bathroom tiles. You can give it a good clean, but it always comes back.
This is why prevention strategies are so important. A medical dermatologist will discuss options to reduce recurrence.
Davin’s Viewpoint on Fungal Acne
The prevalence of fungal acne has not changed, however with the event of the internet and social media, this ranks as one of the most popular searches.
Most cases can be easily diagnosed as the clinical findings are usually classic, namely monomorphic red bumps, most frequently seen on the chest, back, and shoulders. The peak age is usually 15 to 25 years. This condition is frequently itchy, unlike normal acne. Diagnosis can be challenging as it can occur with normal acne.
A swab, skin scraping or skin biopsy may be required for cases that are resistant to therapy, or if the diagnosis is in doubt.
Treatments are pretty straight forward, most dermatologists will prescribe a course of antifungal tablets in a pulsed manner, ranging from 3 to 10 days. It is important to come up with a maintenance plan as fungal acne is recurrent.
*Disclaimer: I am a procedural dermatologist. I do not treat acne or fungal infections. Please make a booking with our medical team if you have acne.
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