Fungal Acne Explained

Medically Reviewed By Clare Wightman MS, PAC
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Fungal acne occurs when your hair follicles become infected with the Malassezia species of yeast. Although it is not actually acne, it is often mistaken for regular acne because it causes skin lesions that look like pimples. Fungal acne is a type of folliculitis and often occurs in areas where acne develops. Fungal acne can be itchy, and it tends to appear on the upper chest and back. It can also develop on the hairline, chin, neck, and forearms. Although it is typical to have Malassezia yeast on your skin, not everyone will develop fungal acne.

Fungal acne may occur more often in people with weakened immune systems, who take certain medications, or who live and work in hot climates. It is also more common in teenagers and young adults, especially those ages 11–30 years

This article explains more about the causes, appearance, and treatment of fungal acne. 

What are the causes of fungal acne?

A woman scratching her neck
dtephoto/Getty Images

Fungal acne, or Malassezia folliculitis, can form as a result of Malassezia yeast overgrowth. Most people have Malassezia yeast on their skin, but the yeast can overgrow if the hair follicles become irritated or if another condition affects the skin. 

Factors that can lead to the development of fungal acne include: 

  • sweat clogging the hair follicles
  • excess oil production 
  • the use of medications that weaken the immune system
  • shaving, waxing, or plucking hairs
  • using an improperly balanced hot tub

In some cases, the underlying cause of fungal acne is unclear. 

What does fungal acne look like?

A person with a fungal acne infection on her neck and upper chest
Fungal acne can cause itchy skin lesions, commonly on the upper chest area. Image credit: Shutterstock

Fungal acne usually looks like regular acne, so it might be difficult to identify. One of the main differences between fungal acne and regular acne is that fungal acne will not consist of blackheads or whiteheads.

Instead, people with fungal acne will have small, itchy blemishes in the form of papules or pustules. Papules are small bumps, and pustules are pus filled blemishes.

These blemishes tend to occur on the upper chest and back. They may also appear on your:

  • forehead
  • hairline
  • chin
  • neck
  • upper arms

You may be able to differentiate between fungal acne and regular acne by attempting to manage it with traditional acne treatment. If traditional treatment is ineffective, it may be fungal acne.

How do doctors diagnose fungal acne?

A dermatologist may be able to diagnose fungal acne based on the appearance and symptoms, how long it has been present, and whether or not traditional acne treatments have been effective. 

In some cases, they may take a superficial skin scraping to examine under a microscope or special lamp. These examinations may reveal yeast spores or a color that indicates a fungal infection.

If you have acne near your hair follicles that is not responding to regular acne treatments, a dermatologist may prescribe fungal acne treatments to see if they work.

What are the treatments for fungal acne?

Typically, a dermatologist will prescribe a topical treatment for fungal acne. This may include:

  • selenium sulfide shampoo
  • 2% ketoconazole shampoo
  • ketoconazole cream
  • econazole cream or solution
  • propylene glycol cream

Your doctor may also recommend oral antifungals, such as fluconazole or itraconazole. You may need to use topical treatments and take oral antifungals regularly even after the symptoms of fungal acne have improved. This can help prevent recurrences.

Some people may have bacterial acne or folliculitis in addition to fungal acne. In these cases, dermatologists may also prescribe an antibacterial cream or oral antibiotics

Natural treatments

Most cases of fungal acne will require traditional antifungal treatment from a dermatologist. 

However, the American Academy of Dermatology Association (AAD) notes that you can help relieve your symptoms by applying a warm compress to the irritated area for 15–20 minutes at a time up to four times per day. 

What is the outlook for people with fungal acne? 

Most treatment courses for fungal acne will take a few weeks to work. Some people may need to intermittently use oral or topical antifungals to prevent recurrences.

Without treatment, fungal acne can be extremely itchy, and it may cause you to scratch your skin. Scratching can lead to a secondary bacterial infection and scarring. 

Can I prevent fungal acne?

Although some people may be more prone to developing fungal acne, the AAD notes that you can help prevent an infection by doing the following:

  • Wear loose, breathable clothing during hot weather. Tight clothes can irritate your hair follicles and skin. 
  • Change your clothes after sweating. For instance, change as soon as possible after exercising. 
  • Avoid hot tubs. If you use a hot tub, ensure that it is clean and properly balanced. 
  • Wash and let your bathing suit dry every time you swim. Rewearing a wet suit can lead to folliculitis. 
  • Use care when shaving. Change your razor blades often and shave in the direction of hair growth to prevent irritation.

If your doctor has prescribed any medications, take them as instructed. Not finishing a course of medication or not taking it on schedule could prolong the infection.

Frequently asked questions

Here are a few other commonly asked questions about fungal acne. Clare Wightman, M.S., PA-C, has reviewed the answers.

How do I know if my acne is fungal?

Although fungal acne can look very similar to traditional acne, the blemishes of fungal acne will look uniform and may be itchy. In addition, you may have fungal acne if traditional acne treatments do not improve your symptoms. If you are not sure if you have fungal acne, contact a dermatologist.

How do I treat fungal acne?

Dermatologists can prescribe oral or topical antifungal medications to treat fungal acne. Be sure to follow your dermatologist’s treatment plan, as fungal acne can recur easily.

What triggers fungal acne?

Fungal acne results from an overgrowth of yeast on the skin. Factors such as excessive sweating, oil overproduction, and a weakened immune system may contribute to this overgrowth.

Summary

Fungal acne is a skin condition resulting from a Malassezia yeast infection. If something irritates the hair follicles on the skin, such as excessive sweating or oil production, the yeast can overgrow and cause a skin reaction. 

Although fungal acne may look like other types of acne, it may be itchy and will not respond to traditional acne treatments.

A dermatologist can prescribe various antifungal treatments, such as creams to apply to the skin or oral antifungal medications. Without treatment, fungal acne can lead to a secondary bacterial infection and scarring.

Talk with your doctor if you have acne-like symptoms that do not respond to traditional acne treatments.

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Medical Reviewer: Clare Wightman MS, PAC
Last Review Date: 2022 Aug 10
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