Fungal acne is having a moment on social media; the sheer number of TikTok videos dedicated to the subject, much of them revolving around dandruff shampoo as a treatment, is proof positive. But here’s the thing: the buzzed-about condition isn’t a type of acne at all. “The term ‘fungal acne’ is a misnomer. It’s actually folliculitis, an infection of the hair follicles caused by yeast that manifests as bumps that resemble acne,” says New York City board-certified dermatologist Dr. Joshua Zeichner. While it can be tricky to diagnose, the good news is that it’s fairly easy to treat—so long as you take the right approach. Spoiler alert: traditional acne treatments, such as Accutane, are not the way to go. Here’s everything you need to know about fungal “acne” (we’ll keep referring to it as such, just to keep things easy).
What is fungal acne?
The Internet may be throwing around the term fungal acne, but Dr. Robyn Gmyrek, a board-certified dermatologist in New York City, underscores the fact that dermatologists refer to it as fungal folliculitis (technical term: pityrosporum folliculitis). Folliculitis refers to any type of infection of the hair follicle, and, in this case, the infection is caused by a yeast (a type of fungus). Essentially, it’s a yeast infection on your skin. Sure, there’s a certain ick factor here, but keep in mind that there’s yeast present on everyone’s skin—more specifically, a ubiquitous variety known as malassezia, usually found in the oil glands because it flourishes on sebum, says Dr. Gmyrek. Normal levels of malassezia are not problematic in the least, “but when there’s an overgrowth, it elicits an immune response that leads to inflammation and the formation of acne-like papules and pustules,” she explains.
What causes fungal acne?
The root cause is too much of that yeast, but this can be caused by any number of things. Those with oilier skin, such as teens and young adolescents, have more “food” for the yeast, and therefore are more prone to fungal folliculitis. Excessive sweating plus occlusive clothing also make for an environment where the yeast can thrive. Similarly, fungal acne is more common in those who live in hot, humid environments, notes Dr. Gmyrek. And finally, people using oral and/or topical antibiotics are also at an increased risk, because these alter the normal balance of bacteria and yeast on the skin, she adds.
How is fungal acne different from regular acne?
It’s important to remember that, while bacteria and yeast are both types of microorganisms that live on your skin, they’re still two different things. Traditional acne, aka acne vulgaris, or even hormonal acne, occurs when excess oil and skin cells block oil glands. This creates a prime breeding ground for bacteria, which subsequently triggers inflammation, explains Dr. Zeichner. (It’s why so many standard acne treatments, such as benzoyl peroxide, are antibacterial, while others, such as AviClear and spironolactone, work to minimize excess oil.) But in the case of fungal acne, it’s too much yeast that’s the problem and is what is contributing to the pimple-like bumps.
What does fungal acne look like?
While there are some similarities between fungal acne and the classic type, there are a few 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,” points out Dr. Gmyrek. In other words, someone with acne may have some blackheads, some whiteheads, some fully formed red pimples, some pimples under the skin… you get the picture. But fungal acne appears only as small, one- to two-millimeter bumps that are very uniform in shape and size, explains Dr Gmyrek. (They also typically don’t come to a head, the way regular pimples do.) They can also be clustered together, creating the appearance of a rash, adds Dr. Zeichner. And whereas traditional acne typically crops up on the central face, fungal acne is most likely to appear on the body—namely, the back, arms, and chest. If it does occur on the face, it’s usually on the chin and cheeks, explains Dr. Gmyrek. Finally, fungal acne is very itchy, but traditional acne is not.
How is fungal acne diagnosed?
“It’s very difficult to make a definitive diagnosis, so fungal acne is a diagnosis of exclusion,” says Dr. Zeichner. “It’s usually treated with traditional anti-acne medications. When those don’t work, we move over to antifungal treatments. If it then improves, we can make a presumptive diagnosis.” We’ll get to those treatments in a moment, but it bears mentioning that acne vulgaris and fungal acne can occur simultaneously; Dr. Gmyrek says that this happens in more than 20% of patients.
What are the best treatments for fungal acne?
As Dr. Zeichner mentioned, traditional acne treatments are usually tried first—but these can potentially exacerbate the situation, if the core issue is, in fact, fungal. While bacteria and yeast are two different things, they exist in a delicate balance that’s essential for healthy skin. “When bacteria are killed by antibacterial acne medications, the yeast can overgrow, leading to fungal folliculitis,” explains Dr. Gmyrek. “Conversely, if you use antifungal medications in regular acne, you’ll kill yeast and the bacteria will overgrow.” Point being, you really do need to know what you’re treating. Since this is very challenging to determine, both doctors we spoke with advise seeing a dermatologist if you suspect you have fungal acne.
Prescription-strength antifungal creams and/or oral antifungal pills are often needed, though there are OTC options, such as Lamisil and Lotrimin cream (yes, the same stuff used to treat athlete’s foot), that may be helpful, says Dr. Gmyrek. For those who want to take the DIY route, there’s also some validity to the fungal acne treatment that’s gone viral on TikTok—anti-dandruff shampoo. Because these formulas contain antifungal ingredients such as zinc pyrithione and selenium sulfide, they can be effective, says Dr. Zeichner. “Use one in lieu of your face wash or body wash, daily. In order to give it enough time to work, let it sit on the skin while you sing the alphabet, then rinse,” he suggests.
How long does it take to treat fungal acne?
If you are, in fact, plagued by a case of fungal folliculitis, the results will be rapid and dramatic; you should notice at least some type of improvement after just a few uses of an antifungal treatment, says Dr. Zeichner. But if your skin becomes irritated or the “acne” looks worse, discontinue use immediately and see your dermatologist. That being said, because the yeast that causes the condition is always present to some degree on our skin, it’s often more helpful to think about managing fungal acne, rather than eradicating it entirely. (It also tends to have a high recurrence rate in general, though the exact reasons why are unknown.) Along with using antifungal topicals, lifestyle changes—not wearing sweaty workout clothes for prolonged periods of time, changing your pillowcase daily, minimizing stress —can help. Still, if those tweaks coupled with at-home products aren’t yielding a noticeable change after a few weeks, it is important to see a dermatologist. They can confirm that it is in fact fungal acne you’re dealing with and help you come up with a protocol to address it.
