What is Fungal Acne?

If you have acne that has not responded well to traditional acne treatments, it may be because you have fungal acne.

What is Fungal Acne?
Judy Hsu, DO
December 30, 2020, 5:09:24 AM


Fungal acne is not really acne at all. The official medical term is pityrosporum folliculitis. While the appearance of the skin can be nearly identical, fungal acne has little in common with regular acne (a.k.a. acne vulgaris). It is cause by overgrowth of fungus, so that’s why it is commonly found on the torso and upper arms where it’s typically covered by clothes which can trap moisture, and fungus love moisture. The overgrowth of fungus irritates hair follicles, causing them to become red and swollen, thereby mimicking the appearance of acne.

We all have fungus living on our skin, and typically this does not pose a problem. Our body has adapted to co-existing with the fungus and bacteria found on the surface of our skin. However, when that delicate balance is disturbed, overgrowth of fungus can happen and cause problems. Here are some of the things that can tip things in the wrong direction:

1. Wearing non breathable clothes. Synthetic fabric that traps sweat and moisture encourages fungal growth. Also clothes that are tight discourage ventilation.

2. Suppressed immune system. When the immune system is weakened, your body is unable to maintain the balance of fungus and bacteria that are living on the surface of your skin, thereby increasing risk of overgrowth.

3. Antibiotic use. While antibiotic is great for getting rid of a bacterial infection, it can also invite fungus to grow by taking the place of the bacteria that have been killed off by the antibiotic.

4. Dietary changes. Fungus love sugar, so a diet high on simple sugar and carbohydrates can encourage them to flourish.

Because fungal acne can look very similar to regular acne, it can be hard to diagnose on first look. However, there are some subtle clues that may help you identify it correctly. For example, fungal acne tends to be itchy whereas regular acne is not. Fungal acne also tends to erupt in clusters, and the bumps tend to around the same size. The best way to know for sure is to get your skin tested. This can be done either via skin scraping or biopsy at you doctor’s office.

Treatment of fungal acne include reversing the factors that make them flourish in the first place as outlined above. Anti-dandruff shampoo containing selenium sulfide can also be helpful although this is usually used as a preventative measure against reoccurrence. Although it’s a shampoo, you can apply and leave it on the affected skin for 5 minutes before rinsing it off. This can be done one or several times a week to control fungal overgrowth. What is considered more effective is oral anti-fungal medication like fluconazole which can be prescribed by your doctor. This approach can ensure that the medication is delivered deep inside the pores to control the fungal growth at that level.

In summary, fungal acne can look like regular acne but tend to occur on areas of the skin where there is a lot of oil and sweat production. It is caused by fungal overgrowth. Effective treatments include reducing factors that contribute to overgrowth of fungus and anti-fungal medications. If you have been struggling with acne that doesn’t respond to typical treatments, it may be a good idea to talk to your doctor about fungal acne as a possible diagnosis.