How to Recognize and Treat Fungal Acne Effectively

If you're struggling with a persistent body acne breakout on areas like your chest, arms, or back that doesn't respond to acne treatments, fungal acne might be the culprit. Don’t worry, it’s not as alarming as it seems. The good news is that fungal acne (also called pityrosporum folliculitis or malassezia folliculitis) is easy to treat once you identify it. We spoke to dermatologists about fungal acne—what it is, how to eliminate it, and how to prevent it from returning.

What Exactly Is Fungal Acne?

Fungal acne is actually a misnomer; it's neither caused by fungus nor classified as acne. "The condition we refer to as fungal acne is really malassezia folliculitis (an infection of the hair follicle), which is caused by a yeast that irritates your skin's hair follicles and forms pimple-like bumps," explains dermatologist Hadley King, MD. It's completely normal for this yeast to live on your skin, but an overgrowth can trigger breakouts, especially during season transitions.

Fungal acne typically appears on the chest, upper arms, and back, and it's uncommon to see it on the face. However, yeast can spread through close contact, meaning it can potentially spread across your body or even to others.

Here's the tricky part: since fungal acne isn't actually acne, typical acne treatments won't resolve it. That's why it's crucial to distinguish between the two types of skin conditions.

Fungal Acne vs. Traditional Acne

Although fungal acne can resemble regular acne, there are clear differences. "Regular acne breakouts tend to occur on the face and can vary in size and form—whiteheads and blackheads are common," says King.

"Fungal acne breakouts, unlike regular acne, tend to be uniform in appearance and occur in clusters—they form red bumps and small pustules mostly on the chest, upper arms, back, and occasionally the face. One noticeable characteristic of fungal acne is that it's usually very itchy," says dermatologist Hadley King, MD.

What Causes Fungal Acne?

Fungal acne, like regular acne, can be triggered by a variety of factors. Some of the most common causes include:

• Medications. Certain drugs, such as antibiotics, can disrupt your skin's bacterial balance, allowing yeast to overgrow and cause fungal acne. "For instance, antibiotics, whether taken orally or applied topically, can wipe out beneficial bacteria, leading to an unchecked yeast overgrowth," says King.
• Wearing tight, sweaty clothing. Non-breathable, tight clothing—especially when it's sweaty—creates a warm, moist environment that encourages yeast to thrive.
• Genetics. Your family history may play a role in developing fungal acne. Some people are genetically prone to yeast overgrowth, making them more likely to experience fungal acne outbreaks.
• Chronic medical conditions. Conditions that weaken the immune system, such as diabetes and HIV, can increase your susceptibility to fungal acne.
• Hot, humid climates. Hot, sticky weather creates ideal conditions for yeast to grow, making fungal acne more likely during such climates.
• Immune deficiencies. A compromised immune system can hinder your body’s ability to regulate yeast growth, which could lead to fungal acne.
• Shaving or tweezing hair. Shaving or tweezing can irritate the skin, causing small cuts or micro-tears that increase vulnerability to fungal acne outbreaks.

How Is Fungal Acne Diagnosed?

You may be able to identify fungal acne on your own, but for a definitive diagnosis, it's best to consult a dermatologist. They will assess your condition after conducting a physical exam and reviewing your medical history.

The examination may involve a skin scraping or swab to examine skin cells under a microscope. Your dermatologist may also use a Wood's lamp, which emits UV light, to detect yeast infections, as the affected skin can glow under the light. In some cases, they might send the sample to a lab for yeast detection or even perform a fungal culture or biopsy for more accurate results.

Accurate diagnosis is key because fungal acne requires antifungal treatment, not typical acne medications. The sooner you identify fungal acne, the sooner you can start treatment and clear it up.

How to Treat Fungal Acne

Fungal acne typically does not respond to traditional acne medications, but it can be improved with the use of topical antifungals, says Joshua Zeichner, MD, a board-certified dermatologist in New York City.

Dandruff Shampoo

"If you suspect you have fungal acne, try using a dandruff shampoo as a body wash. These contain anti-fungal ingredients like pyrithione zinc or selenium sulfide, which help balance your skin's pH levels and decrease yeast on the skin."

Both Zeichner and King suggest Dove Dermacare Scalp Dryness and Itch Relief Anti-Dandruff Shampoo for sensitive skin types. With any product, the key is to let the product sit on your skin (Zeichner recommends singing the alphabet as a good measure) before rinsing it off.

Anti-fungal Cream

Other comparable products with active ingredients may also help. "Search for an anti-fungal cream containing econazole nitrate, ketoconazole, or clotrimazole, and apply it to the affected areas twice a day," advises King. "Avoid using topical or systemic antibiotics, as these can disrupt the skin's bacterial balance and allow yeast to proliferate unchecked."

If these treatments aren't effective, visit a board-certified dermatologist who can make a definitive diagnosis and, if necessary, prescribe an oral antifungal medication. "Oral prescriptions typically work faster since they penetrate deeper into the follicle," explains King.

How to Prevent Fungal Acne

Sadly, fungal acne can return after treatment. While there's no foolproof method to prevent it, there are steps you can take to keep breakouts under control. Steer clear of heavy moisturizers and oils, as they create a moist environment that encourages yeast growth. Opt for lighter, oil-free, and non-comedogenic moisturizers that absorb quickly into your skin.

Opt for loose-fitting clothes to allow your skin to breathe, and make sure to shower right after exercising. "There's no need to specifically treat fungal acne once your body has recovered, but you can use dandruff shampoo instead of your regular body wash once a week as a preventative measure," explains King. Lastly, some recommend reducing your intake of sugars in your diet, as sugar can promote yeast growth in the body.