Fungal Acne Actually Isn’t Acne
— Here’s What You Need to Know
If you’ve been scrolling social media or your favorite websites lately, you may have been led to believe that there’s a whole new form of acne out there—one caused by a fungus. But the truth is, this buzzy skin condition isn’t acne at all.
The term is a total misnomer for an entirely different skin condition (the fungus part is about the only thing that’s accurate). While it’s not super common, it can often be mistaken for acne, hence the incorrect name.
Below, dermatologist Julie Harper, M.D., founding director of the American Acne and Rosacea Society and an Acne Store advisory board, explains what’s behind the confusion, and weighs in on tell-tale signs that you are in fact dealing with fungal “acne” and the best ways to treat it.
Q: If it’s not actually acne, what is fungal acne?
A: People are tempted to call anything that looks like a pimple “acne,” but fungal acne isn’t acne at all. It’s a fungal infection in the hair follicle caused by a yeast known as Malassezia, which is present on everyone’s skin. The yeast feed off the oil produced by the sebaceous glands and cause this ‘fungal acne’ to occur. The technical and correct term for ‘fungal acne’ is Malassezia folliculitis or Pityrosporum folliculitis. 
Q: If this yeast is on everyone’s skin, what happens to cause fungal acne?
A: It usually doesn’t cause a problem, but when there’s an overgrowth of the yeast, an infection can develop. We don’t know exactly what causes fungal acne, but there are things that we know can contribute. For example, the use of oral antibiotics or even topical antibiotics can throw the skin’s microbiome out of balance, which then allows the yeast to proliferate. We also know that the environment can play a role; we see Malassezia folliculitis more in humid environments where people are often hot and sweaty. And some people may just be genetically predisposed to this type of yeast-related condition.
Q: What are some of the tell-tale differences between Malassezia folliculitis and acne vulgaris?
A: Part of the reason it gets called fungal acne is that Malassezia folliculitis looks like inflammatory lesions, and it tends to show up on the same areas where people experience acne: on the face, especially around the hairline and the periphery of the face, the upper chest, and the upper back. Malassezia folliculitis manifests as small bumps, sometimes with a little bit of pus in them. The biggest indicator that it’s Malassezia folliculitis and not acne is if these bumps are itchy.
Q: What does fungal acne look like?
Another main difference between acne vulgaris and Malassezia folliculitis (‘fungal acne’) is the size and shape of the infected site. With acne, you typically have some blackheads, some whiteheads, maybe a few inflamed big pimples, a couple of red bumps here and there—basically, a variety of different lesions in all shapes and sizes. Malassezia folliculitis bumps are monomorphic, which simply means they’re all the same. Fungal acne bumps also all look to be the same size (pretty small) and are usually clustered together. But again, the itchiness is the biggest giveaway.
Q: Can someone have both acne and Malassezia folliculitis?
A: Absolutely, although it is important to note that Malassezia folliculitis isn’t a terribly common condition. But yes, you could have both at the same time.  If, for example, you’ve been doing well on your acne treatment and now suddenly you have some bumps that aren’t responding and are itchy, this might indicate that you have developed Malassezia folliculitis. But if you already know you have acne and are using products for it, don’t stop that regimen. Nine times out of 10 Malassezia folliculitis is something a dermatologist can easily diagnose simply based on how it looks and your symptoms. And these days that can be done even via a telehealth visit.
Q: How can I treat Malassezia folliculitis?
A: Over-the-counter topical anti-fungal medications may offer some relief, although most times an oral medication is needed to treat fungal acne because the infection is deep in the follicle.  There are also prescription topicals that your dermatologists can prescribe to treat fungal acne. The good news is that, in either case, these Malassezia folliculitis treatments work quickly. We see results pretty fast with oral medications—you’ll likely notice an improvement in a matter of days, and over-the-counter topicals can treat fungal acne in just a week or two. This is very different than acne treatments when we so often see treatments taking weeks or months to work.
Julie Harper, M.D.
Dr. Julie Harper is a member of the Acne Store Board of Dermatologists and the owner of The Dermatology and Skin Care Center of Birmingham in Birmingham AL. She also served on the faculty at the University of Alabama-Birmingham as an Assistant Professor of Dermatology and was promoted to Associate Professor during her time there. She is a founding director of the American Acne and Rosacea Society and is the society’s immediate past president. She has served on the American Academy of Dermatology’s task force assigned to develop guidelines for the management of acne, which were published in 2016. Dr. Harper is also a former president of the Alabama Dermatologic Society. She has written and spoken on the subjects of acne and rosacea extensively.
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