We’re taught from our hormone-riddled teen years to be on high alert for acne—and to attack it with every product under the sun at the first sign of a zit. Of course, as adults, we’re wise enough to know that acne is more complex and harder to treat than the commercials of the past had us believe.
For one thing, no one ever told us that, sometimes, what looks like acne isn’t acne at all. Fungal acne is one such impostor—and nothing on the acne shelves will do a thing to make it go away.
What causes fungal acne?
Despite its resemblance to bacterial acne, fungal acne is actually caused by yeast (yes, a fungus) that inflames the hair follicles on your skin and causes pimplelike bumps. The condition is technically referred to as pityrosporum folliculitis or malassezia folliculitis, for the specific type of fungus (malassezia is the more updated term, but your dermatologist may still call it pityrosporum).
And for the record, it’s normal for this type of fungus to be living on your skin. But when it gets out of control, it can lead to fungal acne breakouts or other skin conditions, like seborrheic dermatitis.
Under normal conditions, there will be a balance between the bacteria and fungus on our skin, Hye Jin Chung, M.D., assistant professor of dermatology at Boston University School of Medicine, tells SELF. But if something happens to wipe out the bacteria (say, you take antibiotics), there won’t be anything to keep the fungus in check. As a result, an overgrowth of fungus can develop, which in turn can lead to skin irritation, inflammation, and fungal acne.
Antibiotics aren’t the only factor in developing fungal acne—sometimes our own habits are the culprits. For instance, wearing tight, nonbreathable clothes often contributes to breakouts, Dr. Chung says. More specifically, wearing sweaty workout clothes for too long or rewearing fitness gear without washing it can create a very hospitable (read: moist) environment for fungi to grow, Emily C. McKenzie, MD, clinical instructor in the department of dermatology at the University of Utah, tells SELF.
Unfortunately, some people are just genetically predisposed to overgrowths of yeast and, therefore, experience fungal acne more frequently, Dr. McKenzie adds. Having chronic conditions that affect your immune system, like diabetes and HIV, can also predispose you to fungal acne.
Here’s how to tell the difference between bacterial and fungal acne.
Again, fungal acne can look like regular acne, but there are a few key differences. Regular (bacterial) acne breakouts vary in size and tend to feature blackheads or whiteheads on the face, Dr. Chung says.
But, Dr. McKenzie says that fungal acne will usually appear as uniform red bumps and pustules on the chest, upper arms, and back—rarely the face. Also, the bumps that result from malassezia don’t usually come to heads. And, perhaps most noticeably, she adds that fungal acne breakouts will be very itchy. Typical bacterial acne can be itchy sometimes, she says, “but not that much.”
How should you treat fungal acne?
Depending on the severity of your breakouts, clearing up fungal acne may be as simple as adjusting your lifestyle. For instance, showering and changing your clothes right after working out or wearing looser clothes may do the trick.
But, if lifestyle changes don’t help, your next step for a mild case should be trying an over-the-counter topical treatment. For example, Dr. McKenzie says Selsun Blue, despite being marketed as a dandruff shampoo, works as an antifungal body wash, thanks to its active ingredients (some Selsun Blue products contain pyrithione zinc, while others contain selenium sulfide, but either one will do the trick). Other similar products containing those active ingredients might also do the trick. And the key with all of them is to let the product sit on your skin for about five minutes before rinsing, she says.
Other recommended topical treatments include creams containing 2 percent ketoconazole, econozole nitrate, or 1 percent clotrimazole cream, all of which are often used to treat athlete’s foot.
When in doubt, see a dermatologist.
If your symptoms still persist after about three weeks, it’s time to see a dermatologist. They’ll be able to confirm your diagnosis and may prescribe an oral antifungal medication, which will work faster to treat the breakouts than a cream or shampoo because topical treatments may have a harder time getting into the follicle.
Unfortunately, there’s always a risk of recurrence with fungal acne after it’s treated—especially right after it clears up, Dr. Chung says. It’s not totally understood why, but resistance to the drug, changing seasons, and changing habits are all thought to play a role in the recurrence of it.
As a preventive measure, she tells her patients who deal with fungal acne to use an antifungal product in place of normal body wash as often as once a week, though she adds that there’s “no magic number” for how often to work it into your routine. Once your system has recovered, you can ease off on the antifungal wash, but stopping it altogether might put you at risk for a recurrence.
Antifungal products are touted as being “safe” for use when you have fungal acne, but that doesn’t mean other products are full of yeast. Dr. Chung explains that labeling just means that those products won’t contribute to the growth of fungus. As long as you’re doing other things to keep the growth of that fungus in check, you shouldn’t feel pressured to seek them out.
Ultimately, the biggest mistake you can make when dealing with fungal acne is simply mistaking it for regular acne. Conventional acne products, especially antibiotics, won’t help and might even make your symptoms worse.
So, if your breakouts itch and are concentrated on your upper arms, chest, and back (your “trunk,” as Dr. Chung puts it), it’s probably fungal. And, if you simply aren’t sure, you can always check with your derm before trying any treatment. When it comes to fungal acne, Dr. Chung says it’s better to “see a dermatologist sooner rather than later.”