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What You Need To Know About Fungal Acne, AKA 'Malassezia Folliculitis' On Your Skin

It's actually *different* from your regular breakouts.
fungal acne
PHOTO: Shutterstock

If you have a lovely smattering of small pimples that won't freakin' go away, even with your usual acne treatments, you miiiight be experiencing something called fungal acne—i.e., acne-looking bumps that are usually tiny, uniform, red, and/or itchy (more on how to identify it below). As if you didn't have enough types of acne to worry about between the non-inflammatory kind (like blackheads and whiteheads) and the inflammatory type (pustules, papules, nodules, and cysts), you can now add fungal acne to that list. ...Well, more or less.

Here's the thing: Even though we call it fungal acne, it's not actually acne at all, says board-certified dermatologist Christine Choi Kim, MD. It's technically an infection of the hair follicles caused by the yeast that naturally lives on your skin (yup, we've all got yeast rn), and its official names are Malassezia folliculitis, or sometimes Pityrosporum folliculitis. And that's also why fungal acne doesn't respond the same way to your regular spot treatments and acne regimen—it's not your average type of zit.


So to find out how to get rid of fungal acne and stop it from popping up in the first place, keep reading.

What does fungal acne look like?

You can spot fungal acne (ahem, Malassezia folliculitis) by its itchy, red papules or pustules that are about 1 to 2 millimeters in size (about the tip of a pencil). These aren't your cystic zits or giant, squishy whiteheads—they're usually smaller and pretty similar in size.

Fungal acne also tends to appear most often on the chest, back, shoulders, and sides of the arms—basically, anywhere you tend to trap sweat or bacteria, both of which aggravate fungal acne—but Dr. Kim says it can also be found on the neck and face, usually along the hairline and the sides.

Fungal acne vs. closed comedones:

Gonna be honest: It's pretty difficult to tell the difference between fungal acne and regular ol' acne (aka acne vulgaris, aka closed comedones, aka clogged pores, aka whiteheads). Not only can they look similar to the untrained eye, but it's very common for someone to have both forms of acne at once, sometimes even in the same area.

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So whaddya do? You see a doctor. Your dermatologist can easily assess your situation with a physical exam, but Dr. Kim says your derm can also run a simple fungal test called a potassium hydroxide (KOH) preparation to positively confirm it.

What kills fungal acne?

If you've been taking oral antibiotics to treat your acne vulgaris (you know, real acne), it's not uncommon to develop fungal acne afterward. Why? Because antibiotics and antibacterial products can disrupt the balance of fungus and bacteria on your skin, making Malassezia folliculitis worse. Dr. Kim says this imbalance is what allows the fungus to ~flourish~.

What shampoo gets rid of fungal acne?

Most weird remedies you read on the internet do little to help the situation, but this one actually has some truth to it. Dr. Kim says for milder cases, something as simple as dandruff shampoo can help since dandruff products contain yeast-killing ingredients like zinc pyrithione or selenium sulfide. Just apply it onto dry skin and leave it for 10 minutes (it has to sit on the skin to actually do anything) before rinsing it off.


Dr. Kim also recommends OTC topical anti-fungal cream, like miconazole or clotrimazole, once or twice daily, but don't expect overnight results. Malassezia folliculitis can take several weeks to months to improve, so be patient. Because Malassezia is normally present on our skin, Dr. Kim says long-term use of the formulas once or twice weekly might be necessary to stop it from coming back. And if all that doesn't work, ask your doctor about a prescription version of your shampoo and cream and or a short course of oral anti-fungal medication.

Can apple cider vinegar kill fungal acne?

Now that we know that certain ingredients found in dandruff shampoos can def be helpful, what about other at-home remedies, like apple cider vinegar and tea tree oil? Although the internet might swear by their efficacy, Dr. Kim isn't fully convinced. Yes, both ACV and tea tree oil are antibacterial and antifungal, they're not quite as specific in addressing the exact overgrowth of Malassezia on the skin, which means they shouldn't be your first line of defense.


The best fungal acne routine

Treating fungal acne isn't only about using the right products—you'll also want to make some changes to your everyday routine if you want to prevent it in the future. Since excess sebum production and sweating can worsen fungal acne, Dr. Kim says it's super common in anyone who exercises a lot or sits around in tight, non-breathable fabrics, especially while getting all hot and sweaty. So make sure to change out of your sweat-soaked clothes right away and shower immediately after your workouts.

Dr. Kim also recommends stopping all antibacterial cleansers and topical and oral antibiotics for the time being, but of course, consult your doctor before making changes to your regimen. Actually, the best idea is to consult your doctor from the get-go because like the name implies, fungal acne looks just like acne, so better to leave it up to a doctor. Got it? Cool.



This article originally appeared on Minor edits have been made by the editors.