Fungal Acne: A Mimic of Acne Vulgaris - Symptoms, Diagnosis, and Treatment

Fungal acne has been gaining more attention in the past few years because the condition can mimic traditional acne (acne vulgaris) but does not respond to the same treatment. Fungal acne is also known as pityrosporum folliculitis or Malassezia folliculitis and has a history of being misdiagnosed by those unfamiliar with the entity. Unlike traditional acne, fungal acne is caused by an overgrowth of the yeast, Malassezia, within the hair follicles. Understanding its unique characteristics, causes, and treatments can help you effectively manage this condition. If you’ve been diagnosed with traditional acne and do not seem to be responding to traditional treatments, it may be time to ask your dermatologist if they’ve considered fungal acne.

What is Fungal Acne and what are the Symptoms?

Fungal acne is a term coined by social media, and in medical literature is referred to as pityrosporum folliculitis or Malassezia folliculitis. Fungal acne is most often described as numerous 1-2 mm monomorphic bumps and pustules. The bumps are most often located on the forehead and extend into the hairline and upper back. While the location can be similar to traditional acne, the appearance differs. While fungal acne is usually monomorphic, meaning all the bumps resemble each other, traditional acne is usually accompanied by a variety of bumps, from whiteheads, to blackheads, and sometimes cysts. Another characteristic feature of fungal acne is that the bumps are usually itchy, unlike traditional acne which can be more painful or itchy. Finally, fungal acne should be suspected if you have recently used antibiotics and failed to improve.

A classic example of fungal acne

Why did I get Fungal Acne?

Several factors can contribute to the development of fungal acne:

1. Use of Antibiotics: This appears to be the biggest risk factor for fungal acne development. The use of antibiotics for acne was seen in 75% of patients who were later diagnosed with fungal acne. Antibiotics disrupt the natural balance of bacteria and yeast on the skin, leading to an overgrowth of yeast.

2. Weakened Immune System: Immunocompromised patients are at higher risk for fungal acne. This is likely because a compromised immune system can make it harder for the body to control yeast levels, leading to fungal acne.

3. Excessive Sweating: Yeast thrives in warm, moist environments. Excessive sweating, especially without proper hygiene, can create an ideal environment for yeast overgrowth.

4. Tight Clothing: Wearing tight clothing can trap sweat and moisture against the skin, promoting the growth of yeast.

5. Hot and Humid Climates: People living in hot and humid climates are more prone to fungal acne due to the increased likelihood of sweating.

Diagnosing Fungal Acne

Proper diagnosis of fungal acne can be difficult, because the yeast is a normal organism found on the skin. Oftentimes, the diagnosis is made from the clinical presentation by a dermatologist, but if a test is desired to confirm the diagnosis, a biopsy or a skin scraping with KOH preparation can be performed. To confirm the diagnosis, yeast needs to be seen in the hair follicle with concomitant inflammation.

Treating Fungal Acne

Treating fungal acne requires targeting the yeast overgrowth. According to a retrospective review of 110 cases, effective treatments include:

1. Topical Antifungals: Over-the-counter antifungal creams or shampoos containing ingredients like ketoconazole, clotrimazole, or selenium sulfide can be effective. Ketoconazole shampoo, used as a wash, led to improvement or resolution in most cases.

2. Oral Antifungals: In more severe cases, a dermatologist may prescribe oral antifungal medications like fluconazole or itraconazole. The study found that oral fluconazole and ketoconazole were also effective treatments, though the use of oral ketoconazole is now discouraged due to potential side effects.

3. Proper Hygiene: Regularly cleansing the affected areas with an antifungal wash can help manage yeast levels on the skin.

4. Avoiding Tight Clothing: Wearing loose, breathable clothing can reduce moisture buildup on the skin.

5. Controlling Sweat: Showering promptly after sweating and using antifungal powders can help keep the skin dry.

Ketoconazole shampoo is one of the best treatments of yeast overgrowth

Preventing Fungal Acne

To prevent fungal acne, it’s important to maintain good skin hygiene and make lifestyle adjustments to minimize yeast growth:

• Shower regularly, especially after sweating

• Wear loose, breathable clothing

• Avoid using oily skincare products that can trap moisture

• Maintain a healthy diet and consider probiotics to support a balanced skin microbiome


Fungal acne can be frustrating, especially if you are unsure whether your acne is traditional acne or fungal acne. With proper diagnosis and treatment, it is completely manageable and curable. If you suspect you have fungal acne, call us now or book online to consult with a board-certified dermatologist who can confirm the diagnosis and provide personalized treatment options.