What is fungal acne? How to tell it from regular acne

Key takeaways

• “Fungal acne” isn’t true acne. It’s an infection of the hair follicles by Malassezia, a yeast that normally lives on most people’s skin. Doctors call it Malassezia or Pityrosporum folliculitis.

• It shows up as clusters of small, similar-looking bumps, usually on the chest, upper back, shoulders and forehead, and it’s often itchy. It doesn’t cause blackheads.

• Heat, sweat, tight clothing, heavy oils and antibiotics can all trigger it.

• Regular acne treatments often don’t help, and antibiotics can make it worse. Antifungal shampoos used as a wash, or prescription antifungals, are the usual treatment.

• It often comes back, so many people keep using an antifungal wash once a week.

What is fungal acne?

Cleveland Clinic describes fungal acne as a common skin condition that happens “when hair follicles become infected with a fungus called Malassezia yeast.” It’s also called Malassezia folliculitis or Pityrosporum folliculitis.

The yeast itself is normal. A 2014 review notes that Malassezia is part of the normal skin flora in 75% to 98% of healthy people. It only causes problems under certain conditions, such as when follicles get blocked or damaged and the yeast grows inside them. The same review calls it a condition “commonly misdiagnosed as acne vulgaris.”

Cleveland Clinic says anyone can get it, but it’s most common in teenagers and young adult men, who tend to have oilier skin where the yeast thrives.

Fungal acne vs regular acne

The two can look alike, but a few features set fungal acne apart:

• The bumps look the same. DermNet describes small, uniform, itchy bumps and pustules, and notes that “comedones are not seen.” Regular acne usually mixes blackheads, whiteheads and pimples of different sizes.

• It itches. Cleveland Clinic says the main difference is that fungal acne can be itchy and regular acne isn’t. In one study of 110 young people with Malassezia folliculitis, 65% of those whose charts noted it reported itching.

• It shows up on the body. The chest, upper back, shoulders, upper arms, neck and forehead along the hairline are the usual spots.

• It doesn’t respond to acne treatments. The 2014 review says the two can be told apart by the lack of response to antibiotics, the absence of blackheads and whiteheads, and the itching.

It’s also possible to have both at once. The same review notes that regular acne and fungal acne occur together in 12% to 27% of cases.

What causes fungal acne?

DermNet lists these triggers:

• A hot, humid climate.

• Oily skin and heavy sweating.

• Occlusion, from heavy moisturizers and sunscreens.

• Antibiotics.

• A weakened immune system, including from steroid creams or pills.

Cleveland Clinic adds that shaving, plucking or waxing, hot tubs and tight clothes can damage follicles and let the yeast in. Ohio State notes it tends to flare in summer with heat, humidity and sweat.

Why acne treatments can make it worse

Many acne treatments target bacteria, not yeast. Cleveland Clinic explains that antibiotics can reduce the good bacteria on the skin and cause an overgrowth of yeast. Ohio State says that by eliminating normal skin bacteria, antibacterial acne treatments can create “a perfect environment for yeast to proliferate.”

It often follows acne treatment. In a 2018 study of 110 patients, more than 75% had acne that had recently been treated with antibiotics. The 2014 review warns that it “may persist for many years if it is misdiagnosed as acne vulgaris.”

How is fungal acne diagnosed?

A dermatologist can often tell by how it looks, how it feels and the fact that it hasn’t improved with acne treatments. Cleveland Clinic says a doctor may also look at a skin scraping under a microscope or check the skin with a Wood’s lamp, a small black light. DermNet notes a scraping may show budding yeast.

If you’ve been treating “acne” on your chest or back for months with no change, it’s worth asking a dermatologist whether it could be fungal.

How to treat fungal acne

• Antifungal shampoo as a body wash. Ohio State says dandruff shampoo can be used as a body wash, and topical antifungals applied to the chest and back. If you use it on your face, rinse it off thoroughly. Cleveland Clinic lists econazole, ketoconazole and selenium sulfide shampoo among topical options.

• Prescription antifungal pills. For more stubborn outbreaks, a dermatologist may prescribe an oral antifungal such as fluconazole or itraconazole. Cleveland Clinic calls oral antifungals the most effective treatment, though they can have side effects, including stomach upset and liver damage, so they need a prescription and a doctor’s oversight.

• Combination treatment. Danish guidelines suggest oral antifungals are probably more effective than topical ones, but that a combination may be the better choice.

In the 2018 study, ketoconazole shampoo was the most common treatment and led to improvement or resolution in most cases, though some patients needed oral antifungals. Ohio State notes that fungal acne won’t clear up on its own.

Does fungal acne come back?

Often. DermNet says “recurrence is common, even after successful treatment.” In one small study, the acne came back within three to four months after people stopped treatment. To help prevent flares, Cleveland Clinic and DermNet suggest using an antifungal wash about once a week once it’s under control.

How to help prevent fungal acne

• Shower and change soon after you sweat. Cleveland Clinic suggests doing it right after a workout.

• Wear loose clothing, especially in hot, humid weather.

• Go easy on heavy oils. Heavy moisturizers and sunscreens can trap heat and oil. Our lists of moisturizers for oily skin and sunscreens for oily skin cover lighter options.

• Wash swimwear and workout clothes after each use, and let them dry fully.

• Keep up a weekly antifungal wash if you get flares often.

If what you have looks more like blackheads and mixed pimples, our list of face washes for acne covers treatments for regular acne, and our guide to hormonal acne covers breakouts along the jaw.

Frequently asked questions

How do you tell if acne is fungal?

Fungal acne usually shows up as clusters of small, same-sized bumps, often itchy, on the chest, back, shoulders or forehead, with no blackheads. It also tends not to improve with regular acne treatments. A dermatologist can confirm it with a skin scraping.

Does fungal acne go away on its own?

Usually not. It typically needs antifungal treatment, and it often comes back, so many people use an antifungal wash once a week to keep it away.

How long does fungal acne take to clear?

It varies. Many people see improvement with an antifungal wash, but stubborn cases may need prescription pills. Because it often returns after treatment stops, ongoing weekly use is common.

Can you get fungal acne on your face?

Yes. The forehead and hairline are common spots, along with the chin and neck. If you use an antifungal shampoo on your face, rinse it off well.

Is fungal acne contagious?

It isn’t considered contagious. The yeast behind it lives on most people’s skin already and only causes problems under certain conditions.