This Condition Is Often Mistaken For Acne, But Treating It The Same Way Is A Mistake. Here's How To Tell The Difference.
Blackheads, whiteheads, cystic acne, hormonal acne: It seems like there's a never-ending list of breakouts that can follow you into adulthood. But there's one particularly frustrating skin condition that often resembles traditional pimples, yet resists your classic acne-fighting creams and cleansers.
It's itchy. It causes pus-filled bumps. And it looks a bit like a rash. That's right, folks, we're talking about the skin infection known as 'fungal acne.' "The term is actually a misnomer," says Joshua Zeichner, MD, an associate professor of dermatology at the Mount Sinai Hospital in New York City, "because it's not true acne" at all.
Meet the experts: Blair Jenkins, MD, PhD, is a clinical assistant professor of dermatology at Michigan Medicine. Joshua Zeichner, MD, is an associate professor of dermatology at the Mount Sinai Hospital in New York City. Adele D. Haimovic, MD, is a board-certified dermatologist and clinical associate professor of dermatology at New York University Langone Medical Center.
These skin bumps are typically found on the body and aare uncomfortable and can do a number on your self-confidence if left untreated. But understanding the condition can help you get rid of the pesky spots for good. Here's what dermatologists want you to know about fungal acne—from what causes it, to treating it, and how to avoid it in the first place.
What causes fungal acne?
While the exact circumstances that trigger fungal acne can vary, the underlying science remains the same: It's an infection that forms when a type of naturally-occurring yeast called Malassezia overgrows on the skin, gets inside hair follicles, and triggers inflammation, explains Blair Jenkins, MD, PhD, a clinical assistant professor of dermatology at Michigan Medicine. The infection, which experts call Malassezia Folliculitis, commonly crops up on the back and chest, she says, but it can happen on the face, too.
That yeast living on our skin likes to eat sebum, Dr. Jenkins says, an oily and waxy substance produced by certain glands in the middle layer of our skin. When we're hot and sweaty, those glands tend to release excess sebum, creating a perfect environment for yeast to thrive and potentially grow out of control.
Here are a few common scenarios that might lead to yeast overgrowth and cause fungal acne:
Sitting in sweat: Look, we've all been there. Sometimes it's all too easy to let the hours slip by before you've had a chance to change out of your sports bra. But wearing sweaty (and tight) clothes can trap perspiration, oil, and dead skin cells onto the skin, allowing the yeast that causes fungal acne to rapidly grow, Dr. Jenkins says.
Skipping showers: Sometimes Dr. Jenkins encounters patients who might avoid showering frequently to prevent drying out their skin or exacerbating conditions like eczema or psoriasis. But skipping showers, especially if you're sweating, creates a breeding ground for yeast by allowing oil and dead skin cells to accumulate.
Being somewhere warm and humid: Given that yeast loves sebum, this one may feel pretty obvious. But to reiterate, hot and muggy weather increases sebum production. In humid climates, that sebum is more likely to mix with sweat, stay trapped on the skin and give yeast a chance to proliferate.
Using antibiotic medications: Oral antibiotics can change the skin's microbiome, the community of microorganisms such as bacteria and fungi that live on our skin, Dr. Jenkins says. Even though these medications are important to fight off bacterial infections, they can disrupt our natural balance of good and bad microorganisms in the process, potentially allowing yeast to grow. "I don't think that's super common," she says, "but it can definitely happen."
And some risk factors are harder to control: For instance, people with weakened immune systems, such as older adults, people who've had organ transplants and those living with HIV, are also more susceptible to fungal acne because their bodies are less able to keep the growth of yeast in check, Dr. Jenkins adds.
How is fungal acne different from typical breakouts?
The underlying causes of regular ol' pimples are far more varied and complex than fungal acne. In most cases, classic acne (which experts call acne vulgaris) happens when hair follicles become clogged due to excess sebum, hormonal changes, or an overgrowth of certain bacteria, says Dr. Jenkins, which can trigger inflammation. Point is, yeast overgrowth has nothing to do with it.
Despite the different underlying causes, it can still be difficult for the average person to tell the difference between regular facial acne and fungal acne since they both can lead to small, pus-filled bumps on the skin, says Adele D. Haimovic, MD, a board-certified dermatologist and clinical associate professor of dermatology at New York University Langone Medical Center.
Here's a trick to tell them apart: If you have blackheads or painful cysts that form deep under the skin, you know you're dealing with traditional acne, Dr. Haimovic explains. Fungal acne, meanwhile, typically presents as superficial, uniform bumps that can look red or purplish, depending on skin tone. "And many people find the bumps itchy," she says. "That's a big distinguisher," Dr. Jenkins adds.
But if you're ever unsure, consult your dermatologist—they're trained to spot these things.
How can I treat fungal acne?
Get this: There actually aren't many products on the market sold specifically to treat fungal acne, Dr. Zeichner says. So don't waste your time hunting for creams or ointments with the term plastered on the label. And don't bother trying the best at-home skincare routine for acne either: Products containing salicylic acid or benzoyl peroxide to target bacteria, for instance, won't effectively target an infection caused by yeast overgrowth.
But don't worry, there are over-the-counter and prescription medications that can still do the trick. You just have to know what to look for! The TL;DR? Anti-fungal treatments, Dr. Haimovic says.
Creams
Creams sold to treat fungal infections like athlete's foot or ringworm contain ingredients that kill the yeast that causes fungal acne, Dr. Zeichner says. Check product labels for ingredients such as clotrimazole, ketoconazole or terbinafine hydrochloride, Dr. Jenkins says. You can also ask your doctor for a medication containing econazole nitrate, which requires a prescription.Clotrimazole Cream Antifungal
This antifungal cream is marketed to treat athlete's foot. But the active ingredient, clotrimazole, is shown to kill the yeast that causes fungal acne, too, experts say.
$16.99 at WalgreensCream for Athlete's Foot
This cream is clinically proven to cure athlete's foot, especially in between the toes. But the active ingredient, terbinafine hydrochloride, may also be able to target and reduce the presence of Malassezia, the yeast that leads to fungal acne.
$14.97 at amazon.comAntifungal Treatment
This anti-fungal cream can help with a range of issues caused by too much fungus on the skin, including seborrheic dermatitis, which happens when the same kind of yeast that causes fungal acne grows out of control. Use it as a fungus-fighting body wash.
$29.99 at amazon.com
Shampoos
ICYDK, dandruff is caused by an overgrowth of the same yeast that causes fungal acne. This means you can use shampoos marketed to treat dandruff as a fungal acne-fighting body wash instead. To make sure you use a product that'll be effective, check to see if it includes pyrithione zinc or selenium sulfide, Dr. Zeichner says. Those chemical compounds are known to effectively target and get rid of the right kind of yeast.Anti-Dandruff Shampoo
This shampoo, which contains ketoconazole 1%, is intended to control the fungus that causes dandruff. Since that same fungus causes fungal acne too, you can use this product as a fungal acne-fighting body wash.
$15.88 at amazon.comAntidandruff Shampoo
This anti-dandruff shampoo contains selenium sulfide 1%, another active ingredient shown to inhibit the growth of Malassezia, the yeast that leads to fungal acne.
$7.48 at walmart.comClinical Strength Dandruff Defense
When you hear the brand name head & shoulders, you might immediately think of dandruff shampoos. But the active ingredient is selenium sulfide, making this product another plausible body wash to fight fungal acne as well.
$23.94 at amazon.com
Prescription medications
If you're not having luck with any over-the-counter anti-fungal treatments after two to four weeks of continuous use, it's time to visit a dermatologist, Dr. Zeichner says. They could prescribe you stronger versions of medications or treatments containing ingredients that you can't find in stores. A doctor can also help you manage the underlying causes of the infection, and tailor treatment to your unique skin.
But perhaps a doctor will realize your condition isn't fungal acne and recommend a different treatment plan altogether. "Believe it or not, it's not as common as you would think based on its popularity on social media," Dr. Zeicher says.
How Can I Prevent Fungal Acne?
Even though fungal acne can be stubborn, avoiding some of the common causes of the condition can keep the itchy bumps at bay.
Avoid sitting in sweat: We now understand that yeast can really thrive on moist, oily skin. If you live in a hot, humid environment or consistently exercise, be sure to quickly change out of soiled clothing, Dr. Zeichner says.
Consider moisture-wicking clothes: Some people just naturally sweat more than others. If you're one of them, you might also consider investing in loose-fitting clothing that helps ensure sweat doesn't stay trapped on your skin and give yeast a chance to overgrow.
Don't unnecessarily take antibiotics: There's a common misconception that antibiotics can treat viral illnesses like the common cold or the flu, even though they're only effective for bacterial infections. If you're worried about fungal acne, don't take antibiotics unless you've specifically been prescribed them by a healthcare provider, Dr. Haimovic adds.
But the most important step you can take to stop those bumps from appearing in the first place is to bathe consistently, Dr. Jenkins says. Keeping your skin clean and dry, ideally every single day, can help prevent the yeast that causes fungal acne from thriving. "There are a lot of factors that are out of one's control. I don't want it to seem like only the unwashed get fungal acne," she says. "But if you're washing more often, you're probably going to be less likely to have really bad flares of this condition."
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