What is fungal acne, or pityrosporum folliculitis?

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Why isn’t my acne improving? Could I have fungal acne?

Ever struggle with what looks like facial acne that just doesn’t seem to respond to your typical acne treatments? You may have a condition called pityrosporum folliculitis, known commonly as fungal acne. This condition is routinely mistaken for acne but is actually related to a yeast called Malessezia furfur that’s found naturally on the skin. Fungal acne can occur simultaneously with acne, can be mistaken for acne or can flare as a result of acne treatment. Because it’s related to a yeast overgrowth in the hair follicles, it won’t respond to normal acne treatment and requires a different treatment approach.

What is fungal acne?

Fungal acne is an overgrowth of yeast within the hair follicles. Sebaceous glands within your skin produce an oil called “sebum.” These glands can overproduce oil, and your pores and hair follicles can become clogged with oil as well as bacteria and yeast that are naturally found on your skin. Bacteria can lead to the traditional acne blemishes, but the yeast can cause an inflammation of the hair follicles, or “folliculitis.” It’s not contagious, infectious or an indicator of poor skin hygiene.

What causes fungal acne?

Yeast grow in warm, moist environments. Fungal acne tends to flare in the summer months with heat, humidity and perspiration. It can also arise after treatment with medications such as antibiotics and steroids/prednisone, and in conjunction with other systemic diseases like diabetes. Many acne treatments are antibacterial, thus eliminating the normal skin bacteria and creating a perfect environment for yeast to proliferate and fungal acne to flare.

What does fungal acne look like?

These breakouts tend to be small, uniform red bumps arising from the hair follicles, often in symmetric rows on the forehead, scattered on cheeks and, occasionally, on the upper back and upper chest. Fungal acne differs from traditional acne in that you won’t see the blackheads, pustules or deeper, painful nodules and cysts.

How do I know if I have fungal acne?

The most common symptom that you’ll notice is itchiness of the bumps. Fungal acne is itchy but never painful, as typical acne can be when a blemish becomes inflamed. Fungal acne can be persistent, worsen with sweating, and flare in hot and humid temperatures. Your dermatologist will be able to diagnose this condition by its appearance, clinical symptoms and the lack of improvement with traditional acne medications. Skin scraping for yeast can be performed to confirm the diagnosis, if needed.

How is it treated?

Remember, because this condition is caused by the yeast Malessezia furfur, it will not respond to the traditional antibacterial and anti-inflammatory acne treatments. Anti-yeast and antifungal treatments are needed. For mild disease, you can start by using a topical antifungal cream or lotion, applied daily to the affected areas. For a more prolonged or significant outbreak, your dermatologist may prescribe an oral antifungal medication. Maintenance treatment may be needed as well because this condition can recur, especially when the environment is right for the yeast to proliferate.

If you’re struggling with facial breakouts that aren’t improving or responding to over-the-counter treatments, see a board-certified dermatologist to help find the best treatment and tailor a skin care regimen that’s right for you.

Susan Massick is a dermatologist at The Ohio State University Wexner Medical Center and an associate professor in the Ohio State College of Medicine. Follow her on Twitter @SusanMassickMD.