Everyone knows about acne, whether as a teenager or later into adulthood. Even newborns can develop acne. This acne is called acne vulgaris. However, there is another type of skin condition that results in the appearance of acne (which looks like acne) and is often incorrectly diagnosed as acne. Malassezia folliculitis (formerly known as Pityrosporum folliculitis) or more commonly called fungal acne.
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- The fungal acne is Malassezia, a yeast that normally inhabits the skin.
- It is not true acne and is often exacerbated by common acne treatments. You can have both types of breakouts at the same time.
- Fungal acne rashes are often itchy and consist more often of small bumps on the chest, back, and shoulders.
- Treatment usually includes habit modification, over-the-counter cream/shampoo, and prescribed oral antifungal medications.
But it’s not real acne. It just looks that way. Many people don’t get a diagnosis of Malassezia folliculitis until they try traditional acne treatments without improvement. Because fungal acne is often confused with common acne, it is difficult to determine the exact number of people with Malassezia folliculitis. However, an estimate is that 12% to 27% of people with acne also have fungal acne.
How is fungal acne (Malassezia folliculitis) different from common acne (acne vulgaris)?
Usually, acne is scattered mainly on the face, and there are various lesions such as whiteheads, blackheads, papules, etc. in the area of exhaustion. Fungal acne looks slightly different. They usually look like small (1 to 2 mm) bumps and pustules of similar size. and shape. Another difference is that acne can affect anyone, young or old. Malassezia folliculitis is usually associated with young adults, especially those who live or visit warm places, due to the high temperature and humidity of the tropical climate.
Unlike acne, Fungal Acne is usually itchy. 80% of people with fungal acne have this symptom (Cohen, 2020). You can usually find fungal acne more often. Trunk (shoulder, chest, back) than the face (Rubenstein, 2014). When it occurs on the face, it usually occurs on the chin or on the sides, rather than on the central face, such as typical acne (Rubenstein, 2014).
As mentioned, you can have both fungal acne and classic acne at the same time, so it’s sometimes difficult to tell the two apart. Like acne vulgaris, Malassezia folliculitis is more common in teens because of oily skin (thanks hormones!). However, regular acne outbreaks are usually caused by skin bacteria ( P. acnes / C . acnes ), while fungal acne is naturally caused by a skin fungus. Malassezia yeast. The final key difference is that fungal acne does not respond to common acne treatments that focus on stopping clogged pores, oily skin, inflammation, and bacterial infections. Treating acne can make fungal acne, especially antibiotics and steroids, worse.
Causes of fungal acne
The main culprit of fungal acne is skin yeast Malassezia. Malassezia usually grows on the skin and usually doesn’t cause any problems. Like skin bacteria, they are part of the common skin flora (substances that grow on the skin). Malassezia relies on your skin to emulsify (sebum), which is why it grows on more oily skin (such as certain areas of your face, scalp, and back) (Saunte, 2020). When yeast grows out of control, it can enter the hair follicles, causing inflammation and burnout. Malassezia also has seborrheic dermatitis, and other skin conditions and 40% of people with fungal acne also have seborrheic dermatitis. Skin problems where something disrupts the normal skin flora and overgrows Fungal acne.
In Fungal Acne, What is best for my SKin?
- Climate: Warm tropical climate Malassezia grows due to temperature and high humidity. One study found that 56% of people with acne also had fungal acne in the Philippines (Jacinto-Jamora, 1991). Some people also notice that their symptoms change year-round, worse in hot summer and better in cold winter (Ayers, 2005).
- Oily skin: Malassezia folliculitis is common among adolescents due to increased sebum production during adolescence.
- Moisture trapped in your skin: Sweating is a natural way to help cool your body. However, if sweat remains on the skin, yeast can overgrow. Wearing sweaty, sweaty, or tight-fitting clothing can trap moisture in your skin. After sweating heavily, wear loose, breathable clothing to shower.
- Antibiotic use : A balance of bacteria and yeast in the skin is essential for healthy skin. Balancing by killing and balancing skin bacteria with antibiotics, skin yeast, etc. can take over and cause skin problems. Bacterial acne is sometimes treated with oral antibiotics or antibacterial creams/lotions that can make fungal acne worse.
- Decreased immune system function : The use of medications such as steroids (used by mouth and applied to the skin) and certain medical conditions such as diabetes and HIV may decrease immune system function. This will allow your body to further inhibit Malassezia yeast overgrowth and leading to Fungal Acne.
Symptoms of fungal acne
Common signs and symptoms of Fungal Acne include:
- Itching (almost 80% of people)
- Rashes, acne, papules and pustules (1 to 2 mm) that are similar in shape and size
- Acne that gets worse in hot weather
- More breakouts from the chest, shoulders, and back than the face
- Other concurrent Malassezia seborrheic dermatitis or related skin conditions such as dandruff
- Does not improve or worsen with traditional acne remedies
How is fungal acne diagnosed?
If fungal acne is too often confused with plain acne, how do you know if you have it? Unfortunately, the exact diagnosis was not revealed for many hours until common acne treatments were tried and failed.
- Common clinical symptoms: Papules and pustules of the same size and shape, and more pimples on the shoulders, chest, and back than on the face suggest but are not certain of fungal acne.
- Scratching the skin: scraping papules and pustules, staining the cells with certain chemicals, and examining them under a microscope can help with the diagnosis because a dermatologist or health care provider can visualize them Fungal acne yeast.
Asian woman has red rash on her left arm - Skin biopsy: More invasive than scratching. Small pieces of skin, including infected hair follicles, are removed and examined under a microscope to detect Malassezia yeast.
- Treatment response: An improvement after antifungal treatment is a good indication that acne is fungal and not just acne vulgaris.
How to get rid of fungal acne
Chances are you’ve tried various creams, lotions, etc. to get rid of acne. However, if you have fungal acne, it’s likely that traditional treatments haven’t helped your acne and made it worse. But there is hope! Several effective treatments can help improve fungal acne. Often, your healthcare provider or dermatologist will combine fungal acne treatment methods, and your plan may include habit modification, and over-the-counter and prescription medications.
Habit modification includes taking a shower whenever you sweat excessively, changing your workout clothes right after your workout, and wearing breathable fabrics. All these changes help reduce sweat and moisture trapped in the skin. We also know that oily skin plays an important role in fungal acne. Therefore, changing your skin care routine to reduce skin oil may help. Use skin care products that are non-greasy and cleanse regularly.
Over-the-counter medications may help reduce the fungal population on your skin. However, these antifungal creams or lotions do not work well on their own because they cannot penetrate deep into the hair follicles. Your provider may recommend use with antifungal medications. Over-the-counter antifungal creams or lotions include (Levin, 2011):
- Ketoconazole lotion 2% daily
- Econazole nitrate cream 1% daily
- Clotrimazole Cream 1% Daily
- Selenium sulfide 1% dandruff shampoo is used both as a shampoo and body wash (eg Selsun blue)
The most effective way to treat Fungal Acne is to use prescribed antifungal medications. Oral antifungal therapy (pills) is best used to reach the yeast deep inside the hair follicles, so it is usually used first for a few weeks. Once the acne resolves, applying a topical lotion or shampoo and/or antifungal medication once a week or once a month can help keep the Fungal acne off.
How to prevent fungal acne
Most people find acne embarrassing or annoying and are willing to do anything to avoid it. Unfortunately, not all acne is preventable. Genetics play a major role in how bad acne is, whether it’s acne vulgaris or Malassezia folliculitis. If you have a medical condition such as HIV or diabetes, you are more likely to develop acne, especially fungal acne. However, there are things you can do to prevent the development of fungal acne.
- Shower whenever you sweat excessively
- Change sweat-soaked clothes immediately
- Avoid wearing tight-fitting clothing and opt for breathable fabrics instead.
- Choosing non-greasy skincare products
- Avoid unnecessary antibiotics, whether for topical use or pills. Talk to your doctor before stopping the medication.
When to see a dermatologist in case of Fungal acne?
If you have fungal acne, changing your habits with over-the-counter topical remedies may improve it. However, you should see a dermatologist if your acne persists for more than a few weeks, does not improve, gets worse, or if you are shy and shy. Your dermatologist or health care provider will work with you to develop a treatment plan that is right for you.