What Is Fungal Acne?

Medically Reviewed by Stephanie S. Gardner, MD on May 03, 2023
Written by Lori M. King, PhD
8 min read

Fungal acne is a skin condition called pityrosporum folliculitis. It is one of many types of folliculitis, an infection in your hair follicle. It's caused by an overgrowth of a yeast called Malassezia that most people have naturally on their skin. But, when your hair follicles are damaged (for instance, when you shave) or blocked, the yeast can grow into the hair follicle and cause an infection. 

It's often confused with acne because it can cause whiteheads, but fungal acne breakouts often look like a rash with clusters of bumps that are similar sizes and shapes. It's also usually itchy, unlike regular acne.

Changes in your personal care routine may help prevent a case of fungal acne. But if you get it, your doctor can prescribe you an antifungal medicine that you either spread on your skin or take by mouth that should clear it up. If you keep getting fungal acne, your doctor may prescribe an antifungal for you to take long-term. 

It's common for fungal acne to be confused with regular acne (acne vulgaris). Both types lead to pimples because they are both caused by an infection in your hair follicles, which are the pores that surround the roots and strands of your hair. 

The difference is in what causes the infection. In fungal acne, the infection is caused by a fungus called Malassezia (pronounced mah-luh-See-zee-uh) yeast that's gotten into your hair follicles because they're damaged or blocked. In regular acne, your hair follicles are blocked with dead skin, oil, and bacteria. 

The breakout from fungal acne may look like a rash of small pimples about the same size that cluster together. In people with light skin, the pimples may have a red ring or border around them. Sometimes, the pimples of fungal acne come to a head (whitehead), but it's not as often as with regular acne.  

With regular acne you will likely see more of the different types of acne sores, such as blackheads, whiteheads, pustules (small, swollen, pus-filled sores), nodules (swollen lumps under or in your skin), or cysts (blister-like growths under or in your skin). But the main difference in symptoms between regular and fungal acne is that fungal acne tends to be itchy whereas regular acne doesn't. 

With fungal acne, you may also notice pimples more on your upper back, chest, and shoulders. And when you get them on your face, they may be on your forehead, cheeks, and chin more often than in the middle of your face, as it would with regular acne.

If you have acne that doesn't seem to get better, even after taking antibiotics for a while, you may not have acne. Instead, you may have pityrosporum folliculitis (pronounced pity-RAH-spur-uhm fuh-lihk-you-LIE-tiss). Folliculitis is what doctors call an infection in your hair follicles. You can get folliculitis anywhere you have hair.‌

Pityrosporum folliculitisis is caused by a fungus that most people have on their skin. But when you have an overgrowth of this yeast and it gets into your hair follicles, it can cause an infection.

Anyone can get pityrosporum folliculitis (fungal acne), but you're more likely to get it if you:

  • Are a teenager, especially if you're assigned male at birth (AMAB)
  • Live in a hot, humid area
  • Sweat a lot
  • Have recently taken antibiotics, especially tetracycline, either as a cream on your skin or by mouth
  • Have recently taken steroids
  • Are immunocompromised, either because you have a condition (such as HIV, leukemia, or lymphoma) or are taking immunosuppressive medicines
  • Have other fungal infections, such as seborrheic dermatitis or tinea versicolor
  • Have oily skin
  • Have diabetes

There are many types of folliculitis. Some of these include:‌

Superficial bacterial folliculitis. This type is the most common. It's caused by Staphylococcus aureus, which is abacteria that usually grows on your skin. But, as with the yeast that causes fungal acne, the bacteria can get inside damaged or blocked hair follicles and cause an infection.

Viral folliculitis. The virus that causes herpes may also cause folliculitis. Viral folliculitis often looks like bacterial folliculitis, but it has clusters of spots and plaques. Molluscum contagiosum can sometimes cause viral folliculitis, too, but it’s not as common. ‌

Gram-negative bacterial folliculitis. Also called hot tub folliculitis, this is caused by Pseudomonas aeruginosa bacteria. It comes from sitting in contaminated water or a poorly treated hot tub or swimming pool. ‌Klebsiella and Enterobacter bacteria species can also cause this type of folliculitis. You might get this after you've been taking antibiotic medicines for a long time. ‌

Demodex folliculitis. The Demodex folliculorum mite causes this type of folliculitis. Most people have this mite on their skin without developing folliculitis, but it may cause a reaction in some people with weakened immune systems or those who already have skin conditions.‌

Eosinophilic folliculitis.  If you have HIV, you might get this type of folliculitis. It’s not clear exactly what causes it, but it can also be a side effect of chemotherapy. It usually shows up on the scalp, face, and neck and might look like hives. ‌

Pseudofolliculitis barbae. This kind of folliculitis is also called razor bumps, and it doesn’t always cause a skin infection. This often happens to people who have curly-haired facial hair. After shaving, the hair curls back and grows into the skin, causing inflammation and bumps. ‌While it mostly affects facial hair, this type of folliculitis can happen anywhere you shave. It’s also common to have ingrown hairs on your groin where your clothes rub against your skin a lot. 

The cause of fungal acne is an overgrowth of Malasseziayeast that has infected your hair follicles. Damage may happen to your follicles when you: 

 

  • Rub skin against skin, clothes, or other materials often (chafing)
  • Wax, pluck, or shave your hair
  • Use a hot tub or whirlpool
  • Rub or touch your skin often
  • Leave your skin hot and damp (for instance, after you exercise for long periods of time or when you live in a hot, humid area)

The main symptom of fungal acne is a breakout of itchy bumps. The breakout may appear suddenly, and your skin may also burn and feel painful. 

Because it's caused by an infection in your hair follicles, breakouts can happen anywhere you have hair. However, it's more common to have them on your:

  • Face, especially the forehead, cheeks, and chin

  • Upper back

  • Upper arms

  • Chest 

  • Shoulders

  • Neck

What does fungal acne look like?

Fungal acne breakouts may look like a rash with clusters of bumps that are similar sizes and shapes. If you have light skin, the bumps may be surrounded by a red ring or border. 

 

To diagnose fungal acne, your doctor may ask about your symptoms and look at your skin. They may use Wood's lamp, a small black light, while they look at your skin. Some fungi, such as Malassezia yeast, will glow under a black light. Malassezia usually glows a yellow-green color.

To confirm your symptoms are caused by fungal acne, your doctor may also perform a couple of tests. For instance, they may

 

  • Gather some skin cells by gently scraping your skin where you have a breakout. They will look at these skin cells under the microscope for signs of Malassezia yeast. 
  • Remove a small section of skin for a biopsy. The lab will then stain your skin samples with dyes that react with yeast so they can see them under the microscope. 

Your doctor will usually prescribe antifungal medication to help you get rid of your fungal acne. They may prescribe an antifungal that you take by mouth (oral antifungal) or a cream that you spread on your skin or both. However, oral antifungals seem to work the best because the yeast may be deep in your hair follicle where a cream may not reach. Oral antifungals include fluconazole and itraconazole. 

Side effects of fungal acne treatment

Oral antifungals can cause side effects, such as:

  • Stomach pain

  • Diarrhea

  • Nausea and vomiting

  • Liver damage

Because of this risk of side effects your doctor may try an antifungal cream that you spread on your skin (topical antifungal) before prescribing you an oral antifungal. These topical creams include econazole and ketoconazole. 

If you get fungal acne often, your doctor may prescribe you long-term antifungal medicine or try something called photodynamic therapy. Photodynamic therapy uses a combination of photosensitizing medicine and light to kill off the yeast that's causing your infection. They may also prescribe photodynamic therapy if other antifungal medicines haven't worked. 

 

Here are a few simple things you can do at home to help prevent fungal acne:  

 

  • Shower and change out of your work-out clothes soon after working out
  • Wear loose clothes, especially when it's hot and humid or when you work out
  • Take care when you shave, pluck, or wax your hair 
  • Use only well-maintained and clean hot tubs and pools
  • Wash your bathing suit and let it dry between each use
  • Use selenium sulfide shampoo (such as Selsun Blue) weekly as a body and face wash

If you have fungal acne, you may be able to clear up your skin if you take a break from shaving, plucking, and waxing your hair, avoid hot tubs and pools, and wear loose clothes for about a month. Also, try putting warm compresses on the affected area several times a day. 

Some people also use tea tree oil to treat both acne and athlete's foot, which is a fungal skin infection. You can dab it directly on your breakout or you can dilute it in a carrier oil (like coconut or jojoba oil) and dab that on. Take care, though, because tea tree oil can be neurotoxic (it can change the activity of your nervous system). Keep it out of reach of small children and pets, and don't use it in a diffuser.

 

If you've been treating your breakout at home and it doesn’t clear up in about 3 weeks, make sure to see your doctor.