Fungal Acne (Malassezia Folliculitis): The Complete Guide

Does your acne look like the acne shown in the picture below? Does it take the form of small bumps on your forehead and other parts of your face? Maybe it also itches and you have dandruff as well? If you answered yes to even some of these questions, you likely have fungal acne. While it may look like acne, it's a different animal and requires somewhat different treatment since a lot of things that may work for regular acne, won't work if your acne is fungal.

Image of girl with fungal acne

We have an extensive amount of experience treating fungal. Here are just a few images that clients have shared of their results. Here's everything you need to know about fungal acne and how you can get rid of it, just by having a solid, fungal-acne safe skincare routine in place.

Contents

What Is Fungal Acne?

What Causes Fungal Acne?

Diagnosing Fungal Acne

Treating Fungal Acne

Recommended Skin Care Routine

What Is Fungal Acne?

While regular acne, or acne vulgaris, is caused by bacteria, malassezia folliculitis, also known as fungal acne, is caused by the malassezia fungus. This fungus has 22 currently known species, and is naturally found on our skin.

Malassezia is an opportunistic pathogen. This means that it is generally harmless and only causes disease when immunity is in some way compromised. It has also been linked to other conditions in dermatology including seborrheic dermatitis and dandruff.

Malassezia is lipophilic and needs to feed on fat to grow. It is thus, most commonly found on areas of the body that have a dense population of oil-producing glands: the scalp, face, and trunk. Rapid growth of the fungus disrupts the natural renewal of skin cells, resulting in flaky skin (dandruff) and itching.

What Causes Fungal Acne?

The causes of fungal acne are poorly understood. Some health conditions however, can make people more susceptible to it. These include diabetes, HIV, organ transplant, and immunological deficiency. Studies have also linked fungal acne to obesity, steroid use, birth control pills, and stress.

The infection can also be triggered by prolonged antibiotic use. Antibiotics alter the delicate balance of our skin’s microbes, causing the death of bacteria that keep the growth of malassezia in check. This is especially problematic because fungal acne is often misdiagnosed as acne for which doctors are quick to prescribe antibiotics. This ends up further aggravating the condition.

There are also factors that increase how quickly the fungus is able to grow. We know that malassezia multiplies faster in a pH range of 5.5 to 7.5 and in hot, humid climates. This explains the high incidence of fungal acne in countries like the Philippines, and from my personal experience, also in Pakistan.

Diagnosing Fungal Acne

It is often difficult to distinguish fungal acne and regular acne. However, there are factors that can help us differentiate between the two:

Image of black girl with fungal acne
  • Itching of the affected areas is characteristic of fungal, but not of acne vulgaris.

  • Plentiful small, uniform, whitehead-like lesions. These tend to be more common on oilier areas of the face such as the forehead.

  • Dandruff. Individuals with fungal acne often have dandruff as both conditions can be caused by the same fungus.

  • Unsuccessful attempts at treatments with antibiotics in the past. If you’ve had antibiotics in the past but they didn’t help, or made your acne worse, you most probably have fungal acne.

Treating Fungal Acne

Treating fungal acne starts with choosing the right skincare and sticking with it even once the fungal acne has cleared, to keep it from coming back. If you’re prone to fungal acne, you need to avoid most oils and a wide range of other lipids as they are food for malassezia and cause it to grow very quickly. Fungal acne safe lipids include our Medium Chain Triglyceride (M.C.T.) Oil, and squalane.

Once your skincare routine is in order - I will make recommendations below - it also often helps to use a topical anti-fungal, for 3-5 nights if the acne is severe. Leaving it on overnight often results in skin irritation. Contact therapy, where the ointment is applied for 20 minutes and then rinsed off, tends to be just as effective but carries much lower irritation risk. Ask your pharmacist for an ointment containing 2% ketoconazole for this purpose. If you're unable to find an ointment, a ketoconazole shampoo will also do the job. Apply a thin layer of it over affected areas for 10 minutes and then rinse it off.

Several active ingredients in skincare can also treat fungal acne and prevent it from coming back, when used in a fungal acne safe formulation. These include honey, azelaic acid, sulfur, urea, and my personal favourite: salicylic acid, which also has anti-inflammatory and anti-bacterial properties and helps unclog pores.

Recommended Skin Care Routine

When it comes to skincare for fungal acne, we recommend keeping it simple - an excessive number of products might just work against you. To start with, stick with only what's recommended and continue this routine even after your fungal acne has cleared. It’ll keep the fungal acne from coming back and will also help maintain general skin health. Pro tip: if you're confused about whether your acne is fungal or bacterial, you can still start out with this routine. It's also suitable for acne vulgaris! And if you need more help or have more questions, feel free to reach out. Here's the routine, in video form, and in writing.


Morning

Wash your face with the AccuFix Hydrating Gentle Daily Cleanser. Follow up with the AccuHydra Hydrating Gel Cream Moisturiser while your skin is still damp, right after cleansing- this is very lightweight and is also fungal acne safe. Finish with a fungal acne-safe SPF.

Night

Wash your face with the AccuFix Hydrating Gentle Daily Cleanser. Follow up with the Salicylic Acid Pore Cleansing Emulsion as a treatment. Finish with the AccuHydra Hydrating Gel Cream Moisturiser. If your skin is on the sensitive side, feel free to use the moisturiser before the treatment.

Get in touch if you have any more questions, or need help treating your acne or fungal acne and we'll be more than happy to help!