Fungal Acne

fungal acne

Fungal Acne

Clinically proven and safe fungal acne treatments to restore your healthy skin!

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Neck and chest fungal acne

What is Fungal Acne?

You would be surprised to learn that technically, there is no such thing as fungal acne despite it being a common term used. ‘Fungal acne’ is a misnomer and is often confused for acne vulgaris. Many individuals may indeed be suffering from fungal acne instead and often realize that treatment with oral antibiotics are unhelpful to manage their condition.

Fungal acne describes the infection of the pilosebaceous unit by the Malessezia furfur yeast species. These yeast, which are normally present on human skin, can feed on the sebum and cause skin conditions such as Malassezia folliculitis or Pityrosporum folliculitis (aka Fungal acne), Seborrhoeic dermatitis and Pityriasis versicolor. 

In contract to acne vulgaris, one would find colonization by the Cutibacterium acnes bacterium species. Over here, we will share the distinguishing factors between the 2 and treatment options.

Who gets Fungal Acne?

The Malessezia yeast species can proliferate and cause symptoms when conditions are ripe. Factors that encourage the Malessezia species to thrive include heat, humidity and moisture. These include:

  • Hot and humid environment like Singapore. Fungal acne is more common in individuals living in the tropics.
  • Excessive sweating (hyperhidrosis) 
  • Excessive oil skin. Young males are more prone to fungal acne.
  • Trapping of moisture from the skin from occlusive clothing, excessive skin care products and sun screens.
  • Antibiotic use may encourage the Malessezia yeast to thrive when bacterial counts are lowered.
  • Weakened immunity such as long term use of topical, oral steroids and immune deficiency syndromes.

What does It look like?

chest fungal acne folliculitis
Chest fungal acne

Fungal acne or Malessezia folliculitis manifests as multiple small, uniform papules and pustules. The duration of symptoms are often more than 2 months. One often complains of itch that if severe, might affect sleep. Fungal acne is most often located on the back, chest, neck and shoulders. One of the key distinguishing factors, is the lack of the presence of open and closed comedomes typically seen in acne variants.

Fungal Acne vs Normal Acne

Fungal Acne

Acne Vulgaris

How Is It Diagnosed?

Most cases can be diagnosed based on history and examination finding. A skin scrapping test to determine the presence of the yeast organism may be performed in cases that are not straightforward.

Fungal Acne Treatment

  • Antifungal Medications: The cornerstone of treatment includes topical antifungals such as ketoconazole, itraconzole and clotrimazole. In more severe cases, oral antifungal agents like fluconazole may be prescribed. These medications target the Malassezia yeast directly, helping to reduce inflammation and clear the lesions.

  • Skin Care Adjustments: Patients are advised to discontinue the use of heavy, oil-based products that can exacerbate fungal growth. Instead, opting for non-comedogenic and lightweight formulations is crucial. Regular cleansing with gentle, antifungal cleansers can help maintain a balanced skin environment.

  • Lifestyle Modifications: Managing factors that promote fungal overgrowth is essential. Recommendations include:

    • Wearing breathable fabrics, especially in hot and humid conditions.
    • Practicing good hygiene, particularly post-exercise.
    • Avoiding excessive moisture and sweat accumulation on the skin.
  • Education and Monitoring: It is vital to educate patients about the differences between fungal acne and traditional bacterial acne to prevent misdiagnosis. Continuous monitoring during treatment ensures effectiveness and allows for adjustments as needed.

Can Fungal Acne be cured?

Unfortunately, fungal acne or Malessezia (Pityrosporum) folliculitis is known to recur despite treatment. Retreatment may be necessary if symptoms are bothersome and affect your daily activties. Here are some tips to reduce the recurrence of fungal acne:

  • Wear loose fitting clothing to reduce occlusion e.g. 100% cotton
  • Avoid excessive moisturization of your skin
  • Shower soon after exercise or workout
  • Healthy diet that is not indulgent in sugars or carbohydrates.

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References:
  1. Prindaville B, Belazarian L, Levin NA, Wiss K. Pityrosporum folliculitis: a retrospective review of 110 cases. Journal of the American Academy of Dermatology. 2018 Mar 1;78(3):511-4.
  2. Yong AM, Tan SY, Tan CL. An update on pityrosporum folliculitis in Singapore from a single tertiary care dermatological centre. Singapore medical journal. 2021 Oct;62(10):526.

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