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.Â
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)Â
- 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 looks like?
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.
How can I tell the Difference?
Fungal Acne
- Uniform sized and shape of papules and pustules
- Itchy
- More often on chest, back, shoulders and neck
- Absence of open/closed comedomes
- Does not respond to antibiotics, benzoyl peroxide, retinoids.
Acne Vulgaris
- Different sized papules and pustules. May have cysts and nodules.
- More painful than itchy
- More often on face, chest and back
- Presence of open/closed comedomes
- Responds to antibiotics , benzoyl peroxide, retinoids.
How Is It Diagnosed?
A skin scrapping test to determine the presence of the yeast organism may be performed.
Fungal Acne Treatment
- The treatment of fungal acne must first take into account the risk factors mentioned above.
- Topical therapy in the form of shampoos (containing selenium sulphide or pyrithione zine) may be helpful.
- Topical anti-fungal creams
- Oral anti-fungal therapy for more severe and extensive cases.
Can Fungal Acne Recur?
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:
- 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.
- 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.
