Fungal Acne (Pityrosporum Folliculitis): Causes, Symptoms, Images, and Treatments

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If you have breakouts that won't go away like regular pimples do, you might have fungal acne, also called pityrosporum folliculitis. Fungal acne is a rash that's easily mistaken for acne. Unfortunately, acne medications can make it worse. But once you have the right diagnosis, you can get rid of fungal acne with proper treatment.

Let's take a closer look at pityrosporum folliculitis, including its symptoms, diagnosis and treatment, and some images to help you understand what it looks like.

What is fungal acne (pityrosporum folliculitis)?

Fungal acne, also known as fungal folliculitis or pityrosporum folliculitis, is a yeast infection of the hair follicles. The culprit is Malassezia, a yeast that normally lives on human skin. In certain conditions, this yeast can grow out of control. When this happens, it can invade hair follicles and trigger inflammation.

What causes fungal acne?

It's common to have yeast on your skin, but not everyone develops fungal acne. Different conditions increase the risk of developing fungal acne, including things like:

• Having a weakened immune system

• Taking antibiotics

• Taking oral steroids

• Being around heat and humidity

• Sweating excessively

What does fungal acne look like?

Fungal acne might look like tiny pink, red, or purple bumps and pimples around hair follicles. The bumps are usually all the same size.

Fungal acne can happen anywhere you have hair, but more common locations include the:

• Upper forehead

• Hairline

• Shoulders and upper back

Here are some fungal acne pictures to help you know what to look for.

Close-up of fungal acne rash.

What are the symptoms of fungal acne?

Fungal acne doesn't always cause symptoms. But when it does, you may experience some of the following symptoms in the area of your rash:

• Itching

• Burning

• Pain

How can you tell the difference between fungal acne and regular acne?

Fungal acne looks a lot like acne, so it can be hard to tell them apart. Like acne, you can get red breakouts on your:

• Forehead

• Face

• Chest

• Back

It's also possible to have regular acne and fungal acne at the same time, which can make it even harder to tell the two apart.

But there are some important features of fungal acne that can help you distinguish it from regular acne:

• The breakouts are rash-like - tiny pustules that look the same and are the same size.

• Fungal acne tends to be itchy, while acne isn't.

• You're less likely to see blackheads and whiteheads with fungal acne.

• Fungal acne gets worse with antibiotics, rather than better.

How is fungal acne (pityrosporum folliculitis) diagnosed?

Most often, your dermatologist can diagnose pityrosporum from your symptom history and a physical exam. In some cases, they might scrape the contents of a pustule and look for yeast under a microscope. Rarely, a skin biopsy might be necessary.

What is the treatment for fungal acne?

The best way to get rid of fungal acne is with lifestyle changes and medications. Here are some things you can try to keep your skin clean and dry:

• Choose sweat-wicking fabrics whenever possible.

• Make sure to change out of your sweaty clothes quickly.

• Avoid heat and humidity, especially while exercising.

• Don't use heavy moisturizers that can clog pores.

Your dermatologist may also suggest medications as treatment for fungal acne. If you're on topical antibiotics for acne, it's best to discontinue those. They can make fungal acne worse. Treatment for fungal acne typically involves topical and/or oral antifungal medications such as:

• Ketoconazole cream, shampoo, and tablets (Extina)

• Clotrimazole cream (Mycelex, Lotrimin AF)

• Ciclopirox cream and shampoo (Loprox, Penlac)

• Fluconazole tablets (Diflucan)

• Itraconazole tablets (Sporanox)

The treatment you get will depend on how severe your breakout is, what medical problems you have, and what other medications you're taking.

Side effects of fungal acne treatment

The creams and shampoos used to treat fungal acne don't usually cause side effects. At most, you may experience some skin irritation or dryness.

Antifungal pills may cause any of these side common side effects:

• Nausea

• Diarrhea

• Vomiting

• Stomach pain

In rare situations, people can develop more serious side effects, like liver damage or an allergic reaction.

Are there any home remedies for fungal acne?

If you have a mild case of fungal acne, you may be able to improve it at home by eliminating some of the underlying causes. In addition to keeping your skin clean and dry, it can help to avoid any type of hair removal, like shaving or waxing, for a few weeks.

If you don't notice any improvement with these home remedies, talk to your dermatologist. You may need prescription medication or additional treatments.

How can you prevent fungal acne?

You may not be able to avoid having yeast on your skin, but you can lower the chance that it turns into fungal acne. Try the skin care and home remedies noted above to prevent fungal acne. You can also use dandruff shampoo (like ketoconazole) a few times a week. Let the soap sit on your skin for a few minutes before rinsing.

Frequently asked questions

Images used with permission from VisualDx (www.visualdx.com).

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