Do you have stubborn zits that just won’t go away despite trying every acne treatment under the sun? Chances are, you might just be suffering from fungal acne instead, which is NOT the same as bacterial acne despite its similar appearance, and will not respond to regular acne treatments.
But don’t worry, fungal acne is not difficult to treat once you know what you’re dealing with in the first place and seek appropriate treatment from a medical professional. Many patients who suffer from fungal acne have shared with me different remedies and tips they saw online, from skincare youtubers to an entire sub-Reddit dedicated to fungal acne. While a number of these hold some truths, many are pseudoscience packed with misinformation that may lead to a worsening of your condition.
Instead of being misguided by social media, let me break down fungal acne for you — including how to tell if you have this condition, the dangers of a misdiagnosis and treatment options in Singapore.
What is fungal acne?
Contrary to its name, fungal acne is a total misnomer — not only is it not really acne, it has nothing to do with fungus too. Rather, fungal acne is an infection of hair follicles on the face or body caused by excess yeast called Malassezia folliculitis.
While fungal acne can be hard to diagnose due to its similarity in appearance to regular acne, there are a few tell-tale signs:
Size of infection
Look out for blackheads and whiteheads that are about a millimetre big. There might also be pus-filled bumps that are all the same size, unlike bacterial acne that come in different sizes.
Fungal acne often appears on the chest, back, or upper arms, though it can also show up on the face like typical acne.
An obvious characteristic of fungal acne is itching around the infection site.
Fungal acne often appears in clusters; usually as uniform papules or whiteheads.
Now, one thing to know is that the yeast that causes fungal acne, Malassezia, actually lives on everyone’s skin. However, because yeast levels tend to spike in the presence of sweat or hot and humid weather, this condition is extremely common in Singapore given our climate.
On top of hot weather, other triggers to fungal acne include;
- Greasy skin
- Tight fitting clothing
- Sweating a lot especially during and after exercising
- Using too much makeup, sunblock or moisturisers that can block hair follicles
- Overuse of antibiotics for acne
- Bodily contact with someone with the infection (yes, fungal acne is contagious)
How do I know if I have fungal acne?
Due to the similarities between Malassezia folliculitis and acne, trying to determine yourself whether you suffer from fungal acne is extremely difficult. Even many doctors who either lack the experience or do not know how to test for Malassezia folliculitis are prone to making a wrong diagnosis. To further complicate things, fungal acne often coexists with bacterial acne on the face, misleading many to arrive at the wrong diagnosis and treatment plan.
If you would like to find out for sure whether you have fungal acne in order to embark on the right treatment plan for your spots, consult a doctor who is experienced and well-equipped in testing for fungal acne.
An easy and inexpensive way that I do to test if my patients are suffering from fungal acne or regular acne is to shine a black light on the infection site—as fungal acne appears differently from regular, bacterial acne. Illuminated by black light, bacterial acne appears orange-red while fungal acne has a blue-white hue.
The dangers of a misdiagnosis and the harm conventional acne treatments can cause
In Singapore, acne is treated with a myriad of procedures, from microneedling to lasers depending on your condition. While they are known to not just treat acne but also bring on a slew of additional benefits (e.g. collagen production, skin rejuvenation), they DO NOT work the same for fungal acne. In fact, it’s been shown that treating fungal acne with conventional acne treatments can worsen the condition and exacerbate symptoms 1. What’s a cure to bacterial acne can be sustenance for fungal acne to flourish.
Since we’re on this topic, I’d like to again emphasise the importance of choosing the right doctor and treatment for your acne — especially if lasers are involved. I’ve spoken about how the wrong lasers can worsen acne, but did you know that wrong lasers can cause fungal acne too?
In this particular study 2, more than 50% of patients experienced significant fungal growth after full-face laser resurfacing. The lasers used in question were Fractional CO2 and Erbium:YAG lasers — both fractional ablative lasers that involve removing the top layer of skin, hence increasing the chance of micro-organism population.
This is why I only use non-ablative fractional lasers in my practice that can treat acne and acne scars at the same time for patients that exhibit symptoms of fungal acne.
Read more to find out how I treat acne scars.
How can I treat fungal acne in Singapore?
First, correct diagnosis is most important — so make sure you get that out of the way before doing anything else.
At home, I recommend the following:
- Use Nizoral, an anti-dandruff shampoo that gently and effectively cleanses your face and body. Allow the shampoo to sit for a few minutes before rinsing off for best results
- Avoid any oil-based products that contain ingredients such as oleic acid, shea butter, cocoa seed butter, avocado oil and linoleic acid
- Avoid engaging in activities that cause your skin temperature to rise, such as hot yoga, sauna
- Shower and change out of your dirty clothes right after sweating
- Opt for loose, breathable fabrics so your skin gets adequate air circulation and balanced fungal growth
For those impatient with the results of home treatments, or find it difficult to adjust their lifestyle habits in Singapore to avoid fungal acne, I highly recommend them to consider aesthetic treatments to eradicate their spots. In a clinical setting, I usually treat fungal acne with:
- Agnes RF, a minimally invasive radiofrequency microneedling device that permanently removes bacterial acne and fungal acne by targeting the common root cause, hyperactive sebaceous glands. This is especially suitable for those with stubborn spots that always reoccur at the same areas as AGNES RF can precisely target and treat these compromised facial follicles without damaging the skin’s epidermis.
- Oral medication such as Fluconazole
- Skincare containing BHA (salicylic acids) and retinoids. Although these ingredients can be found in OTC products, prescription strength retinoids are more effective.
So there you have it! I hope this guide helped you understand fungal acne better and the treatment options available. Remember both acne bacterial and fungal acne can look and feel similar, but they are not the same and require different treatments. When in doubt, always speak to a professional to avoid worsening your condition.
- Ayers K, Sweeney SM, Wiss K. Pityrosporum Folliculitis: Diagnosis and Management in 6 Female Adolescents With Acne Vulgaris. Arch Pediatr Adolesc Med. 2005;159(1):64–67. doi:10.1001/archpedi.159.1.64
- Alam, M., Pantanowitz, L., Harton, A. M., Arndt, K. A., & Dover, J. S. (2003). A prospective trial of fungal colonization after laser resurfacing of the face: correlation between culture positivity and symptoms of pruritus. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 29(3), 255–260. https://doi.org/10.1046/j.1524-4725.2003.29060.x