What Is Fungal Acne? Plus, How to Tell If You Have It

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When you wake up with a cluster of pus-filled pimples on your forehead or along your hairline, your standard course of action probably involves dotting on a spot treatment, keeping up with your deep-cleaning face wash, and crossing your fingers that the blemishes vanish overnight. But if that stubborn breakout refuses to disappear despite your best efforts, your flare-up could actually be fungal acne.

Before you freak TF out about the idea of potentially having a skin condition involving fungus (*shivers*), take a deep breath and know that it’s not as scary as it might sound. Here, the answers to all of your now-burning questions about those red bumps, including fungal acne symptoms and tips on how to get rid of fungal acne. (P.S. this guide will help you prevent every other type of adult breakout.)

What Is Fungal Acne, Anyway?

Surprise: Fungal acne isn’t really acne. The condition, medically known as Pityrosporum folliculitis, develops when a particular type of yeast (called Pityrosporum or Malassezia) that’s a normal part of your skin’s microbiome overgrows, says Marisa Garshick, M.D., F.A.A.D., a dermatologist based in New York City. From there, the yeast will dig deep into hair follicles — not the skin’s pores — causing inflammation and what’s colloquially known as fungal acne.

For comparison, other types of acne are usually caused when bacteria (specifically Cutibacterium acnes) gets trapped in the skin, excess oil production clogs the pores, or hormones shift, she explains. “Fungal acne is sort of a misnomer,” adds Dr. Garshick. “I would basically say it’s folliculitis, which essentially describes an infection of the hair follicle.” (Which, BTW, could be a reason why you have bumps on your nether regions.)

While Dr. Garshick can’t say for sure how common fungal acne is, she does note that it’s under-recognized — and, according to an article in the Journal of Clinical and Aesthetic Dermatology, likely under-diagnosed too. Some people may have it but think it’s regular old acne that’s being particularly difficult, and others who typically treat their breakouts sans derm appointment might not think to ask for help getting it under control, she explains. While it's always a good idea to consult a doc when you're dealing with dermatological difficulties, being able to recognize fungal acne symptoms could clue you in on whether or not you have the condition. And on that note...

What Does Fungal Acne Look Like?

Since fungal acne isn’t *technically* acne, it will look and feel a little different from your typical breakout. The skin condition can develop anywhere, but it typically appears along the hairline and on, in Dr. Garshick's words, "the trunk of the body" (think: the back, chest, and shoulders). Another fungal acne symptom is having small, red bumps that look similar to one another, some of which may have a little bit of yellow-ish pus, explains Dr. Garshick. Most often, you won’t have the whiteheads or blackheads that you’d develop with comedonal acne, she adds.

Unlike traditional forms of breakouts in which the skin feels sensitive AF, fungal acne can be super itchy, says Dr. Garshick. Plus, they don’t present themselves as the full-fledged, large bumps associated with nodular acne (hard, painful acne that's caused by inflammation deep in the skin). “They’re more like these slightly elevated bumps off the surface,” she adds. “If you run your finger over them, you’ll feel them, but they’re maybe like one to three millimeters in size.”

What Causes Fungal Acne?

In general, you can encourage yeast overgrowth and potentially develop fungal acne if you subject your skin to hot, humid, and sweaty environments and spend a lot of time in unbreathable, skin-tight clothes (i.e. sitting in your sports bra for two hours after running a 5K), says Dr. Garshick. Other contributing factors include using greasy sunscreen and oily moisturizers, having oily skin (the yeast feeds on that oil), and being immunosuppressed, according to the American Osteopathic College of Dermatology.

But in some cases, the driving force behind fungal acne can be actually be prolonged use of antibiotics to treat other classic types of acne, such as comedonal acne and cystic acne, she says. (Ironic, right?) The reason: The bacteria and yeast that normally live on the skin surface are in constant competition with each other, but antibiotics can suppress the bacteria, disrupting that balance and allowing the fungal-acne-causing yeast to thrive, according to the AOCD. “Sometimes we’ll have people come in who are doing their normal acne treatment and be like, ‘It was so weird because just a few weeks ago, all of the sudden I got a breakout that was much worse than what I had before,’” notes Dr. Garshick.

That’s why one of the keys to preventing fungal acne in the first place is to limit the amount of time you’re on antibiotics — if you’re able to, she says. Keeping up with your post-workout showers and changing out of your sweat-drenched clothes ASAP can also help reduce your chances of developing it. But for the most part, “there's nothing specific I would say any person has to do to prevent it,” adds Dr. Garshick. “I think it’s important to know that it’s not contagious, it’s not particularly harmful, and it’s not a hygiene thing. This type of yeast is totally normal to live on the skin. Everybody has it, but some people may be more likely to develop a rash that goes with it.”

How to Get Rid of Fungal Acne

In case you needed a third reminder, fungal acne isn’t actually acne, so the standard treatment protocol — applying retinoids, using benzoyl peroxide products, and taking antibiotics — won’t target the problem, says Dr. Garshick. Instead, you’ll need to employ an anti-fungal pill or topical cream prescribed by your doctor or an over-the-counter anti-fungal spray or shampoo used as a body wash, all of which make the fungal acne vanish relatively quickly, she says.

As far as over-the-counter fungal acne treatments go, Dr. Garshick suggests using a Nizoral shampoo (Buy It, $15, amazon.com), which contains an anti-fungal ingredient known as ketoconazole, as a body wash. After your fungal acne symptoms disappear, you can continue to use the shampoo as a body wash once or twice a week to prevent it from coming back, she says. You can also add a Lamisil Spray (Buy It, $10, walmart.com) to your skin-care routine, spritzing it on the affected areas once daily (morning or night), for two weeks, according to the AOCD. While you're using these anti-fungal products, you may still need to apply your usual acne treatments, such as benzoyl peroxide and retinol, since fungal acne often co-exists with actual acne, according to the aforementioned article in the Journal of Clinical and Aesthetic Dermatology.

But even if you’re 99.5 percent certain you’re dealing with a bout of fungal acne, Dr. Garshick urges you to see your derm before you start slathering drugstore products all over your body. “It doesn’t mean every red bump on your back is going to be [fungal acne],” she explains. “There are also different types of folliculitis, including one caused by bacteria. So I generally would say anything that develops on the skin that seems unfamiliar is worth getting checked out by a dermatologist.”