This is not just another acne blog. Fungal acne is an ongoing problem that many people struggle with. Fungal acne – is that even a thing? Well, it is and if you suffer from acne and have tried multiple products, facials and treatments only to have your condition worsen then you may be suffering from fungal acne (aka Pityrosporum folliculitis or Malassezia folliculitis). Unfortunately, fungal acne often goes misdiagnosed by family physicians and aestheticians alike.

The skin is an incredibly dynamic and complex ecosystem of microflora flooded with bacteria, viruses, and fungi that interact with each other and with us. Research continues to investigate how all of these micro-organisms network, what they do for us, and what we do for them. The reality is, certain micro-organisms are needed for healthy skin, while others can cause disease or set the playing field for disease.

What is Fungal Acne Anyway?

We all have a magical ecosystem of microflora living on our skin. What is that? Bacteria, yeasts and fungi! The good, the bad and the ugly living in harmony together on your skin. Until…dysbiosis occurs. How does this happen? Well, there are a number of possibilities which may lead to the skin responding in a way that shows up as red, itchy acneic looking skin. This fungus then feeds on oil on our skin and inside our pores including other oils or oil-rich ingredients that are applied to the skin. Yes! Your products that you thought were helping solve the problem could very well be perpetuating it.

What Causes Fungal Acne?

Contributing factors of Fungal acne can one or many of the following but not limited to:

ANTIBIOTICS:

Long-term use of topical or oral antibiotics such as clindamycin, doxycycline and minocycline can make fungal acne worse. Antibiotics cannot differentiate from good or bad bacteria, so it kills all of it, which creates dysbiosis, which allow the fungi on the skin to proliferate.

HUMIDITY:

Yeast thrives in warm, humid places. Fungal acne is more common in these types of climates and seasons. Keep this in mind after your workout! Always make sure you shower and dry off well! Sweating and using products that contain oil (fatty acids) is a haven for fungal acne.

SKINCARE PRODUCTS:

Yeast feeds on oil! If you’re using skincare or makeup that contain certain types of fatty acid, oils, esters and some polysorbates (even small amounts), it could be a trigger. The list of ingredients that can exacerbate fungal acne is vast. Therefore, we will focus on ingredients that will counter it.

DIET:

While diet usually isn’t the initial cause of a fungal acne outbreak, once there is an existing imbalance your diet can play significant role, especially if it is high in sugar. Think about a candida diet and then a probiotic. Yeast will thrive in this environment.

INFLAMMATION:

Those who have a condition that suppresses the immune system and those who take immunosuppressant medication may also be vulnerable to fungal acne. A suppressed immune system prevents proper regulation of Malassezia, allowing the yeast to grow freely.

IMMUNO-COMPROMISED:

Research indicates higher incidences of fungal acne among patients with diabetes, HIV, Hodgkin’s disease, organ or bone marrow transplant recipients, or those with nutritional disorders, neurotransmitter abnormalities, and immunologic deficiencies.

How do I tell the difference between Acne and Fungal Acne?

LOCATION:

While fungal acne can potentially happen anywhere on the body, a common way to tell the difference between fungal acne and traditional bacterial acne is often, but not always, the location. Traditional acne typically occurs primarily on the cheeks, jawline, and T-zone (this includes the forehead, nose and chin). The acne along the hairline or on your upper back, shoulders, and upper chest is more commonly associated with fungal acne, but there are always exceptions to the rule! We are all different and nothing is surprising when it comes to fungal acne.

APPEARANCE:

Fungal acne can appear as small, uniform red bumps filled with pus. However, when comparing, traditional comedones, it may progress at different rates and can largely vary in severity and size. Fungal acne is quite often ITCHY and sometimes even burns! Whereas traditional acne, typically doesn’t present with that characteristic. It also can be especially uncomfortably worse on those hot humid summer days which Calgary weather is fortunately or unfortunately however you may see it, usually lacking.

BIOPSY:

If, however, you still find that you are unsure, you can always choose to seek the expertise of a board-certified dermatologist. They may also let you know which strain(s) of fungi you have, as there is a vast array of them. This process is usually done through a shave biopsy or culture in one of the areas where you have the majority of activity (i.e. upper back, chest, shoulders, scalp, or t-zone area of the face). Although, this isn’t even 100% definitive as the majority of the fungi live within the follicle as opposed to the surface of the skin. Ideally a sample of what is extracted from the follicle would give a truer picture. Keep in mind you may need a referral from your primary health care provider and waits to be seen in some provinces can be up to one year.

Don’t let this discourage you! Read on because help may be on the way!

How is Fungal Acne treated?

KETOCONAZOLE:

Most fungal acne will respond well to ketoconazole 2% which is a broad spectrum anti-fungal agent which can be applied topically and is used as a first line defense for fungal acne. For more severe conditions an oral anti-fungal of itraconazole, fluconazole, ketoconazole and terbinafine may be introduced short term.

ZINC PYRITHIONE:

Is also known as a mild anti-fungal and keratolytic agent, studies have shown that it’s less effective than ketoconazole at inhibiting fungal acne.

BENZOYL PEROXIDE:

Can be an effective ingredient (antimicrobial) to fight both acne bacteria and yeast. However, is best when applied and left on the skin for 10-20mins then rinsed off to avoid dehydrating the skin.

SALICYLIC ACID:

Is a keratolytic and has anti-inflammatory, anti-bacterial, and anti-fungal properties. It’s an oil-soluble beta hydroxy acid, and desmolytic agent. What does that mean? It does an effective job at dissolving all the fungi that accumulate inside of clogged pores as well as removal of dead skin cells.

SULFUR:

Washes, spot treatments or masks containing sulfur can be useful. Sulfur is naturally anti-bacterial and anti-fungal, allowing it to regulate fungal or yeast production and remove it from within your pores.

AZELAIC ACID:

This natural ingredient and commonly used to treat fungal acne as well as rosacea also has fungal acne properties. It may help by regulating the fatty acid content in your skin, a common mechanism used by antifungals. As the yeast or fungi/survive on the fatty acids and oils in the skin, reducing the free fatty acid content may help to reduce the yeast population.

CAPRYLIC ACID:

Products containing this powerful antifungal property have been shown in studies to inhibit several fungi species.

CINNAMIC ACID:

Derived from cinnamon oil, cinnamic acid has been shown to possess antifungal activity against a variety of fungi species.

TEA TREE OIL:

Derived from the Melaleuca alternifolia plant, it is a well known antimicrobial. In vitro studies show that it may be effective in inhibiting several species of fungi and we know there are many.

Remember, there may be other ingredients not listed that you find work well for your particular case and some ingredients in this list that don’t agree with you. Let’s remember, we are all individuals and may respond differently to each ingredient. Best defense is try introducing one ingredient at a time to prevent any negative reactions.

An important note on sunblock – “Sunblock makes me breakout” – Quite a few acne clients don’t want to wear sunblock because quite often they say sunblock will make them breakout. Yes, you may be right! Read your ingredients and ensure you are applying sunblock with ONLY physical ingredients like zinc and titanium dioxide, any additional ingredients or chemical sunblock can inflame acne or even cause breakouts, they also have been proven to cause hormonal disruption. It doesn’t matter what skin colour you have, you need sun protection.

Supplements that Might Help Fungal Acne

PROBIOTICS:

Studies have shown that supplementation of Lactobacillus paracasei reduces fungi. Probiotics improve fungal acne. Your gut microbiome balances the microbiome in other parts of your body, including your skin.

IN-OFFICE TREATMENTS:

Yes! Do find a trusted clinic who is experienced in treating fungal acne and is able to provide you with treatments to clean and unclog your pores, give advice on products etc… and work together to help keep your skin clean, clear, healthy and strong.

It is possible to live fungal acne free. Don’t feel like there is something wrong with you or suffer in silence because it just won’t clear up. If you have had fungal acne once you are susceptible to have future outbreaks or perhaps yours has never cleared up. Addressing your skin concerns and getting a prompt and accurate diagnosis is the first step to clean, clear, healthy skin!

THE SKINSCIENCE TEAM