Fungal acne on the forehead and hairline
The forehead is one of the most common places for fungal acne. In a review of 110 young patients with a confirmed diagnosis, the bumps typically sat on the forehead and ran up into the hairline, and on the upper back. They were small, 1 to 2 mm, all about the same size, and often itchy.
The forehead is also where hair products and ordinary acne show up, so it is worth knowing the differences. If you think a product is involved, the fungal acne checker reads its ingredient list for the classes of ingredient lab studies found the yeast can feed on.
Why the forehead
Fungal acne is an overgrowth of Malassezia yeast in the hair follicles. The yeast cannot make its own fatty acids and lives on the skin's oil (Ro and Dawson, 2005), so it does best where oil glands are busy. The forehead, the hairline, the upper back and the chest are all oily areas, and DermNet lists the forehead and hairline among the usual sites alongside the back and chest (DermNet).
The 2018 review found the forehead and hairline pattern in patients aged up to 21, more than 75 percent of whom had recently been on antibiotics for acne (Prindaville and colleagues, 2018). That review describes young patients only. Adults get it too, and the other triggers are covered on what causes fungal acne.
Three things that look alike on the forehead
| Fungal acne | Ordinary acne | Hair product acne | |
|---|---|---|---|
| Bumps | Many, small, the same size; papules and pustules | Mixed sizes | Mostly closed comedones (whiteheads) |
| Blackheads and whiteheads | Not seen | Usual | Usual |
| Where | Forehead into the hairline, upper back, chest | Face, chest, back | Hairline, upper forehead, temples, back of the neck |
Fungal acne: Prindaville 2018, where 65 percent of patients reported itch when it was recorded, and DermNet, which notes that comedones are not seen and that this separates it from acne vulgaris. Hair product acne: a 1970 study of 735 men using scalp creams and oils found an eruption on the forehead and temples, mostly closed comedones, in about 70 percent of long-term users (Plewig and colleagues, 1970), and the American Academy of Dermatology describes breakouts along the hairline, upper forehead and back of the neck (AAD). The two can overlap, and only a test tells them apart for certain.
Hair product breakouts have their own page, pomade acne. If you are choosing a shampoo, the non-comedogenic shampoos guide names the rated ingredients in each one.
Pictures
This site does not show photographs of fungal acne, and it will not show drawn or generated ones presented as what the condition looks like. DermNet, a dermatology reference written by dermatologists, carries licensed clinical photographs on its Malassezia folliculitis page. Comparing your skin with a photograph is not a diagnosis, and a doctor can confirm it with a quick scraping.
What to do about it
See a doctor to confirm it. In the 2018 review, ketoconazole shampoo, used on the affected skin, was the most common treatment and improved or cleared most cases, and some patients needed tablets. The full picture is on how to get rid of fungal acne. Meanwhile, look at what touches your forehead: hair oils, styling products, fringe, hats and sweatbands all sit on that skin.
Common questions
Is the forehead a common place for fungal acne?
Yes. In a 2018 review of 110 patients aged up to 21 with a confirmed diagnosis, the bumps were typically on the forehead extending into the hairline, and on the upper back. DermNet lists the forehead and hairline among its usual sites too.
How do I know if forehead bumps are fungal acne?
You cannot be sure without a test. The pattern doctors describe is many small bumps of the same size, 1 to 2 mm, often itchy, with no blackheads or whiteheads among them. Ordinary acne is usually mixed in size and has comedones. A doctor confirms fungal acne by finding the yeast in a scraping or swab.
Can shampoo or hair products cause forehead breakouts?
Hair products can cause ordinary acne along the hairline, which the American Academy of Dermatology describes, and an older condition called pomade acne. For fungal acne, oily products on that skin are one possible food source for the yeast. Ketoconazole shampoo is also one of the treatments used for it, so a doctor may suggest a shampoo rather than ask you to stop using one.
Where can I see pictures of fungal acne on the forehead?
DermNet, a dermatology reference run by dermatologists, carries licensed clinical photographs on its Malassezia folliculitis page. This site does not show pictures of the condition.
Check a product for fungal acne
Paste the ingredient list of a hair or skin product and the checker marks anything in the four classes lab studies found Malassezia can feed on.
More questions about breakouts
Sources used on this page
- Prindaville B, Belazarian L, Levin NA, Wiss K. “Pityrosporum folliculitis: a retrospective review of 110 cases.” Journal of the American Academy of Dermatology, March 2018;78(3):511–514. doi:10.1016/j.jaad.2017.11.022 (opens in a new tab) 110 patients aged 0 to 21 with the diagnosis confirmed by a potassium hydroxide preparation. More than 75 percent had acne recently treated with antibiotics, and 65 percent reported itch where it was recorded. The picture was numerous 1 to 2 mm uniform papules and pustules, typically on the forehead extending into the hairline and on the upper back. Ketoconazole shampoo was the most common treatment and improved or cleared most cases; some patients needed oral azole antifungals.
- DermNet, “Malassezia folliculitis”. (opens in a new tab) Risk factors listed: a hot humid climate, high sebum production, excessive sweating, occlusion from emollients and sunscreens, antibiotic use, and immunosuppression including steroid use. Sites: the upper back and chest, and also the forehead and hairline, chin, neck and upper arms. Comedones are not seen, which distinguishes it from acne vulgaris. Diagnosis is confirmed by finding the yeast in a scraping, tape strip, swab or biopsy. Topical selenium sulfide, econazole and ketoconazole work in most cases but may need a longer course than tablets; recurrence is common, and weekly topical use can serve as maintenance. The page carries clinical photographs.
- Ro BI, Dawson TL. “The role of sebaceous gland activity and scalp microfloral metabolism in the etiology of seborrheic dermatitis and dandruff.” Journal of Investigative Dermatology Symposium Proceedings, December 2005;10(3):194–197. (opens in a new tab) Review. M. restricta and M. globosa free fatty acids from triglycerides, consume particular saturated ones and leave the unsaturated ones behind.
- Plewig G, Fulton JE, Kligman AM. “Pomade acne.” Archives of Dermatology, May 1970;101(5):580–584. (opens in a new tab) Examined 735 Black men who used scalp creams and oils daily. About 70 percent of long-term users had an eruption on the forehead and temples, mostly closed comedones. Eight weeks of occlusion with five pomades on back skin produced early comedones under the microscope.
- American Academy of Dermatology, “Are your hair care products causing breakouts?”. (opens in a new tab) Breakouts along the hairline, upper forehead or back of the neck; stop the product, wash anything that touches the hair, and allow 4 to 6 weeks to clear.