How to get rid of fungal acne
Fungal acne is a yeast overgrowth in the hair follicles, so it clears with antifungal treatment. Acne washes and antibiotics are aimed at bacteria and tend to miss it, and antibiotics are the trigger named most often. The first step is a diagnosis, because it looks like ordinary acne.
Changing products is a smaller part of it, but it is the part you can check yourself. The fungal acne checker reads an ingredient list for the classes of ingredient lab studies found the yeast can feed on. This page covers what the treatment studies report. It is not medical advice, and treatment belongs with a doctor.
1. Get it confirmed
Fungal acne, properly Malassezia folliculitis, is commonly misdiagnosed as acne vulgaris and can persist for years on typical acne medication (Rubenstein and Malerich, 2014). Bacterial folliculitis and steroid acne look similar too. A doctor confirms it by finding the yeast in a skin scraping, tape strip, swab or biopsy (DermNet), and the European dermatology position statement sets out the findings required before treatment starts (Henning and colleagues, 2023).
Signs that point a doctor towards it: many bumps all about the same size, 1 to 2 mm, often itchy, on the forehead and hairline or the upper back and chest, with no blackheads or whiteheads among them. In one series, 65 percent of patients reported itch where it was recorded (Prindaville and colleagues, 2018).
2. What the treatment studies report
- Antifungals applied to the skin. In the 2018 review of 110 patients aged up to 21, ketoconazole shampoo was the most common treatment and improved or cleared most cases (Prindaville and colleagues, 2018). DermNet lists selenium sulfide shampoo, econazole and ketoconazole as effective in the majority of cases, and notes they may need a longer course than tablets.
- Antifungal tablets. The 2014 review calls oral antifungals the most effective treatment, with rapid improvement. Some patients in the 2018 review needed them. DermNet adds that trials have not consistently shown tablets beating topical treatment. These are prescription medicines with side effects and interactions, so whether they suit you is a doctor's decision.
- When it comes with ordinary acne. The two often occur together, and the 2014 review notes that combining antifungal and acne medication may be needed.
3. Deal with what let it grow, because it comes back
DermNet says recurrence is common even after successful treatment, recommends addressing the predisposing factors at the outset, and notes that ongoing weekly topical use may help as maintenance. The triggers it and the case series name are covered on what causes fungal acne. In practice that means:
- Shower and change out of sweaty clothes soon after exercise or heat.
- Ask whether an antibiotic you are taking for acne is still needed.
- Look at heavy, occlusive products on the affected area. The fungal acne checker shows which ingredients fall in the classes the yeast fed on in lab studies. No study has shown that avoiding them clears or prevents fungal acne, so a match is a reason to look closer and nothing more.
If the bumps are on your forehead or along the hairline, hair products touch that skin too, and fungal acne on the forehead covers that case.
Common questions
How do you get rid of fungal acne fast?
With antifungal treatment after a diagnosis. A 2014 review found oral antifungals the most effective treatment, with rapid improvement. In a 2018 review of 110 young patients, ketoconazole shampoo used on the skin improved or cleared most cases, and some needed antifungal tablets. Tablets need a prescription and a doctor to decide whether they suit you.
Will regular acne treatment clear fungal acne?
Usually not. The 2014 review notes that fungal acne can persist for years on typical acne medication, and antibiotics are the trigger named most often. Some people have both conditions at once and need both kinds of treatment.
How long does fungal acne take to go away?
The sources used here give no single figure. DermNet notes that topical treatment may need a longer course than tablets. It also comes back often, even after treatment works, which is why weekly topical use is sometimes kept up afterwards.
Do I need to see a doctor?
Yes, to be sure of the diagnosis. It looks like ordinary acne and like bacterial folliculitis, and a doctor confirms it by finding the yeast in a scraping or swab. The European dermatology position statement lists the findings it wants before treatment starts.
Check your products for fungal acne
Paste an ingredient list and the checker marks anything in the four classes lab studies found Malassezia can feed on, with the study behind each rule.
More questions about breakouts
Sources used on this page
- Rubenstein RM, Malerich SA. “Malassezia (pityrosporum) folliculitis.” Journal of Clinical and Aesthetic Dermatology, March 2014;7(3):37–41. (opens in a new tab) A review of how the condition presents and how it is diagnosed and treated.
- 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.
- Henning MAS, et al. “Position statement: recommendations on the diagnosis and treatment of Malassezia folliculitis.” Journal of the European Academy of Dermatology and Venereology, July 2023;37(7):1268–1275. (opens in a new tab) The European Academy of Dermatology and Venereology position on diagnosing and treating it. Malassezia folliculitis appears when the benign colonisation of hair follicles by the yeast becomes symptomatic, with itchy papules and pustules. The recommendations set out the positive findings required before therapy is started.
- American Academy of Dermatology, “Acne: When to see a dermatologist”. (opens in a new tab)