acne vs fungal acne

Bacterial acne vs Fungal acne—let’s find out if you have one or the other (or both).

When you’ve been dealing with blemishes for so long, but they won’t go away—it’s a sign that your acne may not be acne.

The typical ‘true acne’ we know is bacterial

But fungus naturally existing on our skin can cause acne-like blemishes. Hence, fungal acne.

And since these blemishes are not actual acne, our arsenal of acne-fighting products may not work on them at all.

Let’s get to the bottom of this and see if you’re acne is not what it seems.

What is Fungal Acne?

The term ‘fungal acne’ can be very misleading if you’ve just heard about it. It isn’t the acne we know—acne vulgaris.

Fungal acne is actually an infection of the hair follicles caused by Malassezia yeasts. And the proper term for the condition is not fungal acne. It's Malassezia folliculitis or pityrosporum folliculitis [1].

M. globosa, M. sympodialis, and M. restricta are the particular Malassezia yeasts that can cause hair follicle infections. These yeasts can be naturally found on our skin and are normally chill inhabitants. But they can cause disease under specific conditions, like hot humid climate and excessive sweating.

Malassezia yeasts feed on the fatty acids in our skin’s oils (sebum) [2]. And as they feed, they grow in numbers and cause problems for our skin. When the infection starts, Malassezia folliculitis forms as small, uniform, itchy lesions.

And you know how they love to feed on our skin oils, right? Because of that, they typically show up on places with higher sebum production. Like the chest, back, and upper arms—also on the face, particularly the T-zone.

Bacterial Acne VS Fungal Acne

acne vs fungal acne

The typical ‘true’ acne called acne vulgaris is bacterial in nature. It usually goes down like this:

  • Hair follicles get clogged with dirt and oil
  • Acne bacteria (Cutibacterium acnes) multiply in the follicles
    • Like Malassezia, Cutibacterium acnes lives on our skin. As anaerobic organisms, they tend to multiply when there’s a lack of oxygen. And that's exactly what happens when follicles become clogged.
  • The follicles become inflamed because of bacterial infection
  • Inflamed lesions we call pimples and zits form on our skin

From looking at this process, you can see how different Malassezia folliculitis is from acne vulgaris.

The tricky part is how to tell them apart when they form on your skin.

Spotting Fungal Acne

acne vs fungal acne

Malassezia infections can really become so confusing. So much so that a study came out calling these infections a conundrum [3].

Often, Malassezia folliculitis is misdiagnosed as acne vulgaris. That's how similar-looking they are [1].

Both fungal and bacterial infections appear as inflamed lesions. AKA reddened skin with bumpy blemishes. But there are some characteristics we can look at to help spot Malassezia folliculitis [4]:

  • Small pimple-like bumps that look like closed comedones (whiteheads), excretes pus, and are clustered together
  • Itching, rash, tenderness, and at worst case scenarios, burning sensation on the affected area
  • Redness
  • Pimples that take a long time to disappear and don’t respond to traditional acne treatment like benzoyl peroxide

The sure-fire way to know if you have Malassezia folliculitis is to go to a dermatologist. There, you can ask to have a clinical examination done. Tests from skin swab, scraping, tape stripping, or skin biopsy can confirm the presence of yeasts that could be causing infection [1].

Treating Fungal Acne

Remember that Malassezia folliculitis is fungal and not bacterial. So, you won't have much luck using typical acne treatments like benzoyl peroxide to treat it.

Anti-fungals are the way to go for Malassezia folliculitis. By inhibiting fungal activity, anti-fungals can put a stop to the growing number of yeasts wreaking havoc on your skin [5].

If you paid a visit to your derm, you could be given an oral anti-fungal to deal with Malassezia folliculitis. You can also ask for a prescription strength anti-fungal cream if your Malassezia folliculitis is very stubborn.

acne vs fungal acne

For non-prescription options, we’ll need to enter nontraditional products for anti-fungal measures.

Believe it or not, anti-dandruff shampoos make for a good Malassezia-fighting product.

Nizoral, for example contains 1% Ketoconazole. Many studies have found ketoconazole to be effective in inhibiting every species of Malassezia [5, 6, 7, 8, 9]. Using it like a cleanser, let it sit for a few seconds to do its job. This can help end the pesky yeasts causing your fungal blemishes.

Selsun Blue, another anti-dandruff shampoo, contains 1% Selenium Sulfide. It's not as effective as ketoconazole as an anti-fungal [10]. But selenium sulfide can still help fight Malassezia yeasts.

Of course, if the infection has gotten to a point of great discomfort or even unbearable pain, it’s still the best option to go to a dermatologist and ask for prescription anti-fungals.

Preventing Fungal Acne

Malassezia folliculitis can recur even after successful treatment [1]. Taking steps to prevent it whenever possible is your best course of action. As they say, prevention is better than cure.

You can’t truly prevent Malassezia folliculitis from forming. But there are still some steps that can contribute in avoiding this skin condition:

  • Keep your skin clean and dry of sweat, especially after workouts.
  • If you’re prone to Malassezia folliculitis on your body, remove your sweaty clothes right after workouts.
  • Exfoliate your skin regularly to prevent feeding and growing yeasts colonies on your skin through excess oil.


Dealing with acne when it turns out to not be acne can be very frustrating. At least after finding out what the skin condition actually is, you can take the appropriate steps needed to treat it.

So, I hope you'll join me again next time to find out more about acne-like skin conditions. Thank you for reading!

About the author 

Valeria

Valeria Dzhodzheva is the author, full-time acne coach, and content professor for Pretty Blooming. In 2016, Valeria completed her Master of Science (MS) in cold Denmark, and uses her newly gained skill set to translate acne research into plain English. She has a baby on its way, and that makes her cat Snow jealous.

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