Acne Series: Fungal Acne

Do you have little itchy bumps that never seem to go away? Do they tend to get worse in hot and humid weather?

If this sounds familiar, this one’s for you! As we continue our Acne Series, we finally break down what those little bumps actually are. Commonly referred to as “fungal acne,” Malassezia Folliculitis isn’t acne at all and requires an entirely different approach than regular acne.

Well if  it’s not acne, then what is it??

Malassezia Folliculitis (MF), is caused by the overgrowth of yeast on our skin. These oil-loving fungi are commonly found in normal human skin, however there are several factors that can lead to their overgrowth like hot and humid conditions, oily/greasy skin, as well as immunosuppression. This then leads to an infection of the hair follicle which causes our skin’s immune system to come into its defense leading to inflammation.

What makes it different?

  • The Culprit
    • Fungal acne is caused by an overgrowth of fungi, while regular "acne" is caused by bacteria. They might look the same on the outside, but they couldn't be more different. 
  • Acne = Bacteria -> Acne
    • Malassezia = Fungi -> Malassezia Folliculitis (MF)/Fungal "acne" 
  • The Lesion 
    • Size: MF lesions bumps are generally smaller and are of the same size (monomorphic) while regular acne are less predictable and range from 1-3 mm papules/pustules
    • Signs: It can feel itchy and especially exacerbated after sweating/increased skin temperature
    • Location: MF mainly concentrates around the T-zone, forehead, hairline, back, and chest where you have the highest oil gland activity

Their similarities

Both Malassezia and P. Acne love oil. Overproduction of sebum is one of the major causes of acne, that’s why it is very common for MF and Acne Vulgaris (regular acne) to coexist in the same area at the same time.


MF is commonly misdiagnosed as Acne Vulgaris.

It is common for even the most trained dermatologists to miss the diagnosis of MF. When they coexist with Acne Vulgaris, it can be hard to distinguish them just by looking at it since the regular acne can “cover up” the typical MF lesion characteristics.

It is extremely important to differentiate MF since regular acne treatment such as Benzoyl Peroxide or oral antibiotics (prescribed by your doctors) can cause your fungal infection to worsen.

So, how do you know if you have MF/ Fungal acne?

  1. The best way to check if you have it is by going to a dermatologist and request for a fungal infection check. They will scrape/extract a part of the lesion and look at it under the microscope
  2. The acne medication you’ve been using for a long time doesn’t work or progressively makes it worse
  3. Testing how your skin responds to topical treatments, which we will discuss further below

How to treat MF

MF is caused by fungi, which means it should be treated by antifungal medication.

  1. Ketoconazole 2%

This antifungal agent can be easily found in drugstore anti-dandruff shampoo (such as Nizoral, Ketoconazole 1%). You can use it by applying the shampoo on your damp face (yes, you read it right) - just like a wash-off mask, leave it on for around 5 minutes before rinsing it off. You can use it every night or once every two nights for 2-4 weeks and see how can change your skin   

  1. Zinc Pyrithione 1% or Selenium Sulphide 2.5%

Another antifungal agent you can also find in anti-dandruff shampoo (such as Head & shoulder) and can be applied just like ketoconazole (see above)

  1. Sulfur

This treatment can be both effective for fungal AND bacterial acne! You can apply this as a sulfur wash or as a sulfur spot treatment.

Once the episode is over, these treatments can be used for maintenance to prevent future outbreaks.

Skincare tips for MF

There are some ingredients in your skincare products that might indirectly feed and exacerbate MF. Remember to #pressreset on your skincare game when you’re having MF. There are quite a few notable ingredients that should be avoided:

  • Oils and fatty acids (Example: Lauric, Palmitic, stearic, oleic, linoleic acid, etc)
  • Fermented ingredients (Example: Galactomyces)

Skincare ingredients that are great and have anti-fungal properties:

  • Honey/Propolis extract
  • Green tea extract
  • Salicylic Acid (BHA)

Extra tips: Do not over-moisturize your face especially during hot and humid weather. Fungi LOVE humidity, applying multi-step hydrating products can support their growth.

Lifestyle tips for MF

Here we list some extra tips that you can do to help alleviate MF:

  • Cool down your skin temperature
  • Increased skin temperature increases inflammation and sebum production which indirectly leads to Malassezia overgrowth. Heat is sometimes inevitable, but try to avoid steaming hot saunas and sunbathing. You can also use cold rollers to cool down your skin temperature

  • Wipe off your sweat!
  • Don’t forget to wipe or rinse off your sweat right after exercise

  • Change out of your sweaty clothes
  • This is especially important if you’ve been dealing with MF around your chest and back. Those damp sweaty shirts and sports bras become their favorite place to live

    Source: here

    16 comments

    If you‘re not sure wether the products you are using are MF safe, you can go to Sezia.co and just copy and paste your ingredient list in there and it will tell you. It just saves me so much time. 😊🙈

    Nicki March 10, 2020

    Yeah avoiding oleic and the other fatty acids Malassezia likes to eat is essential.

    Acne vulgaris is caused by both Cutibacterium acnes and Malassezia spp. Treatments like isotretinoin, tretinoin, and Azelaic inhibit the expression of the TLR2 receptors that both C. acnes and Malassezia bind. Acne prone skin has very exaggerated expression of TLR2 receptors compared to normal skin. The American Journal of Clinical Dermatology published an article July 2019 on Malassezia and C. acnes both causing acne vulgaris and there are many more papers on this topic.

    When you have comedones and these progress to acne vulgaris papules/pustules/cysts this is acne vulgaris. When you don’t have comedones (which can be hard to find in cystic acne) then you have folliculitis. There is also Staph and Pseudomonas folliculitis. All need attention by a dermatologist when it’s more than just mild acne.

    Theacneoriginstory July 30, 2020

    I have tried a lot of things and head and shoulders work decently for me the otc stuff did not work for me so if the otc stuff does not work for u try head and shouders

    Alexis February 27, 2020

    since i have FA all over my forehead i was wondering if using the mario badescu rose water facial spray would promote the bumps or calm them?

    k. February 27, 2020

    Mind asking if anyone having experience using nixoderm sulfur & salicylic acid bar soap to treat your FA?

    Nabyys January 23, 2020

    I have fungal acne and this is a few tips on how to get rid of it. I using IUNIK propolis extract and all the fungal acne has gone in about 5-7 days. For moisturizer, i use Cerave (it’s fungal acne product) .

    Adel January 16, 2020

    I am currently undergoing treatment (at home) for the pesky little fungal bumps on my forehead aka rocky-road of a nuisance and prime source of irritation – and have to say that Nizoral shampoo is a little miracle worker. If you haven’t tried it already, apply the shampoo (as suggested above) on forehead (or anywhere else on face -or body) and wear it like a mask, letting it dry. PLEASE BE MINDFUL OF TWO THINGS WHEN USING NIZORAL – Now if you did not know this, in the US – Nizoral shampoo’s active ingredient “ketoconazole” only comes in 1% in shampoo. Whereas in Canada, Europe, Australia and other parts of the world where this product is sold, the shampoo comes in pink form (not the US blue form) and has the active ingredient at 2%. THIS MEANS – if you are applying the NON-US Nizoral shampoo with 2% of the active ingredient “ketoconazole”, be careful not to severely over-dry your skin. Most folks using the 2% version would suggest to not leave the shampoo on affected area for more than 10-15 min. If using the US version with 1% of active ingredient, (which is what I have access too and currently use) you can extend the wear time up to 20-30 minutes since the concentration of active ingredient is less. BUT you know your skin better, so please be careful. What works for one person may affect another quite differently. All I can say, is that my face wasn’t responding to ANYTHING, and now the bumps are reducing and my forehead is slowly healing. Each day I have less and less bumps to deal with. DIET is also key. Lay-off carbs (pasta, rice, sweets, and sweet drinks, alcohol and massive amount of coffee)…. Yeast is triggered frequently by lack of a better balanced diet + dash of stress + massive wear of make-up = rocky road forehead. Try to keep it somewhat natural and lay-off the foundation and creams as they can be triggers… I am on week 1, and I am seeing awesome results, your forehead will say “thank-you”!

    A January 02, 2020

    Sadly only the oat cream is fungal acne safe ! Hoping for more FA safe Krave products in the future :)

    Lola December 30, 2019

    Does iunik propolis serum can get rid of fungal acne??

    A October 22, 2019

    I wanted to know if I can use products which aren’t fungal acne safe after these bumps disappear but continue with the treatment once every week or 2 times a week. Will it be enough not to trigger the fungal acne again?

    Subha October 22, 2019

    I’ve been using great barrier relief for just 5 days and the product triggers my fungal acne. Now it’s back and i’m panic

    Friska Unandy October 16, 2019

    wat if cnt but the miosterizer for the fungel acne wat can i use instead cause right now i have nothing that wont feed it and im useing cerave hydrating cleanser i have oily skin is that ok it dosnt fell striped after and its gental i also have large pores

    faneshia scott September 25, 2019

    Is maxi peel zero exfoliant fluid allowed to be use when u are suffering from fungal acne? It has BHA just wanna makw sure if it is safe

    Aliya September 04, 2019

    THANK U FOR THIS INFORMATIVE ARTICLE. this is life changing.

    Gina G August 22, 2019

    thank you so much for this article, it really helped me know what to do about my fungal acne. i didn’t realize what i had and after i found this i got to know everything about fungal acne so much love – shreya :)

    sk March 27, 2019

    I am so sad that none of the products from KRAVE can be used if you have fungle acne. If you are worked about a product containing ingredientes that are good or bad check out sezia.com (like malassezia). It has a data bank to back check. Hope this helps someone.

    N. March 19, 2019

    Leave a comment

    All comments are moderated before being published