Fungal acne (Malassezia folliculitis): signs and antifungal treatment
Fungal acne is a yeast overgrowth in hair follicles, also called Pityrosporum folliculitis: itchy bumps, uniform in size, on the chest, back and forehead. It's treated with antifungals like ketoconazole, not with regular acne products.
Last reviewed · 4 medical sources, listed below
Fungal acne vs regular acne
Specimen A vs specimen B
| Attribute | Specimen AFungal acne | Specimen BRegular acne |
|---|---|---|
| Cause | Malassezia yeast multiplying inside hair follicles | Hair follicles blocked with oil, dead skin and bacteria |
| Uniform appearance | Clusters of small bumps, all about the same size and shape | A mix of blackheads, whiteheads, pustules, nodules and cysts |
| Itching | Usually itchy; can burn | Usually not itchy |
| Common locations | Chest, upper back, shoulders, upper arms, neck; forehead, cheeks and chin | Often the middle of the face |
| Blackheads and whiteheads | No blackheads; a whitehead now and then | Common |
| Triggers | Heat, humidity, sweat, tight clothes, antibiotics | Oil, dead skin and bacteria clogging pores |
| Response to acne products | No real change; antibiotics can make it worse | Acne products are the standard treatment |
| Treatment | Antifungal wash, cream or pills | Benzoyl peroxide, a retinoid or other acne products |
Fungal or regular? Find out from a photo
Not sure which one you have? The acne.today analysis reads a photo of your face and gives you:
- Your severity, graded on the dermatologist 0–4 scale
- Your likely top cause
- A personal morning and evening routine
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30-second face scan + short quiz · photo analysed once, then deleted
AI guidance, not a medical diagnosis.- Severity grade (0–4)
- Example: grade 2
- Likely top cause
- Example: yeast in the follicles, or clogged pores
- Your routine
- Morning and evening steps
What fungal acne is
Fungal acne is an infection of the hair follicles caused by Malassezia, a yeast that lives on almost everyone's skin. It means the bumps come from yeast, not bacteria, so standard acne treatments don't clear it. The cause of fungal acne is yeast getting into damaged or blocked follicles and multiplying.
- Uniform appearance
- Small red bumps (papules) in clusters, similar in size and shape. Some turn into whiteheads (pustules).
- Itching
- The main sign that sets it apart. In a clinic study of 49 people with it, 79.6% had itching.
- Common locations
- Chest, upper back, shoulders, upper arms and neck. On the face: forehead, cheeks and chin.
What causes fungal acne
A fungal acne trigger is anything that lets Malassezia multiply or get into a follicle. It means a normally harmless yeast grows out of balance. The risk of fungal acne is highest in teens and young adult men, who tend to have oily skin.
- Yeast overgrowthMalassezia feeds on skin oil (sebum) and grows fast on hot, damp or sweaty skin.
- Climate & lifestyleHot, humid weather, heavy sweating, tight clothes, hot tubs, shaving, plucking or waxing.
- Skincare & makeupOil-based moisturizers, sunscreens and heavy makeup can promote flares.
- AntibioticsThey lower the good bacteria on your skin, which lets yeast overgrow. Steroid medicines can trigger it too.
- Weakened immune systemConditions or medicines that suppress immunity, and diabetes, make yeast harder to control.
How fungal acne is diagnosed
Diagnosis of fungal acne is a skin check by a dermatologist or primary care doctor. It means the doctor asks about your symptoms, looks at the bumps and may scrape a few skin cells to look for Malassezia under a microscope. The glow of a Wood's lamp (a small black light) can also show the yeast as yellow-green.
Not sure which one you have? A photo analysis of your skin can point to the likely cause first.
Antifungal treatment
Antifungal treatment is medicine that targets yeast instead of bacteria. It means fungal acne needs its own product. The aim of antifungal treatment is to bring Malassezia back to normal levels.
Over-the-counter options
Dandruff shampoos with ketoconazole or selenium sulfide work as a body wash on the chest, back and shoulders. For mild cases, an antifungal cream used daily is another start.
- Lather the dandruff shampoo on the bumps in the shower.
- Rinse it off well, and quickly if you use it on your face.
- Once it settles, a weekly selenium sulfide wash can help stop it coming back.
Prescription options
Ask your doctor about a stronger ketoconazole cream or shampoo, econazole cream, or antifungal pills such as fluconazole or itraconazole. Pills work best because the yeast sits deep in the follicle, but they can cause stomach pain, nausea, diarrhea and liver damage. For repeat flares, a doctor may suggest long-term treatment.
Avoid standard acne fixes
Antibiotics, a common acne treatment, cut the good bacteria on your skin and let yeast overgrow, so they can make fungal acne worse. Other acne treatments don't clear yeast either. The two can happen at the same time, and if it's regular acne, see how to get rid of pimples.
See a dermatologist if home antifungal washing hasn't cleared it in about 3 weeks, if it spreads or hurts, or if you have a weakened immune system.
How to prevent fungal acne
Fungal acne prevention is a set of habits that keep yeast from multiplying. It means fewer flares, since fungal acne often comes back. The timing of prevention matters most in hot, humid months and after workouts.
- Environment
- Shower soon after you work out. Use only clean, well-kept hot tubs.
- Clothing
- Wear loose clothes in the heat and for exercise. Change out of workout clothes right away.
- Medications
- Tell your doctor if the bumps started after antibiotics or steroids.
- Skin factors
- Go easy on oil-based moisturizers and sunscreens. Take care when you shave or wax. Keep up a weekly antifungal wash.
Fungal and regular acne can show up together, so the habits that prevent acne still help.
Ingredient check: what may feed Malassezia
Malassezia is a fat-loving (lipophilic) yeast. It splits skin oil into fatty acids it feeds on. In lab cultures it needs C12, C13 and C14 fatty acids, and labs add olive oil so it can grow.
Reader questions
What people ask most, answered plainly.
How do I tell if my acne is fungal?
Check three things: are the bumps all the same size, do they itch, and are they mostly on your chest, back or forehead? If yes, and acne products haven't helped, fungal acne is a real possibility. A dermatologist can confirm it with a skin scraping. Want a read from a photo first? Start the analysis.
Can you pop fungal acne?
Better not. The yeast sits inside the follicle, so squeezing doesn't remove the cause, and touching or rubbing your skin damages follicles. A warm compress a few times a day is the gentler move.
Can salicylic acid remove fungal acne?
Not on its own. Fungal acne doesn't respond to the usual antibacterial and anti-inflammatory acne treatments. It needs an antifungal, like a wash with ketoconazole or selenium sulfide shampoo.
Can miconazole be used to treat fungal acne?
It's an antifungal, and in lab tests it worked about as well as ketoconazole against several Malassezia species. Against Malassezia furfur, ketoconazole was stronger. Ask a pharmacist or your doctor.
What can be mistaken for fungal acne?
Regular acne is the big one, and the two can show up together. Bacterial folliculitis, steroid acne, hot tub folliculitis and razor bumps can look much the same.
Sources
- Cleveland Clinic. Fungal Acne. my.clevelandclinic.org/health/diseases/24341-fungal-acne
- The Ohio State University Wexner Medical Center. Pityrosporum folliculitis: What to know about fungal acne. health.osu.edu/health/skin-and-body/what-to-know-about-fungal-acne
- Rubenstein RM, Malerich SA. Malassezia (Pityrosporum) Folliculitis. J Clin Aesthet Dermatol. 2014;7(3):37–41. pmc.ncbi.nlm.nih.gov/articles/PMC3970831
- WebMD. What Is Fungal Acne? webmd.com/skin-problems-and-treatments/acne/what-is-fungal_acne
Last reviewed
This page is general information, not a diagnosis. See a dermatologist if home antifungal washing hasn't cleared it in about 3 weeks, if it spreads or hurts, or if you have a weakened immune system.