We asked dermatologists to share the best treatment and prevention tips.

By Hana Hong
October 30, 2020
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Do you have a stubborn breakout on your chest, arms, or back that just won't give in to acne medication? You may have fungal acne (don’t worry, it’s not as gross as it sounds). The good news is that fungal acne isn’t hard to treat—once you know what you’re dealing with. 

What is fungal acne?

Interestingly, fungal acne is a misnomer: It’s not caused by fungus, and it’s not even considered acne. "The condition we call fungal acne is actually malassezia folliculitis (infection of the hair follicle), which is triggered by a yeast that inflames the hair follicles in your skin and products pimple-like bumps," says Hadley King, MD, a board-certified dermatologist in New York City. It's totally normal for this type of yeast to live on your skin, but an overgrowth of it can lead to outbreaks, especially during the changing seasons

Here’s where the hard part comes in. Because fungal acne isn’t actually acne, no acne medication will make it go away. This makes it even more important to differentiate the two. 

While fungal acne can look like your regular run-of-the-mill blemish, there are some notable giveaways. “Regular acne breakouts usually appear on the face and can vary in size and shape—there are both whiteheads and blackheads,” says Dr. King. “Fungal acne breakouts, on the other hand, are more monomorphic and appear in clusters—they look like uniform red bumps and small pustules on the chest, upper arms, back, and rarely the face. And perhaps most noticeably, fungal outbreaks are usually very itchy."

Credit: Getty Images

Causes of fungal acne

So why does fungal acne happen? As with regular acne, it could be a lot of things. Certain medications or environmental factors can upset your bacterial balance. “For example, antibiotics, used either systemically or topically, can deplete bacteria on your skin and the yeast can then grow unchecked, leading to fungal acne,” says Dr. King. Same goes for wearing tight, non-breathable clothing (or worse, sweaty clothing), as it creates a moist environment for yeast to flourish. 

Unfortunately, some people are just genetically predisposed to overgrowths of yeast and experience fungal acne more frequently. Certain chronic conditions that affect your immune system, like diabetes and HIV, can also leave you more vulnerable to the condition.

How to treat fungal acne

Fungal acne typically does not respond to traditional acne medications, but it can be improved with the use of topical antifungals, says Joshua Zeichner, MD, a board-certified dermatologist in New York City. “If you suspect you have fungal acne, try using a dandruff shampoo as a body wash. These contain anti-fungal ingredients like pyrithione zinc or selenium sulfide, which help balance your skin’s pH levels and decrease yeast on the skin.” Both he and Dr. King suggest Dove Dermacare Scalp Dryness and Itch Relief Anti-Dandruff Shampoo ($3; amazon.com) for sensitive skin types. With any product, the key is to let the product sit on your skin (Dr. Zeichner recommends singing the alphabet as a good measure) before rinsing off.

Other similar products containing active ingredients might also do the trick. “Look for an antifungal cream with econazole nitrate, ketoconazole, or clotrimazole, and apply it to the affected area twice daily,” says Dr. King. “Don't use topical or systemic antibiotics. This can deplete bacteria on the skin and allow yeast to grow unchecked.”

If these treatments are not working, see your board-certified dermatologist, who can confirm the diagnosis, and if needed, prescribe an oral antifungal medication. “This prescription will usually work much faster because it penetrates more effectively into the follicle,” says Dr. King. 

How to prevent fungal acne

Unfortunately, there’s always a risk of recurrence with fungal acne after it’s treated. Although there’s no surefire way to prevent it, there are methods to keep breakouts at bay. For one, heavy moisturizers and oils can make fungal acne worse by creating a moist environment that allows yeast to grow. Opt for lighter, oil-free, and non-comedogenic body moisturizers that absorb quickly into skin. 

Dr. King also recommends wearing loose-fitting, breathable clothing and showering immediately after a workout. “While there’s no need to actively treat fungal acne once your system has recovered, you can still use dandruff shampoo in lieu of normal body wash once a week as a preventative measure,” she adds.