The Truth about Fungal Acne. Here’s What It Really Is.

Is fungal acne even a thing? If you’ve been seeing little bumps on your skin with pustules, you might think, “Oh, I have fungal acne!” But, it’s important to understand that it’s not actually acne. Acne is when your hair follicles become plugged with oil and dead skin cells in addition to acne bacteria (c-acnes bacteria). 

With acne, bacteria consumes the oil and creates waste products. All of this causes an inflammatory response, and that’s why you’ll see redness and swelling with acne. 

On the other hand, what we know as “fungal acne” is actually called “pityrosporum folliculitis.” Pityrosporum folliculitis is triggered by a yeast called "malassezia." When too much malassezia grows on your skin and gets into your hair follicles, it creates inflammation and causes a fungal infection.

An overgrowth of malassezia is associated with clusters of small, itchy, and red bumps on the skin. Sometimes these bumps can grow, and they can even develop white heads or pockets of yellow residue. That’s why it’s so commonly mistaken as acne. 

But, as mentioned before, it’s not a type of acne. The same fungus, malassezia, can actually trigger or cause the flaring of chronic conditions like seborrheic dermatitis. Additionally, it can increase the reactivity of atopic dermatitis.

What is the difference between seborrheic dermatitis and atopic dermatitis?

Seborrheic dermatitis and atopic dermatitis are both chronic conditions, meaning they are long-lasting. Chronic conditions aren’t curable, but they can be managed over time with lifestyle changes, certain skincare regimens, and medications. Chronic conditions are linked to genetics, your environment, and your immune system.

Both conditions can produce bumps, but with atopic dermatitis you’ll see more blisters that might weep or ooze. With seborrheic dermatitis, you may see more round, scaly bumps, oily scales, and isolated plaques.

In regards to atopic dermatitis, hyperpigmented brown, gray, or white plaques might appear. Atopic dermatitis can also present with papules (little bumps). 

Malessezia can make both of these conditions flare up because it increases their reactivity. It disturbs the skin barrier like an allergen, and too much of it can cause the skin to be more reactive. 

More simply, malessezia can alter the skin barrier and trigger certain skin conditions like  pityrosporum folliculitis, seborrheic dermatitis, and atopic dermatitis. All three can present with flaking, and likewise, when there is a reaction to malassezia on the scalp, there might be dandruff. 

What causes dandruff?

Dandruff or pityriasis capitis itself can be natural, and it’s often non-inflammatory. The skin naturally desquamates and sheds its top layer, but when there’s an overgrowth of malassezia, you might see increased scalp scaling, redness, oiliness, and scaly eruption.  Similarly, an overgrowth of malassezia is also associated with atopic and seborrheic dermatitis, and this overgrowth perpetuates the cycle of inflammation. 

However, you don’t have to have seborrheic dermatitis or atopic dermatitis to have an overgrowth of malassezia. It can be the result of not washing the hair, certain hair products, and keeping the scalp in a humid and hot environment. For example, covering the hair after showering might cause an overgrowth of yeast as well – even if you don’t have a chronic condition. 

It’s best to see a dermatologist to determine whether you’re dealing with seborrheic dermatitis, atopic dermatitis, a dry scalp, or just plain dandruff. Simply washing your hair more can be ineffective, especially if you have a dry scalp. Also, see a dermatologist if you think you may have pityrosporum folliculitis. Products containing sulfur may also help with yeast overgrowth.