Fungal acne looks like normal acne, but requires completely different products to treat — here's how to tell if you have it
- Folliculitis, commonly referred to as "fungal acne," isn't technically acne at all.
- It's a skin condition caused by yeast overgrowth that leads to inflamed hair follicles.
People are curious about fungi — whether it's therapeutic mushrooms or imagining a fungus pandemic by watching "The Last of Us.
The same applies to fungal acne, a skin condition that has been tagged over 190 million times on TikTok.
Fungal acne resembles other types of acne, but it is "fairly rare," according to Dr. Mallory Abate, a board-certified dermatologist at The Dermatology Clinic in Baton Rouge, Louisiana. "To the untrained eye, it can be very difficult to pick up the difference," Abate said.
That may be why Shannon Ranger, 42, said she was misdiagnosed with regular acne for years, only to have her skin clear up once she self-diagnosed herself as having fungal acne "after years of failed treatments and dermatologist visits."
"I tried everything from exfoliants, AHAs, BHAs, and dermatologist prescribed Protopic (for eczema) and Aczone (for acne)," Ranger told Insider.
The issue is: Fungal acne is treated differently than regular acne. Oral antifungals can cause side effects like diarrhea, nausea, vomiting, and abdominal pain, so Abate says it's better to be sure of your diagnosis — and try other treatments for acne first — before trying to treat blemishes as folliculitis.
Fungal acne is caused by yeast overgrowth in hair follicles
Despite the name, fungal acne isn't really acne, according to Abate. It's actually folliculitis, a hair follicle infection caused by yeast that naturally exists in the skin but can sometimes overgrow. When it does, it can inflame the hair follicles and cause an acne-like appearance via red, pus-filled bumps.
Getting diagnosed might take some troubleshooting, especially since it's rarer to have facial folliculitis than regular acne.
Abate said regular acne typically looks more varied: You're more likely to see an assortment of blackheads, larger lesions, and cysts, while folliculitis bumps tend to be "monomorphic" and generally look the same.
One of the biggest things to look out for is itchiness — Abate said folliculitis is very itchy compared to acne.
"Usually, we make the diagnosis when the pimples do not improve using traditional acne treatments but do resolve using antifungal therapies," Dr. Joshua Zeichner, an Associate Professor of Dermatology at the Mount Sinai Hospital in New York City, told Insider.
Folliculitis crops up in oily parts of the body and is exacerbated by sweat
According to Abate, the yeasts that are a normal part of our skin flora "are lipophilic, meaning that they really like oils and fats," which is why folliculitis can form in the oiliest parts of our bodies such as the scalp, face, chest, or back.
Since folliculitis thrives in oily or sweaty areas, Abate said some of the best preventative measures include keeping skin clean and dry in hot weather and after workouts, as well as avoiding clogging skincare products such as heavy moisturizing creams.
Another factor could be the medications you're taking: Abate recommends "avoiding long-term use of oral antibiotics, which can alter the normal microbiome and allow for yeast overgrowth."
The most effective treatments are the ones prescribed by dermatologists
For Ranger, it wasn't until she started looking for products without irritating substances like fragrances and alcohol that her skin started to improve.
In some cases, Abate said over-the-counter medicated shampoos like Selsun Blue can provide some relief and also be used on the chest and back.
She generally noted that "most cases of fungal acne require dermatology evaluation and prescription drug therapy" such as antifungals for rapid results. For instance, left untreated, persistent folliculitis on the scalp can lead to hair thinning or permanent hair loss.
"Treatment regimens really vary on a case-by-case basis, which is why it's important to see a board-certified dermatologist for a thorough evaluation," Abate said.
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