What is Fungal Acne? Causes, Treatments and Symptoms

One of the vastly seen skin disease in adolescents is acne. It affects about 80-90% adolescents attaining pubertal age. Some of this acne also continues into adulthood leaving some kind of psychological and social impact. Acne, also called as acne vulgaris is a chronic skin condition that results from dead skin cells and sebum from the sebaceous glands. Acne presents itself in the form of pimples, blackheads, whiteheads, and scarring. Acne are common in body parts which consists of higher density of sebaceous glands – especially on the face, back and chest. Some of these inflammatory acne lesions can cause permanent scarring.

Overview

Fungal acne, also known as malassezia folliculitis or pityrosporum folliculitis, is a type of skin condition that can be incorrectly identified. It is usually caused due to overgrowth of the yeast named malassezia, which is similar to fungi, in the hair follicles in the skin. This yeast survives on the sweat that is produced in the skin’s layers. Fungal acne causes inflammation and itching sensation on the skin, which is not commonly seen in other types of acne. It can cause irritation on the skin with some amount of redness. Fungal acne can be pus – filled and grow in size unlike the other types of acne. Some experts are of the opinion that fungal acne is not actually an acne, it is more of an infection of the hair follicle. Inflammatory acne generally affects the face and is because of excess sebum or hormonal changes. However, fungal acne appear as uniform pusutles in congregations on chest, shoulder and back as small whiteheads

The skin microbiome has a balance of both good and harmful micro-organisms that can change if there is any major change in the diet and lifestyle, environmental conditions, medications, exercise sessions or skin care rituals

Causes of Fungal Acne 

• Excess Sebum production : The yeast responsible for causing fungal acne generally exists in the human body. But it is more frequently occurring in adolescents and teenagers, due to changes in the hormonal levels at this age, causing excess sebum production from the sebaceous glands
• Climate : People living in tropical countries with extreme hot and humid climates are more prone to this type of acne as sweating is one of the main reason for development of fungal acne and yeast thrives in warm and wet places
• Diet : A diet that is high in sugar and refined carbohydrates causes fungi to grow and harbour on the skin leading to fungal acne
• Antibiotic use : Chronic use of topical antibiotics like clindamycin or ingestion of antibiotics like doxycycline or minocycline can aggravate fungal acne. This is because antibiotics destroy both the good and bad bacteria (skin barrier function) and allow fungi present on the skin to proliferate and grow
• Hygiene : Wearing tight fitting clothes during intense workouts and not showering immediately after exercise causes sweat to accumulate in the hair follicles leading to fungal acne
• Others : Researchers have seen that fungal acne appear in conditions of compromised immune system like transplants, certain illnesses, use of certain antibiotics and some medicines like immunosuppressants used in the treatment of other disease

Treatment for Fungal acne 

As fungal acne is more pathological than other forms of acne, it generally requires medical intervention to treat them.

• Antifungals : Since fungal acne is cause by excessive yeast proliferation in the hair follicles, antifungals like fluconazole or itraconazole are prescribed for the treatment. These antifungals can act in deep inside the follicle and arrest the growth of the yeast
• Topical application : These include Sulphur containing antifungal shampoos and solutions that have to be topically applied to clear the scalp of dandruff as fungal acne is mainly the infection in the hair follicles. Shampoos containing ketoconazole work best for fungal acne
• Exfoliate : Using a good chemical exfoliator that contains salicylic acid and lactic acid helps in eliminating skin debris and excess sebum trapped in the hair follicles. Salicylic acid has anti-inflammatory and anti-fungal functions, that can help in eliminating the fungi accumulated inside blocked pores and hair follicles. Benzoyl peroxide is one of the best agents to act against acne causing bacteria and yeast
• Home Remedies : Although fungal acne is a more severe form of acne and requires some medical intervention, some natural remedies do not cause harm and help in preventing acne breakouts in the future
  • Lactobacillus : This is a strain of organism found in fermented food products like curd and buttermilk. Lactobacillus breaks down into lactic acid in the body which restricts the growth of yeast. Consumption of these probiotics can help in increasing the immunity and improve skin health. Along with consumption, application of yoghurt masks on the affected areas can help in reducing the fungal acne severity
  • Honey : Honey has been one of the ancient go-to for many conditions like burns and wounds. It has multiple medicinal properties – especially improving the healing process and reducing scarring caused by acne. Honey also has some antibacterial properties which help in fighting infections and thus reduce acne breakouts
  • Coconut oil : It also helps in exfoliating the outer layer of dead skin cells, making the skin smooth and soft. It makes for a great foot scrub particularly since coconut oil has anti-fungal properties and can be used as a home remedy to treat foot infections like athlete’s foot. Although coconut oil is can clog pores, considerable research has shown that it might actually help in treating acne. As coconut oil contains medium chain fatty acids, it helps in reducing inflammation and yeast growth when applied to affected areas
  • Tea tree oil : Tea tree oil has gained a lot of popularity in recent times, for its acne fighting properties. Research has shown that 5% tea tree oil solution helps in reducing the amount and overall severity of acne. The antiseptic and antibacterial properties of tea tree oil can reduce oiliness on the skin which can lead to reduction in acne breakouts. The antimicrobial function of the oil is due to its capacity to damage the cell wall structure of bacteria
  • Essential oils : Essential oils containing herbs like oregano and clove, black walnut are some of the natural antifungals that can be used as they are powerful antioxidant agents and do not damage the skin

Ways to prevent Fungal Acne 

Some basic practices in the routine skincare can reduce the chances of developing fungal acne. They include :

• Showering after workout sessions and keeping the skin clean and sweat-free
• Using antifungal body wash, especially for people who are prone to excessive sweating
• Wearing loose, comfortable clothes, especially during workouts which help the sweat to escape and allows the skin to breathe
• Selecting non-comedogenic skin care products, greasy and heavy moisturizers, makeup and sunscreens that can block the pores and cause sweat accumulation on the skin surface
• Using cleansers that contain salicylic acids or glycolic acids to remove excess sebum from the skin
• Staying hydrated and consuming a diet low in simple sugars and refined carbohydrates can enhance skin health and prevent any skin infections. Improving immunity by consuming adequate vitamins and minerals found in raw fruits and vegetables and plant based diet help in preventing infections and maintaining skin barrier function
• Adequate hair care to prevent dandruff and fungal acne caused by poor hair hygiene
• Removing sweaty clothes immediately after the activity and not let the sweat harbour on the skin

Conclusion

Fungal acne can be treated with medications and simple lifestyle intervention. However, it has the chance of recurrence with seasonal changes and unhealthy lifestyle patterns. It is essential to seek medical advice by an expert for timely treatment. Routine skincare and hygiene is the key to keep the fungal infections at bay

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970831/
2. https://www.ncbi.nlm.nih.gov/pubmed/30085463
3. https://www.tandfonline.com/doi/full/10.1080/19381980.2017.1361573