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Fungal acne symptoms – What to look out for and how to treat it

By SL Aesthetic Clinic
  • Published Date:
Last Updated:
August 26, 2025
Face With Fungal Acne Symptoms Including Small Red Bumps in the Cheeks

TL;DR 

  • Fungal acne isn’t true acne – it’s a yeast (Malassezia) overgrowth in hair follicles, often triggered by sweat, humidity, antibiotics, or a disrupted skin barrier.
  • Key signs include itchy, uniform bumps (often on the forehead, chest, and back) that don’t respond to typical acne treatments and may worsen with antibiotics.
  • Fungal acne requires specialised solutions like antifungals and proper diagnosis by a doctor.

Table of Contents

If you’ve been dealing with persistent, itchy bumps that seem immune to your skincare routine, you might not be dealing with acne at all. Welcome to the world of fungal acne – a skin condition that mimics traditional acne but requires an entirely different approach.

Let’s delve into what fungal acne truly is, how to identify it, and, most importantly, how to treat it effectively.

What is fungal acne and what causes it?

Despite its name, fungal acne isn’t acne. It’s a condition known as Malassezia folliculitis or Pityrosporum folliculitis, caused by an overgrowth of yeast (specifically Malassezia) that lives naturally on our skin.

With heat, humidity, sweat, or a compromised skin barrier, this yeast can multiply and infect the hair follicles, leading to inflammation and breakouts.

Fungal acne is often underdiagnosed or mistaken for regular or bacterial acne, especially when it appears on the forehead, chest, or back. Factors such as prolonged antibiotic use, occlusive clothing, immunosuppression, or a disrupted skin microbiome (resulting from excessive overwashing or the use of harsh products) can all contribute to the yeast overgrowth that leads to this condition.

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What does fungal acne look like?

Fungal acne typically appears as small, uniform (monomorphic) red or skin-coloured bumps, often with pustules. These bumps usually occur in clusters and are commonly found on the forehead, hairline, upper back, chest, and shoulders.

A key distinguishing factor? Fungal acne is often itchy, unlike bacterial acne, which is more likely to be sore or inflamed.

It tends not to come with comedones (blackheads or whiteheads), and unlike typical acne, there are no cystic or nodular breakouts. If your breakouts worsen with heat, sweating, or the use of antibiotics, fungal acne might be the culprit. 

Also Read: Cystic Acne Removal Treatment in Singapore by Acne Specialist

Fungal acne vs closed comedones

At first glance, fungal acne can resemble closed comedones – small, flesh-coloured bumps caused by clogged pores. However, fungal acne tends to be itchier, more inflamed, and appears in symmetrical clusters, especially on the body. Closed comedones typically lack the itching and are more common on the face due to oil and sebum buildup.

Fungal acne vs regular or hormonal acne

Regular acne (acne vulgaris) is caused by a combination of Cutibacterium acnes bacteria, excess sebum, clogged pores, and hormonal shifts. It appears as a combination of blackheads, whiteheads, papules, pustules, and occasionally painful cysts or nodules, particularly on the face.

Hormonal acne tends to flare around the menstrual cycle and appears along the jawline and chin. It often presents as deep, cystic, and tender to the touch—fungal acne is rarely painful.

Fungal acne, on the other hand, is caused by an overgrowth of yeast (Malassezia), not bacteria. It shows up as small, uniform, itchy bumps—often on the forehead, chest, and back.

Here are their key differences:

FeatureFungal Acne (Malassezia Folliculitis)
Bacterial Acne (Acne Vulgaris)Hormonal Acne
CauseOvergrowth of yeast (Malassezia)Overgrowth of Cutibacterium acnes bacteriaHormonal fluctuations
LocationForehead, chest, back, shouldersFace, chest, backChin, jawline, lower cheeks
AppearanceSmall, uniform red or skin-coloured bumpsMixed lesions: blackheads, whiteheads, papules, pustules, nodulesDeep, cystic, inflamed breakouts
SymmetryOften symmetricalRareUsually sore or tender
ItchinessCommonPresent (blackheads and whiteheads)Might be present
ComedonesAbsentPresent (blackheads and whiteheads)Might be present
Response to AntibioticsMay worsenOften improvesLimited effect
TriggersHeat, sweat, humidity, and antibioticsOil, clogged pores, bacteriaMenstrual cycle, hormonal imbalances
Effective TreatmentAntifungals (topical/oral), antifungal shampoosBenzoyl peroxide, retinoids, and antibioticsHormonal therapy, retinoids, gentle exfoliants

I’d like to add that a common myth I often hear is that fungal acne only affects people with poor hygiene. This is false—Fungal acne is related to yeast imbalance, not cleanliness. If you’re struggling with fungal acne and overwashing, it may be the reason why your skin isn’t healing.

Are skincare ingredients like salicylic acid and niacinamide effective for fungal acne?

Both salicylic acid and niacinamide can support the skin when dealing with fungal acne, but neither is a standalone cure for the condition.

  • Salicylic acid helps exfoliate and clear pores, reducing buildup that feeds the yeast. However, it won’t directly target the yeast itself.
  • Niacinamide is anti-inflammatory and helps repair the skin barrier, which is beneficial when you’re calming a fungal outbreak.

That said, some popular acne treatments may worsen fungal acne. Ingredients like fatty acids, esters, and polysorbates (often found in moisturisers and makeup) can feed Malassezia.

Ingredients to Avoid for Fungal Acne – And Why

Fungal acne isn’t just about what you treat it with—it’s also about what you avoid. Certain skincare ingredients can feed the yeast behind fungal acne, making symptoms worse even when your routine seems “clean.”

Here are some common culprits to steer clear of:

  1. Fatty Acids (e.g. Oleic Acid, Stearic Acid, Lauric Acid)
    These can act as a food source for Malassezia, the yeast responsible for fungal acne. Fatty acids can contribute to overgrowth and exacerbate fungal acne breakouts.
  2. Esters (e.g. Isopropyl Palmitate, Glyceryl Stearate, PEG Compounds)
    Esters are often used to create a creamy texture in skincare, but they can also be fungal-feeding, which can worsen or trigger fungal acne flares.
  3. Oils High in Oleic Acid (e.g. Olive Oil, Wheat Germ Oil, Peanut Oil)
    These oils can disrupt the skin barrier and promote yeast overgrowth, which is particularly problematic if your skin is already compromised.
  4. Fermented Ingredients (e.g. Galactomyces, Bifida Ferment Lysate)
    Although trendy in skincare, fermented ingredients can worsen fungal acne due to their potential to feed yeast.
  5. Polysorbates (e.g. Polysorbate 20, 60, 80)
    Used as emulsifiers in creams and serums, these ingredients can feed Malassezia and contribute to clogged follicles.

What makes fungal acne worse?

Several factors can exacerbate fungal acne:

  • Overuse of antibiotics disrupts the bacterial balance on the skin.
  • Occlusive skincare and makeup with esters, oils, and fatty acids that feed Malassezia.
  • Sweaty, humid environments that promote yeast overgrowth.
  • Tight, synthetic clothing that traps moisture.
  • Conventional acne treatments, such as benzoyl peroxide and oral antibiotics, often fail to target yeast and may exacerbate symptoms.

Treatment options for fungal acne

To effectively treat fungal acne, the focus should be on antifungal agents. Options include:

  • Topical antifungals, such as ketoconazole cream or shampoo, selenium sulphide, and ciclopirox, are all effective topical agents.
  • Oral antifungals: For more severe or widespread cases, dermatologists may prescribe oral itraconazole or fluconazole. Always consult a medical professional before starting these.
  • Antifungal shampoos: Over-the-counter dandruff shampoos (like Nizoral or Head & Shoulders) containing ketoconazole, zinc pyrithione, or selenium sulfide can be used as a body wash.

Be sure to keep the skin cool, dry, and non-occluded. Avoid heavy moisturisers, rich oils, and tight clothing during a flare.

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Does dandruff shampoo help with fungal acne?

Yes – and quite effectively. Dandruff shampoos containing ingredients like ketoconazole, selenium sulphide, or zinc pyrithione can be applied to affected areas like a mask and left on for several minutes before rinsing.

Doing so allows the antifungal ingredients to penetrate and work on the skin. It’s a cost-effective and accessible first-line treatment for mild to moderate cases.

Studies have demonstrated that shampoos containing proven antifungal compounds, such as ketoconazole (Nizoral 1% and 2%), are significantly more effective at killing Malassezia yeast compared to other commercial options. Additionally, 2% Nizoral shampoo has been proven to be 100 times more effective than non-ketoconazole shampoos tested.

Final thoughts on clearer days ahead

Fungal acne can be stubborn, confusing, and emotionally draining, especially when it’s mistaken for regular acne. However, with the appropriate knowledge and treatment, it can be well-managed.

If your breakouts are itchy, symmetrical, and unaffected (or worsened) by antibiotics, it may be time to consider treatment for fungal acne.

A professional diagnosis can save you months of trial and error in skincare. If you suspect you may be dealing with fungal acne, speak to us today for personalised treatment options.

Your skin deserves care that truly works for you.

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