Malassezia yeast, itching and folliculitis

Fungal acne on face

Itchy, same size bumps on the forehead and hairline that antibiotics don't clear often come from yeast in the hair follicles; a ketoconazole or other antifungal wash treats them.

  • Uniform Appearance
  • Intense Itching
  • Common Locations
  • Resistance to Antibiotics

Last reviewed

Symptoms: How to Identify It

Uniform Appearance

The bumps all look the same size, small and evenly spread.

Intense Itching

The bumps itch, often more than regular pimples do.

Common Locations

Forehead and hairline on the face, often with the chest and upper back. Breakouts on the jaw and chin that follow your cycle are more often hormonal acne than yeast.

Resistance to Antibiotics

They got worse, or no better, on antibiotics.

HAIRLINEFOREHEAD
The forehead and hairline zones, the usual places for fungal acne on the face.

Answer all four to see where you land.

What fungal acne on the face is

Fungal acne on the face is an itchy rash of small bumps caused by yeast in the hair follicles, not by the bacteria behind regular acne. It means acne creams and antibiotics often miss it, while antifungals clear it. The cause of fungal acne is yeast overgrowth: Malassezia, a yeast that normally lives on skin, multiplies inside the follicle. Doctors call it Malassezia folliculitis (also called Pityrosporum folliculitis).

  • 28.8%of 320 people diagnosed with acne also had fungal acne
  • 7.38×more likely to itch than people with regular acne
  • 8.89×more likely to have spots on the scalp or hairline

The same study found that judging by looks alone can mislead, which is why a sample under the microscope is the real test. Short of that, a photo analysis of your skin can point to the likely cause.

What Causes and Triggers It

Yeast Overgrowth

Malassezia is a normal skin yeast that can turn into a problem when conditions favor it, and it then grows in the hair follicle.

Environment

Heat, humidity and clothing that covers the skin help it along.

Products and Meds

Antibiotics are a classic trigger: in a review of 110 cases, more than 75% had recently taken antibiotics for acne. A weakened immune system, from illness or medicines, raises the risk too.

How It Is Treated

Treatment for fungal acne on the face is an antifungal, as a wash, a cream or a pill.

Antifungal Washes

  1. Wet the skin and lather a ketoconazole shampoo over the bumps and the skin around them.
  2. Leave it on for 5 minutes, then rinse well. Keep it out of your eyes and mouth.
  3. Repeat as often as your doctor or the label says. Over the counter, ketoconazole shampoo is a dandruff product used every 3 to 4 days, so ask a pharmacist before using it on your face.

Topical Antifungals

Antifungal creams and washes worked for 81.6% of people in a review of 15 studies.

Oral Antifungals

Antifungal pills, prescribed by a doctor, worked best in that review at 92%. A Danish guideline adds that pills are probably more effective than creams, and a combination may be best.

Skincare Adjustments

Relapses are common, so many people keep using a wash from time to time after the rash clears.

What can be mistaken for it

  • Regular acne: if your check pointed toward regular acne, this is the likely one. Blackheads, whiteheads and mixed-size spots are regular acne; start with how to get rid of pimples.
  • Cysts: deep, painful lumps are not fungal; they need cystic acne treatment, often from a dermatologist.
  • Other folliculitis: hair follicles can get inflamed by other germs, and only a sample tells them apart.

See a dermatologist if

  • Nothing improves after 2 to 4 weeks of washing
  • The rash spreads or turns painful
  • You have a weakened immune system

Reader questions

How to tell if your acne is fungal acne?

Run the four signs: bumps all the same size, itching, a spot on the forehead and hairline, and no change on antibiotics. Three or four of those point toward fungal acne, but only a skin sample under a microscope confirms it. Want a read from a photo first? Start the analysis.

Can you squeeze out fungal acne?

Better not. The yeast lives inside the hair follicle, so squeezing doesn't treat it, and picking any spot can lead to infection and scars. Let an antifungal wash do the work.

What can be mistaken for fungal acne?

Regular acne, mostly. In one study, more than a quarter of people diagnosed with acne had fungal acne too, or instead. Other kinds of folliculitis can look alike as well.

Will fungal acne eventually go away?

It usually needs treatment, and most cases clear with an antifungal. It also likes to come back, so many people keep using a wash now and then to stop relapses.

Is fluconazole effective in treating fungal acne?

Fluconazole is an antifungal pill, and pills worked best in studies: 92% responded to oral treatment against 81.6% for creams and washes. It's prescription only, so a doctor decides whether it fits and how to take it.

Sources

  1. Prevalence, associated factors and clinical characterization of Malassezia folliculitis in patients clinically diagnosed with acne vulgaris (2022). PubMed 36531566
  2. Pityrosporum folliculitis: a retrospective review of 110 cases (2018). PubMed 29138059
  3. Clinical characteristics and treatment outcomes of Pityrosporum folliculitis in immunocompetent patients (2023). PubMed 36517586
  4. Critical synthesis of available data in Malassezia folliculitis and a systematic review of treatments (2020). PubMed 32012377
  5. Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases (2015). PubMed 24556907
  6. MedlinePlus. Ketoconazole topical. medlineplus.gov/druginfo/meds/a605014.html
  7. MedlinePlus. Acne. medlineplus.gov/ency/article/000873.htm

Last reviewed .

This page is general information, not a diagnosis. See a dermatologist if the bumps don't improve after a few weeks of antifungal washing, spread or hurt, or if your immune system is weakened.