While it looks like acne and it feels like acne, fungal acne isn't really acne at all. That's what makes the products to treat fungal acne so surprising. "Fungal acne is caused by a type of yeast called Malassezia," says Lavanya Krishnan, MD, board-certified dermatologist at Arya Derm. "Malassezia is normally found on the skin, and usually lives in symbiosis with normal types of skin bacteria.
What causes fungal acne?
Conditions that cause the yeast to overgrow, such as excess sweating, or that cause a decrease in the skin bacteria, such as after taking antibiotics, or that affect the immune system, such as diabetes, can lead to fungal acne. Some people are also genetically predisposed to overgrowth of Malassezia on their skin, and can therefore develop fungal acne more often."
How do you treat fungal acne?
Because it's more like facial dandruff than acne, your typical pimple-fighting products aren't going to do the trick, but you'll need to speak with a dermatologist to determine if you have fungal acne. "I typically make a fungal acne diagnosis after traditional treatments for acne don't work," says New York City-based dermatologist Joshua Zeichner, MD. What does work, though, is using dandruff shampoo... on your face.
"You can use your dandruff shampoo as a liquid cleanser for your face, neck, and chest. These shampoos contain ingredients that lower levels of yeast on the skin. The same type of yeast that caused fungal acne can cause dandruff," says Dr. Zeichner. "Simply apply the shampoo on the skin and let it sit while you sing the alphabet before rinsing it off. The shampoo needs enough contact time with the skin for it to do its job."
What to look for in a fungal acne product
Dr. Michael Jacobs, Medical Technology Director at Cortina and Clinical Associate Professor of Dermatology at Weill Cornell Medical College, says when trying to pick an over-the-counter product (OTC) to fight fungal acne, there are some key ingredients. He recommends looking for ketoconazole (which acts as one of the strongest to fight fungal acne), selenium sulfide, fluconazole, salicylic acid, niacinamide, tea tree oil, and zinc gluconate. "For an OTC product, it is also important to make sure that the brand is backed by dermatologists and experts to ensure no false claims are being made," he says.
Because fungal acne is an infection the hair follicles of the skin caused by Malassezia and not true acne, it "responds much differently than whiteheads and blackheads to traditional OTC acne-fighting skincare ingredients, like benzoyl peroxide and salicylic acid," say Cosmetic Dermatologist Dr. Michele Green. "These ingredients may actually worsen fungal acne instead of helping to resolve it. Instead, patients should stick to anti-fungal ingredients like ketoconazole (a common ingredient in dandruff shampoos), sulfur, and zinc pyrithione."
Best Fungal Acne Products
“This shampoo contains zinc pyrithione, which effectively lowers levels of yeast on the skin, making it effective in treating dandruff. It can also be useful if you have fungal acne,” says Dr. Zeichner. “This product is also enriched with a blend of Chinese herbs that soothe inflammation.”
“Selenium sulfide is another ingredient that helps lower levels of yeast on the skin,” says Dr. Zeichner. “Keeping yeast levels low will reduce the driving force behind the inflammation causing fungal acne.”
“For particularly stubborn cases of fungal acne, over-the-counter and prescription topical antifungal creams, such as clotrimazole and ketoconazole, can be effective,” says Dr. Krishnan.
“This shampoo contains salicylic acid, which helps remove excess oil from the skin and exfoliate dead cells,” says Dr. Zeichner. “Once you get your fungal acne under control, you can use this product as a body wash to lower the risk of recurrence. Removing excess oil from the skin will create an inhospitable environment for yeast to grow.”
“Seborrheic dermatitis is treated based on individual symptoms and you may need to treat the condition as it flares up. If it’s mild, topical antifungal creams and OTC creams can help manage symptoms,” says Dr. Reid Maclellan, Founder and CEO, Cortina and Adjunct Faculty at Harvard Medical School and director of Proactive Dermatology Group
He says that this TULA moisturizer has 2% salicylic acid, azelaic acid, and niacinamide, which help clear the pores and address hyperpigmentation. It also has watermelon and aloe to help soothe skin.
Dr. Audrey Kunin, a board-certified dermatologist & founder of DERMAdoctor, recommends looking for an anti-dandruff product that contains pyrithione zinc or selenium sulfide to help kill these yeast. The DERMAdoctor cleaner is gentle and has 2% Pyrithione Zinc to “help make skin inhospitable to the pityrosporum yeast responsible for fungal acne,” she says.
Here's how to deal with adult acne:
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