Fungal acne, medically known as Malassezia folliculitis, is a common skin condition often confused with traditional acne. Both manifest as bumps and blemishes, but fungal acne is distinct, particularly concerning the types of lesions it causes. These can sometimes be mistaken for cysts, and understanding this difference is important for effective treatment.
Understanding Fungal Acne
Fungal acne occurs due to an overgrowth of Malassezia yeast, which naturally resides on the skin. This yeast proliferates within hair follicles, leading to an infection. Unlike bacterial acne, which involves clogged pores and bacteria, fungal acne is a fungal infection of the hair follicles.
Malassezia thrives in warm, humid environments and feeds on skin oils, making certain areas prone to outbreaks. It typically presents as clusters of small, uniform, itchy bumps, often appearing on the chest, back, shoulders, and sometimes the face. The itchiness helps differentiate it from bacterial acne.
Fungal Acne Lesions and Cysts
While fungal acne causes various skin lesions, true, deep, pus-filled cysts are not a typical manifestation. It primarily results in inflamed papules (small, red bumps) and pustules (small, pus-filled bumps). These lesions are generally small and uniform, often resembling a rash.
Inflammation can make these appear larger, leading to them being mistaken for true cysts. However, they differ from the deep, encapsulated cystic lesions of severe bacterial acne, which involve significant inflammation and can lead to scarring. Recognizing this distinction is important, as misdiagnosis can lead to ineffective treatments; traditional acne medications, including antibiotics, can worsen fungal acne by disrupting the skin’s natural microbial balance.
Diagnosis and Management
Diagnosis typically begins with a visual examination for characteristic uniform, itchy bumps. To confirm Malassezia yeast, a skin scraping may be examined under a microscope using a potassium hydroxide (KOH) preparation. A Wood’s lamp examination, using ultraviolet light, may also be used, as Malassezia yeast can fluoresce yellow-green.
Management involves antifungal treatments. Topical antifungal creams like ketoconazole or clotrimazole are often prescribed. Antifungal shampoos with selenium sulfide or zinc pyrithione can also be used as body washes.
For severe or persistent cases, oral antifungal medications, such as fluconazole or itraconazole, may be necessary to reach deeper into hair follicles. Additionally, avoiding factors that promote yeast growth, such as excessive sweating, occlusive clothing, and certain oil-based products, helps prevent recurrence.