Acne is a common skin condition with various forms. It’s possible for different types of acne to appear simultaneously, making it important to understand their distinct characteristics for effective management.
Unpacking Bacterial and Fungal Acne
Bacterial acne occurs when hair follicles clog with excess oil and dead skin cells. This allows Cutibacterium acnes, a natural skin bacterium, to overgrow, causing inflammation, redness, and characteristic pimples, blackheads, and whiteheads. Lesions can vary in size, including deeper cysts or nodules, and commonly appear on the face, chest, and back.
Fungal acne, or Malassezia folliculitis, is a hair follicle infection caused by an overgrowth of Malassezia yeast, a natural part of the skin’s microbiome. An imbalance leads to small, uniform, itchy bumps or pustules, often appearing in clusters. Unlike bacterial acne, these outbreaks are intensely itchy and frequently found on the chest, back, shoulders, and sometimes the forehead.
When Both Appear Together
Both bacterial and fungal acne can occur simultaneously, even in the same skin area. This co-occurrence is due to shared environmental factors like warm, moist, and oily skin conditions that favor the growth of both Cutibacterium acnes and Malassezia yeast.
Disruption of the skin’s natural microbiome can also facilitate co-occurrence. For instance, prolonged antibiotic use for bacterial acne can reduce beneficial bacteria, allowing Malassezia yeast to overgrow. Genetic predispositions, increased oil production, sweating, and a compromised skin barrier can also contribute to the simultaneous development of both conditions.
Recognizing Dual Acne
Distinguishing between bacterial and fungal acne can be challenging due to their similar appearance. While bacterial acne presents with varied lesion types like blackheads and inflamed pimples, fungal acne typically manifests as small, uniform, itchy bumps or pustules, often in clusters, particularly on the chest, back, and upper arms.
Given the symptom overlap, professional diagnosis by a dermatologist is important for accurate identification. Dermatologists conduct a visual inspection and inquire about patient history. To confirm, they may perform skin scrapings for microscopic examination to identify Malassezia yeast or use a Wood’s lamp, under which some fungi may glow.
Navigating Treatment
Treating bacterial acne often involves topical medications like retinoids, which prevent clogged pores, and benzoyl peroxide, which reduces surface bacteria. Topical or oral antibiotics may also be prescribed to reduce bacteria and inflammation, though long-term use is cautious due to resistance risks and microbiome disruption. Salicylic acid also helps exfoliate dead skin cells and unclog pores.
For fungal acne, treatment primarily targets Malassezia yeast overgrowth. Topical antifungal creams with ingredients like ketoconazole or clotrimazole are common. Antifungal shampoos containing selenium sulfide or zinc pyrithione can also be used as body washes. In widespread or severe cases, oral antifungal medications such as fluconazole or itraconazole may be prescribed.
When both conditions coexist, a tailored, multi-pronged approach under professional guidance is necessary. Treating one condition inappropriately, such as using antibacterial treatments for fungal acne, can worsen the other by allowing yeast to flourish. A dermatologist can devise a comprehensive plan combining antifungal and antibacterial therapies, while also addressing skincare routines and lifestyle choices that affect the skin environment.