Small bumps on the skin can be confusing. Fungal acne (Malassezia folliculitis) and closed comedones (whiteheads) both appear as small, skin-colored or whitish bumps, but their causes and treatments differ significantly. Accurate identification is important for achieving clearer skin.
Fungal Acne Explained
Fungal acne is an infection of the hair follicles caused by an overgrowth of Malassezia yeast, a type of fungus naturally present on the skin. This condition leads to clusters of small, itchy, red bumps or papules that tend to be uniform in size, typically ranging from 1 to 2 millimeters. Some bumps may also develop into whiteheads or pustules.
This yeast thrives in warm, humid, and damp environments. Factors contributing to its overgrowth include excessive sweating, hot and humid climates, wearing tight or non-breathable clothing, and using oil-based moisturizers and sunscreens. Certain medications, such as antibiotics, can disrupt the skin’s natural balance, allowing Malassezia yeast to proliferate. A weakened immune system also increases susceptibility.
Closed Comedones Explained
Closed comedones, commonly known as whiteheads, are a type of non-inflammatory acne lesion. They occur when hair follicles become completely blocked by a combination of excess sebum (the skin’s natural oil), dead skin cells, and sometimes bacteria. This blockage forms a small, flesh-colored or whitish bump that remains under the skin’s surface.
These bumps are typically non-itchy and can appear anywhere on the body, though they are most common on the face (particularly the forehead, chin, and cheeks), as well as the neck, chest, and back. Hormonal fluctuations (such as those during puberty, menstruation, or pregnancy) can increase sebum production, contributing to clogged pores. The use of pore-clogging cosmetics or skincare products can also exacerbate their formation.
Telling Them Apart
Distinguishing between fungal acne and closed comedones involves observing several key characteristics. Fungal acne typically presents as uniform, small, red or pink bumps that are often intensely itchy, appearing in clusters and may have a red border around them. In contrast, closed comedones are generally flesh-colored or whitish bumps that do not itch and vary more in size and shape; they may sometimes present with a visible “head.”
Fungal acne frequently affects areas like the chest, back, shoulders, and sometimes the forehead, chin, and scalp, especially areas prone to sweating. Closed comedones, while also found on the chest and back, are very common on the face, particularly the T-zone (forehead, nose, and chin).
Triggers can also help differentiate: fungal acne often flares up in hot, humid conditions or after sweating, whereas closed comedones are more linked to pore-clogging products or hormonal changes. Their response to treatment is a key indicator: fungal acne often worsens or shows no improvement with traditional acne medications, particularly antibiotics, because these do not address the underlying yeast overgrowth. Conversely, closed comedones may respond to conventional acne treatments aimed at unclogging pores.
General Treatment Considerations
Managing fungal acne often involves antifungal agents. Over-the-counter options commonly include washes or creams containing ingredients such as ketoconazole or selenium sulfide. Maintaining good hygiene, especially after sweating, and wearing breathable fabrics can help prevent recurrence by reducing the damp, warm environment favored by the yeast. Avoiding harsh scrubbing is also advisable, as it can irritate the skin.
For closed comedones, skincare routines focusing on gentle exfoliation and ingredients that prevent pore clogging are beneficial. Products containing salicylic acid help to exfoliate inside the pores and remove excess oil and dead skin cells. Topical retinoids, such as adapalene, are also effective as they promote skin cell turnover and help to prevent new blockages. Using non-comedogenic makeup and skincare products can significantly reduce the likelihood of pore occlusion.
When to Consult a Professional
It is advisable to consult a healthcare professional, such as a dermatologist, if skin bumps persist, worsen, or do not respond to general over-the-counter treatments. If there is uncertainty about the diagnosis, or if the skin condition is causing significant discomfort, pain, or distress, professional evaluation can provide clarity. A dermatologist can conduct a thorough examination and, if necessary, perform tests like a skin scraping to accurately identify the cause of the bumps and recommend a targeted treatment plan.