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By Dr Christopher Ross, Dermo Direct — a dermatologist who sees this all the time
Every week I see patients who are absolutely convinced they have “fungal acne.” They’ve read about it online, watched TikTok skincare videos, or spent months trying antifungal shampoos on their face because someone on Reddit swore it was the cure.
Most of them are frustrated. Many have tried every over-the-counter option they can find. A few have even been prescribed acne treatments that didn’t make a dent.
And almost always, the problem is the same:
“Fungal acne” isn’t actually acne — and the name itself is misleading.
So what is “fungal acne” really?
The condition people are usually talking about is Malassezia folliculitis (also known as Pityrosporum folliculitis).
This isn’t acne at all.
It’s an inflammation of hair follicles caused by an overgrowth of Malassezia, a yeast that normally lives on all of our skin. Under certain conditions — humidity, sweating, antibiotics, heavy moisturisers, or occlusive makeup — this yeast can multiply and irritate the follicles.
The bumps it causes can look like acne, but they behave very differently.
How Malassezia folliculitis differs from acne (the real kind)
1. No comedones (blackheads or whiteheads)
This is the biggest giveaway.
True acne always involves clogged pores.
Malassezia folliculitis never does.
2. It’s often itchy
Acne usually isn’t.
Patients often say:
“It feels prickly or itchy after I sweat.”
3. All the bumps look the same
MF tends to cause small, uniform bumps — dermatologists call this a “monomorphic” eruption. Acne, on the other hand, is usually a mix of:
- comedones
- red inflamed papules
- pustules
- sometimes deeper cysts
4. It flares with heat, sweat, and friction
Think gyms, cycling, synthetic clothing, hot weather.
5. Acne treatments don’t help
Benzoyl peroxide, retinoids, antibiotic creams — they usually don’t improve MF and can sometimes make things worse.
6. It responds quickly to antifungal treatment
This is often the clincher.
Once the correct diagnosis is made, antifungal therapy usually works within 1–2 weeks.
Why so many people misdiagnose themselves online
Social media oversimplifies skin conditions
Unfortunately, platforms like TikTok reduce complex dermatology into:
- 10-second clips
- checklists
- product “must-haves”
This results in the classic:
“I definitely have fungal acne; it matches all the signs!”
But when we actually examine the skin, it often doesn’t.
Acne and Malassezia folliculitis can occur together
This makes things even more confusing.
Someone may have blocked pores and folliculitis at the same time, so treating only one condition never leads to full clearance.
Over-the-counter antifungal products are often too weak
Ketoconazole shampoo used as a face wash, for example, is rarely enough by itself for moderate or widespread folliculitis — so patients assume they “must not have fungal acne after all.”
A quick refresher: what is real acne?
Acne comes in several true subtypes:
1. Comedonal acne
Blackheads and whiteheads.
Most common on the forehead, nose, and chin.
2. Inflammatory acne
Red, sore bumps and pustules.
3. Nodulocystic acne
Deep, painful lumps.
High risk of scarring.
Often requires isotretinoin.
4. Rare severe forms (acne conglobata, acne fulminans)
These are urgent medical conditions and look nothing like Malassezia folliculitis.
None of these are caused by yeast or fungi.
How dermatologists diagnose Malassezia folliculitis (and why it matters)
In clinic, the diagnosis is usually straightforward.
We look for:
- absence of comedones
- monomorphic itchy bumps
- classic distribution (forehead, hairline, chest, back, upper arms)
- links with heat, sweat, antibiotics, moisturisers, or occlusion
Sometimes we do dermoscopy or microscopy, but most cases can be diagnosed on pattern alone.
And importantly, we assess whether acne is present as well — because it needs different treatment.
Why “fungal acne” home remedies often fail
Patients often come to me after weeks of:
- ketoconazole shampoo masks
- tea tree oil
- sulphur soaps
- salicylic acid
- over-exfoliation
- random Reddit routines
Most of these don’t work because:
- the diagnosis is wrong, or
- the strength is inadequate, or
- there’s coexisting acne, or
- the skin barrier has been damaged
Once a proper diagnosis is made, treatment becomes straightforward.
Effective treatment for Malassezia folliculitis
Dermatologists usually treat MF with:
- Oral antifungals (short, targeted course)
- Topical antifungal creams or washes
- Reducing occlusion (tight gym wear, heavy moisturisers, thick sunscreen)
- Sweat-management strategies
Most patients see clear improvement quickly.
Disclaimer: The information in this article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you may have about your skin or general health. Individual results may vary.