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Fungal Acne: Bumps That Refuse To Go Away

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Fungal acne, or pityrosporum folliculitis are acne-like bumps. It happens when yeast bacteria, which is naturally present on your skin, get under your skin and into your hair follicles causing inflammation, redness and itchiness.

Fungal acne is commonly misdiagnosed as acne vulgaris. Although often associated with common acne, this condition may persist for years without complete resolution with typical acne medications. The main distinction between fungal and the traditional acne is that the breakouts in the former are caused by fungus whereas bacteria is the main culprit in the common acne. Here is a more detailed science behind this, if you are interested.

Bumps on the forehead caused by fungal infection

Causes of Fungal Acne

  • Many skincare products, high humidity, hot weather, sweat, and excessive occlusion can cause malassezia skin conditions to get worse
  • Prolonged use of broad-spectrum antibiotics can alter the gut microbiota and skin flora causing malassezia to proliferate.
  • Patients with diabetes, HIV, Hodgkin’s disease, organ or bone marrow transplant recipients, or those with nutritional disorders, neurotransmitter abnormalities, and immunologic deficiencies.
  • It has been reported in cases of obesity, pregnancy, after steroid use, birth control pills, and stress/fatigue.

Is this Fungal Acne? How to Diagnose Yourself

The best way to know for sure if your acne is fungal is by getting a proper diagnoses from a doctor. This is usually done through a shave biopsy in one of the areas where it flares most (i.e. upper back, chest, shoulders, scalp, or t-zone area of the face). But if you are an armchair physician, like me, then below are some common symptoms to look out for:

  • Acne-like bumps on the face (especially t-zone)
  • Bumps on the back, chest, and shoulders.
  • Itchiness and redness on these areas
  • Pimples that don’t respond to traditional acne treatment i.e. benzoyl peroxide, and take a long time to disappear.
  • Breaking out from using most of the skincare products (toners, moisturizers, creams, oils etc)

What to Avoid if You Have Fungal Acne

Always make sure to check the ingredient list of your skincare product to see if the product is fungal acne safe since 98% of skincare products contain one of the following ingredients that you should avoid these like a plague!

Fatty acids and Oils.

Malassezia and other strains of fungus typically feed on oils with a fatty acid chain length of 11-24. This is also why fungal acne often appears in areas where sebum (oil) production is higher than other parts of the body.

This means that most skincare products available today (I’d say over 95% of them) are problematic because they almost always contain a variation of a fatty acid that will feed malassezia.

You should avoid using most oils and fatty acids. Here is a short list of oils that come in the 11-24 range:

  • Coconut oil
  • Palm oil
  • Grape seed oil
  • Olive oil
  • Castor oil
  • Flaxseed oil
  • Borage oil
  • Fish oil
  • Peanut oil

Yeast Ferments

People with Malassezia-associated diseases have a 10 to 1000-fold higher aryl hydrocarbon receptor (AhR) activating capacity compared to healthy controls. Ferments to avoid that increase the AhR activity:

  • Galactomyces
  • Saccharomyces

Antibiotics

Antibiotics will also increase your risk of getting fungal acne. But since they are an unavoidable part of life you should inoculate yourself with high quality probiotics following your antibiotic use.

Warm Weather and Sweating

Malassezia grows optimally at 32 to 37 degrees Celcius (89.6-98.6 Fahrenheit), hence, people who live in a warm climate are more susceptible to suffer from fungal acne.

Safe Ingredients for Fungal Acne

Squalane Oil

Similar to crude oils (e.g. mineral oil), squalane is a hydrocarbon derived by the hydrogenation of squalene. (88) This eliminates the double bonds which make it less susceptible to oxidation (i.e. has a longer shelf life than pure squalene).

Other oils that are safe to use: Neem Oil, MCT Oil & Mineral Oil.

Fatty Alcohols

Fatty alcohols do not feed Malassezia. Some of the things to look for in the ingredient list: Sodium Cetearyl Sulfate, Cetearyl Alcohol, Stearyl Alcohol.

Products That Are Fungal Acne Safe

Cleansers

  • Bioderma Sensibio Micellar Water
  • Cetaphil Gentle Skin Cleanser
  • Himalaya Neem Face Wash
  • Head and Shoulders shampoo as a face wash (warning: too drying. Make sure you hydrate your skin afterwards)

Chemical Exfoliants

  • COSRX AHA 7 Whitehead Power Liquid
  • COSRX BHA Blackhead Power Liquid

Toners / Hydrators, Emulsions, Essences

  • Etude House SoonJung pH 5.5 Relief Toner
  • Avène Thermal Spring Water
  • COSRX Advanced Snail 96 Mucin Power Essence
  • Hada Labo Hyaluronic Acid Lotion
  • Hada Labo Gokujyun Premium Lotion
  • Klairs Supple Preparation Toner

Moisturizers

  • Sebamed Clear Face Gel
  • Hada Labo Skin Plumping Gel Cream
  • Benton Aloe Propolis Soothing Gel

Occlusives

  • Vaseline

Sunscreens

  • Biore UV Perfect Bright Milk SPF 50
  • Biore UV Perfect Face Milk SPF 50
  • Biore UV Perfect Milk SPF 50
  • Skin Aqua UV Super Moisture Milk SPF 50
  • Sunplay Baby Milk SPF 34 PA+++
  • Nivea Sun Protect Super Water Gel SPF 50
  • Bioderma Photoderm LEB SPF 30

Treatment of Fungal Acne (including natural remedies)

Azelaic Acid

Azeliac acid has been shown to work on both anaerobic and aerobic microorganisms. It also reduces the overall fatty acid content of skin. The composition of human sebum that has been exposed to pathogenic malassezia is abnormally high in free fatty acids.

One of the mechanisms by which antifungals work against malassezia folliculitis, is by regulating the free fatty acid content of skin. Azelaic acid has been shown to do exactly that. In fact, one study found that the level of free fatty acids was reduced from 15.9 to 10.5% after 1 month of using azelaic acid.

Caprylic Acid Oil

According to a study caprylic acid specifically has the strongest antifungal properties.

You can use pure caprylic acid oil to oil cleanse, or add a few drops of it into your moisturizer of choice.

Cinnamic Acid

Cinnamic acid has antifungal activity against Malassezia species. It’s obtained from cinnamon oil, balsams such as storax, or shea butter.

Green Tea Extract

According to a study, using 5% green tea extract in a bath 3 times weekly for 30 minutes kills M. sympodialis and heals eczema after 4 weeks.

Honey and Propolis Extract

It’s no secret that honey has powerful antimicrobial effects against pathogens that cause skin disorders. Studies have shown that some variations of honey like manuka, scottish heather, and tualang inhibit the growth of staphylococcus aureus, pseudomonas aeruginosa, and escherichia coli.

Salicylic Acid (BHA)

Salicylic acid is a keratolytic and has anti-inflammatory, anti-bacterial, and anti-fungal properties. It’s an oil-soluble hydroxy acid meaning it does a great job of dissolving all the gunk inside of clogged pores.

Tea Tree Oil

A few in vitro and in vivo studies have shown that Melaleuca alternifolia (tea tree oil) has strong antimicrobial properties against malassezia including M. furfur.

Urea

Studies conducted so far on Urea prove that it treats ichthyosis, xerosis, atopic dermatitis/eczema, contact dermatitis, radiation induced dermatitis, psoriasis, seborrheic dermatitis, onychomycosis (i.e. nail fungus), tinea pedis, keratosis, and pruritus.

Aloe Vera

Aloe vera gel has anti-inflammatory, anti-bacterial, and anti-fungal properties. It’s recommended to use pure aloe vera mask rather than aloe vera gel products.

 

Note: The recommendations and advice mentioned in this article is not a substitute for medical advise. Please consult your dermatologist before starting any treatment or product.

Please also do patch tests before starting any new products to ensure you do not have a sensitivity to an ingredient.

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