Will Washing Your Face With Shampoo Get Rid Of Fungal Acne?

Illustration by Olivia Santner
Online forums wield great power. Places like /r/SkincareAddiction and MakeupAlley made The Ordinary into a smash hit, popularised techniques like double cleansing and helped spread the gospel of Korean skincare. They also give you a space to do very important things, like rate the Hollywood Chrises in order of hotness (Messina is number one, don’t @ me). However, for all the genuinely insightful and useful tips they can bring, they also have the power to make mountains out of molehills and turn very uncommon or largely unproblematic conditions or ingredients into a huge panic. And so: fungal acne.

I’d never heard the term until last year and now it’s almost inescapable, generating countless online threads and Instagram infographics. It’s a very popular topic on /r/SkincareAddiction – if you search the term there, you'll find the results are equal parts "Is this fungal acne?" and "Here’s how I cured my fungal acne". 
"While I do understand why the term is used diagnostically, fungal acne is a bit of a misnomer," confirmed consultant dermatologist Dr Mary Sommerlad. "Although the tender red spots you get with fungal acne can look like classic acne and it’s most common in young people, there are several important differences. Namely, there are no comedones (blackheads and whiteheads), no seborrhoea (excessive oil production) and no hormonal influence in fungal acne," she explained.

Quick pimple primer: the anatomy of a spot is excess oil plus acne bacteria, plus inflammation, plus a blocked pore. We all have acne bacteria on our skin but we don’t all have acne, as some of these spot-causing factors are synergistically linked. The more sebum you produce, the more clogged your pores will be; the more clogged your pores are, the more inflammation you’ll develop, and so on. Hormonal surges like the testosterone increase seen in ovulating people around their period can also cause an increase in sebum, which puts you right back on that rollercoaster.
Fungal acne is different. In fact, it’s much more similar to dandruff than it is to a breakout, says Dr Sommerlad. "Fungal acne is actually a type of folliculitis," she explained. It’s unlikely to appear on your face as "[fungal acne] predominantly affects the back and chest of young people. It’s a yeast infection, sometimes called pityrosporum folliculitis or malassezia folliculitis." If you’ve had dandruff in the past, you might recognise the term malassezia as that yeast is also implicated in dandruff and seborrhoeic dermatitis cases. However, Dr Sommerlad explained: "The two conditions are quite different in appearance and treatment." Fungal acne usually presents as sore red bumps on the back and chest, whereas seborrhoeic dermatitis is more about the scales on the skin, often on the scalp and eyebrows, with a greasy sheen. 
@teawithmd #stitch with @parmidarobateau yes you can! I prescribe #nizoral for #fungal #acne #tineaversicolor #seborrheicdermatitis and more. BUT make sure you know what you’re treating first… #dermbypark #fungalacne #skincare ♬ original sound - Dr. Joyce Dermatologist
We all have malassezia present on our skin but not everyone develops fungal acne. So what’s the trigger? "Fungal acne is most commonly triggered by using heavy occlusive moisturisers and sunscreens, the combination of tight clothes and sweat (think exercising in Lycra) and humid weather," explained Dr Sommerlad. If you’re guilty of lounging around in your athleisure after a sweaty HIIT session, here’s yet another reason to whip it off and shower sharpish. "When you have that tight barrier over sweaty skin, the malassezia can go from being harmless to triggering folliculitis," explained Dr Sommerlad, noting that a suppressed immune system, steroid and antibiotic use and immune conditions can also cause it. Fungal acne usually appears in very large numbers and congregates on the aforementioned back and chest but can also crop up on the neck, jawline and backs of arms – anywhere you might get that kind of tight pressure or sweating.
If you think you have fungal acne, help is at hand. Besides those lifestyle factors, Dr Sommerlad said that shampoo could be an unlikely hero. "A medicated shampoo like ketoconazole shampoo, left on for two minutes then rinsed off, for 14 consecutive days is a good initial treatment," she explained, adding that after the initial two-week sprint you should do it twice a week preventatively. "It can be a recurring condition however, so you’ll need to be scrupulous with your showering and change your towels every other day, as well as switching to very light body products," cautioned Dr Sommerlad, adding that asking for a dermatology referral is possible if it’s proving indefatigable. 
TL;DR? Unless it’s on your back or chest, incredibly numerous in appearance, red and without comedones...it’s probably not fungal acne. And if you’ve never experienced any of what I’ve described above? Keep doing what you’re doing. You’re doing fine.
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