fungal acne: everything you need to know about malassezia folliculitis
As we’ve delved deeper into the realms of microbiology to explore the populations of microorganisms resident in and on our bodies, one thing has become clear: that the number of unicellular organisms that live on us, outnumber our own cells by a ratio of a whopping 9 to 1, and play critical roles in the regulation of our health.
Fungal acne, or if you want to be more technically correct, malassezia (pityrosporum) folliculitis, is a skin infection caused by pityrosporum yeast, or fungi, that form part of our skin’s resident microflora. While dissimilar from regular acne in that this infection is caused by yeast and not bacteria, the two conditions are similar in that both are a form of folliculitis and both are caused by an overgrowth of microbes that are normally resident on our skin.
While the causes of fungal acne are poorly understood, some factors can make people more prone to the condition. For instance, it is more common in patients with concerns like diabetes, HIV, organ transplant, and immunological deficiency, among others. Another common way in which the infection is brought about is by the prolonged use of antibiotics. These can alter the composition of our skin’s resident microflora causing the death of bacteria that keep the growth of malassezia in check and consequently, cause the malassezia on our skin to proliferate. This is all the more problematic because malassezia folliculitis is often misdiagnosed as acne and doctors are quick to prescribe antibiotics, which only make the condition worse. Some studies have also reported cases of malassezia folliculitis because of obesity, the use of steroids and birth control pills, and because of stress.
Understanding the differences between the two conditions is critical because both merit slightly different treatments that stem from the difference in the nature of the microbes that cause them. One critical difference is illustrated by the following example: acne patients are known to have sebum that tends to be deficient in linoleic acid. This deficiency causes sebum to thicken, and consequently, become more likely to clog pores. Supplementing a skincare regimen for acne with oils that have a high linoleic acid content, such as grapeseed, sunflower and rosehip oil as a result, tends to help acne sufferers. However, when it comes to malassezia, fatty acids with carbon chain lengths ranging from 11 to 24 (and this unfortunately includes pretty much all the oils we normally use, with the exception of our Medium Chain Triglyceride (MCT) Oil, which makes for a perfect moisturiser if your skin is prone to fungal acne), tend to feed the yeast and help it mushroom rapidly (which means that you can literally go from calm to inflamed skin overnight by using even a single product that isn’t fungal acne friendly!).
Malassezia are also able to metabolise a number of other ingredients commonly found in skincare, such as glycerin, to grow. They multiply faster in a pH range of 5.5 to 7.5 and in hot, humid climates, which explains the high incidence of malassezia folliculitis in countries like the Philippines, and from my personal experience, also in Pakistan.
As I mentioned previously in passing, it is often difficult to distinguish malassezia folliculitis from regular acne. A simple Google image search will, however, reveal the variety of different incarnations that fungal acne can have and some other key ways that you can tell the two apart include the following:
Your skin tends to itch. This is characteristic of malassezia folliculitis, but not of acne vulgaris.
You have small, uniform, whitehead-like lesions on your skin and there are a lot of them. These tend to be more common on oilier areas of your face, such as the forehead and close to the hairline, than they are on other parts of the face, but can be found pretty much anywhere, including your neck, chest and back. In a number of cases, fungal acne will also tend to spread.
You’ve tried antibiotics in the past but they either didn’t help, or only helped for a short period of time before becoming either ineffective, or actively making your acne worse. (Do not in any way interpret this statement of mine as supporting the use of antibiotics for acne. There are much better, more effective options that you can continue to use long-term without experiencing the negative effects of antibiotics on your health.)
By this point we’ve talked about what malassezia is, what causes it, what conditions make it worse, and how you can tell if you have it. The most important question however, still remains to be answered: how do you get rid of it? For starters, you need to keep in mind that if fungal acne is what you have, you can’t experiment a lot with skincare products and routines, even after the infection has cleared. This is due to the vexing tendency of fungal infections to return with a vengeance, the moment you create an environment that facilitates fungal growth. This means that, among other things, you need to steer clear of most oils and very hydrating products because hot, humid and oily is the yeast’s favourite growth medium.
The fastest way to treat fungal acne then is to have fungal acne friendly skincare products in your routine and to use topical ketoconazole 2% (if simply skincare isn’t giving results fast enough), a broad spectrum anti-fungal, in your routine for a few days till your acne settles. While this may not be necessary in all cases, it does generally help the acne settle down a lot faster than skincare alone. On the skincare front, there are a number of ingredients that can treat, and prevent fungal acne from coming back. These include honey, azelaic acid, sulfur, urea, and my personal favourite: salicylic acid. Salicylic acid helps exfoliate the skin and has the unique distinction of also being able to exfoliate the lining of the pore. In addition to anti-fungal properties, it also has anti-inflammatory and anti-bacterial properties and is an oil-soluble hydroxy acid, which means that it does an excellent job of clearing out clogged pores. And our personal favourite product for fungal-acne prone skin is our Salicylic Acid Pore Cleansing Emulsion.
Get in touch if you want help treating your acne or fungal acne and to find out how you can incorporate salicylic acid into your routine for maximum benefit!