You don’t magically stop getting spots the day your turn 20. But if you’re wondering why you suddenly have acne a decade or three after being a hormonal teenager, we feel you. Now that wearing face masks has become de rigour, there’s been a marked rise in the number of people experiencing painful spots, also known as ‘maskne’. At the same time, there’s been an uptick in the number of Google searches for ‘fungal acne.’
Coincidence? We think not.
So since we’re here, let’s make sure you’re treating your blemishes the right way. Which is to say, understanding the difference between regular old acne and fungal acne…
What is fungal acne?
Unlike regular acne, which is triggered by bacteria, fungal acne is caused by yeast (yes, a fungus).
In medical circles, it is known as pityrosporum folliculitis or malassezia furfur, and inflames the hair follicles on your skin, leading to spots.
‘It’s perfectly normal for this yeast-y fungus to live on our skin after sex hormones switch on our oil glands at puberty,’ says skin expert Dr Sam Bunting. ‘It usually sits quietly, occupying its place in the skin’s microbiome, not causing much bother.’
But in certain instances it can get out of control and lead to breakouts:
Sweat: ‘Fungi grow best in warm, moist environments,’ says aesthetician Dr Kemi Fabusiwa. Which means, humid conditions caused by exercise and sitting around in sweaty, non-breathable clothes afterwards. ‘Wearing a face mask can also cause fungal acne as breathing into a closed-off space creates humidity and causes you to sweat.’
Overuse of antibiotics: After a course of antibiotics, there are changes to the skin’s microbiome. ‘This is because these medications decrease bacterial growth,’ says Dr Fabusiwa. ‘With less bacteria on the skin, the yeast is able to grow better and cause inflammation.’
Genetic predisposition: ‘Those who have oily skin or who are excessively sweaty are already at a higher risk of getting fungal acne,’ adds Dr Fabusiwa. While any condition that affects your immune system, like diabetes, can also predispose you to the condition.
Here’s how to tell the difference between bacterial and fungal acne
Fungal acne can look like regular acne, but there are a few key differences.
‘Fungal acne is characterised by fine red bumps with little white pustules. There are lots of them – and they all look the same,’ says Dr Bunting.
This is quite different to regular bacterial acne, where you see blocked pores, inflamed lesions, small pustules or large cysts.
The distribution is also different. Fungal acne can appear on the chest, upper arms and back. Dr Bunting says when it does appear on the face, ‘foreheads and temples, especially the hairline, are affected, whereas in adult women, bacterial acne typically strikes the lower face.’
Perhaps most noticeably, Dr Fabusiwa adds that fungal acne is often itchy and irritated. ‘For these reasons, you might notice that your regular acne treatment, which is usually antibacterial, isn’t effective in managing breakouts.’
How should you treat fungal acne?
Clearing up fungal acne may be as simple as making some tweaks to your lifestyle.
‘Use a fan and only exercise in well-ventilated areas; always wash your body and gym clothes straight afterwards; don’t use antibiotics unnecessarily and regularly change your facemasks,’ she goes on to explain.
Ingredient elimination will also help. Oils are off-limits. Fatty acids – linoleum, palmitic and oleic acids – which are found in coconut oil, only feed the fungus.
‘When I see a patient with fungal acne, the first thing I do is a skincare detox to simplify their routine and eliminate any cleansing balms or facial oils,’ says Dr Bunting. ‘It’s best to use a non-foaming gel cleanser and choose a moisturiser with care. I like Avene Tolereance Extreme Emulsion in this situation.’
She continues, ‘It’s not uncommon for fungal breakouts to co-exist alongside bacterial acne so I’ll treat them with the usual topical retinoids, benzoyl peroxide, and azelaic acid (staying away from all antibiotic-containing topicals).’
It’s also worth switching up your skincare regime to include a salicylic acid body wash to purge pores, and products containing tea tree oil, which is naturally antibacterial and can help to inhibit the growth of yeast.
Another option touted on the internet is dandruff shampoos containing selenium or pyrithione zinc. But Dr Fabusiwa warns, ‘the topical anti-fungals that you find in dandruff shampoos may be beneficial. But the most effective way to treat symptoms is with oral medication from your GP.’
To take the guess work out, we rounded up the best products to sooth your symptoms…
True, an anti-dandruff shampoo may not be the first product you'd reach for to wash your body. But it contains pyrithione zinc, which has an anti-fungal effect. For the best results, apply the shampoo to the affected area and leave for five minutes before rinsing.
A gentle jelly cleanser that even sensitive, acne-prone skin can tolerate. It thoroughly removes sunscreen, oil and grime without chipping away at the skin’s natural barrier.
This ticks so many boxes: it contains zinc; it soothes sensitive skin and it reduces oil production by up to 65%. Basically, it nixes some of the biggest triggers for fungal acne as soon as it hits your skin.
The wash-off clay mask features a trio of fungal acne-fighting ingredients: sulfur, as well as antioxidant-rich green tea and blemish-busting azelaic acid. Hat-trick.
This shampoo is frequently recommended by US dermatologists as a fungal acne treatment thanks to a combination of pyrithione zinc and selenium sulphide on the ingredients' list.
Don't be fooled by the fluffy pink texture. This cleanser packs a punch with 3% sulfur, a powerful anti-fungal, but still leaves skin comfortable thanks to soothing oats and honey.
This product just keeps selling out. And it's not hard to see why. Azelaic acid has anti-inflammatory effects so it's useful for taking down redness in spot-prone skin. More pleasing still, it's under a tenner.
With its minimalist formula, this moisturiser comes with Dr Bunting's stamp of approval. Containing just seven essential skin-friendly ingredients, this lightweight cream hydrates and soothes without riling skin prone to fungal acne.
A cocktail of tea tree and salicylic acid improves the appearance of blemishes in just 30 minutes. Simply dab onto areas of angry skin.