Fungal Acne (Malassezia Folliculitis): Symptoms, Causes and Treatment
Fungal skin guide
Fungal acne, medically called Malassezia or Pityrosporum folliculitis, is an itchy rash of small, same-sized bumps and pustules caused by an overgrowth of Malassezia yeast in the hair follicles. It usually appears on the chest, upper back, shoulders and forehead, often after sweating or a course of antibiotics, and it does not clear with ordinary acne treatment. Antifungal washes and creams are the main treatment.
- Fungal acne is itchy, with uniform 1 to 2 mm bumps and no blackheads or whiteheads.
- In a review of 110 young patients, more than 75% had recently taken antibiotics for acne.
- Ketoconazole shampoo used as a body wash improved or cleared most cases; widespread cases may need antifungal tablets.
- Steroid creams can make fungal infections worse, so choose steroid-free products for the itch.
What is fungal acne?
Malassezia is a yeast that normally lives on oily skin. In hot, humid conditions, or when the skin's normal bacteria are reduced by antibiotics, it can overgrow inside hair follicles and trigger an itchy, inflamed rash. Doctors call this Malassezia folliculitis; the older name is Pityrosporum folliculitis. It mainly affects young to middle-aged adults and people with weakened immune systems (Vlachos et al., 2020).
How is fungal acne different from regular acne?
| Feature | Fungal acne | Regular acne |
|---|---|---|
| Itch | Common and often marked | Uncommon |
| Bumps | Small and all the same size | Mixed sizes, sometimes deep cysts |
| Blackheads and whiteheads | Absent | Typical |
| Where | Chest, upper back, shoulders, forehead and hairline | Face, chest and back |
| Response to antibiotics | No improvement or worse | Often improves |
In a review of 110 young patients with confirmed fungal acne, 65% reported itch, and the bumps were typically 1 to 2 mm, uniform and on the forehead, hairline and upper back (Prindaville et al., 2018).
What causes fungal acne?
- Heat, humidity and sweat, especially in tropical climates or after exercise
- Antibiotics, which reduce the bacteria that normally keep yeast in check
- Tight, non-breathable clothing such as gym wear
- Heavy, oily skin products on the chest, back or face
- Weakened immunity, including diabetes, or medicines such as oral steroids
How is fungal acne diagnosed?
A doctor can usually suspect it from the itchy, uniform bumps and a history of antibiotics or sweating. It is confirmed by examining a sample from a bump under a microscope to see the yeast. A European position statement recommends this kind of direct testing, because fungal acne is easily mistaken for regular acne or bacterial folliculitis (Henning et al., 2023).
How do you treat fungal acne?
| Treatment | How to use |
|---|---|
| Antifungal shampoo as a body wash (ketoconazole, selenium sulfide) | Lather on the affected skin, leave for 5 minutes, rinse; daily for 2 to 4 weeks |
| Antifungal creams (ketoconazole, clotrimazole) | Thin layer once or twice a day on affected areas |
| Oral antifungal tablets | Prescribed by a doctor for widespread or stubborn cases |
| Maintenance wash | Once or twice a week to stop it coming back |
Ketoconazole shampoo was the most common treatment in the 110-patient review and led to improvement or resolution in most cases, with some patients needing oral antifungals (Prindaville et al., 2018). Fungal acne often returns, so a weekly maintenance wash is commonly advised.
What home care helps prevent fungal acne?
- Shower soon after sweating and change out of damp clothes.
- Wear loose, breathable cotton.
- Switch to lighter, oil-free products on affected areas.
- Wash towels and gym clothes regularly.
- Avoid using steroid creams on the rash, which can make fungal infections worse.
How does the Chinese herbal approach help?
In TCM, itchy pustules in hot, humid conditions are linked with Damp-Heat in the skin. External herbs that dry Dampness, clear Heat and stop itching are traditionally used, and modern laboratory studies support their antifungal potential:
- She Chuang Zi extract inhibited the fungus Trichophyton rubrum and damaged its structure (Yanyun et al., 2021).
- Ku Shen alkaloid oxymatrine reduced Malassezia biofilm formation and skin inflammation in laboratory and mouse research (Liu et al., 2025).
- Borneol and menthol calm itch through the skin's cold-sensing channels (Tian et al., 2023).
QICAOGANGMU: steroid-free itch relief
QICAOGANGMU combines She Chuang Zi 3% and Ku Shen 1.5% with cooling Bing Pian (borneol) 2% and menthol 0.5% and Bai Bu 0.5%. Because it is steroid-free, it is a good choice to soothe itchy bumps alongside an antifungal wash. Finished batches are independently tested by TÜV SÜD PSB, with Not Detected results for eight corticosteroids.
When should you see a doctor?
- The rash does not improve after 2 to 4 weeks of antifungal washes
- It is widespread, painful or keeps coming back
- You have diabetes or a weakened immune system
- You are unsure whether it is acne, fungal acne or another rash
Frequently asked questions
How do I know if I have fungal acne?
Fungal acne usually causes itchy, small bumps that are all the same size, without blackheads or whiteheads, on the chest, upper back or forehead. It often appears after sweating or antibiotics and does not improve with acne treatment.
What is the fastest way to get rid of fungal acne?
Use an antifungal shampoo such as ketoconazole as a body wash, leaving it on for 5 minutes daily, plus an antifungal cream on affected areas. Widespread cases may need antifungal tablets from a doctor.
Can antibiotics cause fungal acne?
Yes. Antibiotics reduce the skin bacteria that normally keep yeast in check. In one review, more than 75% of patients with fungal acne had recently taken antibiotics for acne.
Should I use a steroid cream on fungal acne?
No. Steroid creams can make fungal infections worse. Use antifungal treatment and a steroid-free product to soothe the itch.
Does fungal acne come back?
It often does, especially in hot, humid weather. A weekly antifungal wash, showering after sweating and wearing breathable clothing help prevent it.
Related articles
References
- Vlachos C, Henning MAS, Gaitanis G, et al. Critical synthesis of available data in Malassezia folliculitis and a systematic review of treatments. J Eur Acad Dermatol Venereol. 2020;34(8):1672-1683. PMID 32012377
- Prindaville B, Belazarian L, Levin NA, Wiss K. Pityrosporum folliculitis: a retrospective review of 110 cases. J Am Acad Dermatol. 2018;78(3):511-514. PMID 29138059
- Henning MAS, Hay R, Rodriguez-Cerdeira C, et al. Position statement: recommendations on the diagnosis and treatment of Malassezia folliculitis. J Eur Acad Dermatol Venereol. 2023;37(7):1268-1275. PMID 36912427
- Yanyun C, Ying T, Wei K, Hua F. Preliminary study on antifungal mechanism of aqueous extract of Cnidium monnieri against Trichophyton rubrum. Front Microbiol. 2021;12:707174. PMC8417377
- Liu MM, Bai J, Tian ZY, et al. Oxymatrine ameliorates Malassezia overgrowth-induced psoriasis in vivo and in vitro by inhibiting the biofilm formation and inflammation. Mycology. 2025;17(1):2511903. PMID 41878517
- Tian W, He D, Liu J, et al. Topical borneol relieves nonhistaminergic pruritus via targeting TRPA1 and TRPM8 channels in peripheral nerve terminals of mice. Eur J Pharmacol. 2023;953:175833. PMID 37290679
Educational information only. A rash that is widespread, painful or not improving should be assessed by a qualified healthcare professional.
