04/27/2026
Let’s talk about “fungal acne”
I was in Scotland when I first noticed small, itchy bumps along my forehead. I could tell it wasn’t typical acne, but it kind of looked like it. Or maybe it was a rash? Perhaps it was just contact dermatitis - irritation from a new hat I had been wearing.
Well… I stopped wearing the hat, and not only did it NOT go away, but it also actually started spreading down my cheeks and eventually toward my jawline.
This went on for about a week, even after I got back home and was back at work.
Then it hit me.
The week before my trip, I had just finished an oral antibiotic. And knowing what I know about antibiotics wiping out good bacteria (not just the bad), I realized my skin microbiome had been thrown completely off.
That’s when it clicked… I had Malassezia folliculitis, aka pityrosporum folliculitis. Basically, I had a fungal infection on my face. GROSS!
(Note: It’s commonly referred to as fungal acne, but it’s not truly acne vulgaris (the real acne). But for the sake of this article, I’ll be referring to Malassezia folliculitis as “fungal acne,” or just “acne.”)
Back to my story! As soon as I got home, I used a topical antifungal (clotrimazole) to see if it would help, and by the next morning, it was almost completely gone. I guess I was on to something.
Malassezia folliculitis is caused by an overgrowth of yeast on the skin. Malassezia is normally on everyone’s skin and it’s part of a healthy microbiome that protects our skin.
Besides Malassezia fungi, the facial microbiome is heavily populated by lipophilic bacteria, dominated by Cutibacterium (formerly Propionibacterium, especially C. acnes) and Staphylococcus. These thrive in sebaceous areas, forming a community that, along with Corynebacterium, plays a critical role in sebum metabolism, immune system training, and maintaining the skin barrier.
Key components of the facial microbiome include:
• Bacteria: Cutibacterium (previously Propionibacterium), Staphylococcus (including S. epidermidis), and Corynebacterium are the primary residents, dominating oily regions like the forehead and nose.
• Other Fungi: Beyond Malassezia, other fungal species exist in smaller amounts.
• Viruses: The facial skin harbors numerous bacteriophages (viruses that infect bacteria), which regulate bacterial populations.
• Microscopic Mites: Demodex mites reside in or near hair follicles, feeding on sebum.
Regional Variations on the Face:
• Oily Areas (T-zone): High concentrations of Cutibacterium and Malassezia.
• Moist Areas (Corners of mouth/nose): Higher levels of Corynebacterium and Staphylococcus.
The facial microbiome is crucial for regulating the skin's immune response. But when our microbiome is compromised, due to medications, or physical stressors (like too many facial treatments, or too much sun, etc), our microbiome becomes compromised and is laid bare for all sorts of imbalances (called dysbiosis), and is linked to acne, atopic dermatitis, psoriasis, and in this case, and overgrowth of yeast, which can get into your hair follicles, and suddenly you’ve got what looks like acne.
This is one of the biggest things I see my clients misidentify. They are convinced they have acne vulgaris, but what they really have is either congested pores or fungal acne.
Fungal acne usually shows up as:
• Small, uniform bumps (all about the same size)
• Less redness than inflamed acne
• Rough texture
• Sometimes tiny pus-filled bumps
• And the BIG clue… itching
If it itches, pay attention. That’s a huge giveaway. It can also show up FAST, sometimes overnight, especially after sweating or being in heat.
It can show up anywhere you sweat:
• Forehead
• Cheeks
• T-zone
• Neck
• Chest
• Back
What triggers it
There’s a difference between what causes it and what triggers a flare-up.
Common triggers include:
• Heat + humidity
• Sweating
• Oily skin (yeast feeds on oil)
• Heavy or occlusive skincare (like thick sunscreens or slugging)
• High sugar intake
• Tight or synthetic clothing
• Certain medications (especially antibiotics or steroids)
• A compromised skin barrier
In my case, it was antibiotics combined with my mildly oily skin, and I had used an occlusive on the plane to prevent trans-epidermal water loss (TEWL). And let’s be honest; I experiment with a LOT of skincare products, so I’m pretty sure I’ve damaged my skin barrier at least a few times.
According to guidance from the American Academy of Dermatology, excess oil and damaged follicles make it easier for infections like this to develop.
Why it happens
When your skin barrier is compromised (or oil production is high) it creates the perfect environment for yeast to thrive.
And because yeast feeds on oil, the more oil present, the easier it is for it to multiply.
How I treated my fungal acne (and what I recommend)
The biggest thing to understand is this: You can’t treat fungal acne like regular acne. It will not respond to typical acne treatments. You have to treat the yeast.
Step 1: Antifungal treatment This is the most important step.
Topical Cleanser Recommendations
• Antifungal Cleansers (2-3 times/week): Use Nizoral 1% Ketoconazole Shampoo (leave on for 5-10 minutes before rinsing), or soaps containing zinc pyrithione or sulfur.
• Daily Gentle Cleansers:
o Vanicream Gentle Facial Cleanser: Free of soap, sulfates, and fragrance.
o Cetaphil Gentle Skin Cleanser: A non-drying, non-comedogenic staple.
o The Ordinary Glucoside Foaming Cleanser: Good for oilier, sensitive skin.
o Malezia Cleansing Balm: Specifically formulated to be safe.
• Makeup Removers: Use micellar water, such as Garnier SkinActive Micellar Water (pink cap) or Bioderma Sensibio H2O, to remove makeup without triggering yeast.
Ingredients to Avoid
• Fermented ingredients (galactomyces, bifida ferment filtrate).
• Oils/esters: Avoid olive oil, coconut oil, avocado oil, and polysorbates.
Tips for Success
• Sit time: For active antifungal washes, let them sit on the skin for 5-10 minutes to maximize efficacy.
• Consistency: Consistent use is key, but switch to a gentle, non-medicated cleanser once the acne clears to avoid over-drying.
• Check Products: Use tools like Sezia.co or Folliculitis Scout to check if your current products are safe.
Step 2: Masks
I used Clotrimazole as a mask:
• Apply to face + neck
• Leave on 5–10 minutes
• Rinse
But Sulfur is amazing, too, for calming and drying out fungal breakouts. Sulfur treats acne and fungal acne by acting as an antimicrobial, antifungal, and anti-inflammatory agent that absorbs excess oil and exfoliates dead skin cells. It dries out pimples, clears clogged pores, and kills Malassezia yeast, making it effective for acne vulgaris, fungal acne, and rosacea.
Éminence has a mask I love: Acne Advanced Clarifying Mask. Ingredients:
Basil Oil: natural cleansing properties to help purify and soothe skin’s appearance
Encapsulated Salicylic Acid: beta-hydroxy-acid; delivers time-release protection against acne breakouts by encouraging exfoliation and unclogging pores.
Sulfur: natural exfoliating benefits to reduce the appearance of acne.
Clay (Montmorillonite Clay, Kaolin Clay, Red Kaolinite): three clays combine to absorb impurities, gently exfoliate and absorb excess oil
Skin Moderne’s Clarifying Mask is my favorite! Ingredients are:
Bentonite & Kaolin Clay to remove dirt and impurities from skin pores, preventing breakouts, reduces skin toxins and inflammation.
Niacinimide helps build cells in the skin and protects the skin from environmental stressors such as sunlight, pollution, and toxins. Neutral pH and good for all skin types.
Gluconolactone is a polyhydroxy acid that dissolves dead skin cells and improves fine lines and discoloration, and removes excess oils from the skin.
Copaifera Officinalis Resin promotes wound healing and encourages skin homeostasis.
Carapa Guaianensis Seed Oil has anti-inflammatory and skin-purifying properties.
Euterpe Oleracea Pulp Oil is loaded with nutrients, and promotes cell renewal and hydrates and nourishes the skin.
Melaleuca Alternifiolia (Tea Tree) Leaf Oil has skin purifying and anti-microbial benefits.
Cananga Odorata Flower Oil has potent antioxidant and anti-inflammatory properties and improves uneven skin tone.
Salicylic Acid is a beta hydroxy acid with exfoliation and pore-clearing properties. Of all the AHAs and BHAs, salicylic acid is the smallest molecular size, so it can actually enter the pore or follicle and clean it out.
Step 3: Simplify your routine
I made sure I was using simple, fungal-acne-safe products. I use Éminence Tea Tree Facial Recovery Oil when my skin feels extra dry. And if you like squalane like I do, make sure it’s regular squalane (not hemi-squalane). It gives hydration without feeding the yeast.
Step 4: Be careful with sunscreen
I avoid occlusive ingredients as much as I can, and want my sunscreen to be a physical barrier (not chemical barrier). And I want it to do double-duty. Why have only sunscreen when you can also have it be good for your skin AND even out skin tone?
These worked best for me:
Lucrèce Clear Zinc Tinted Sunscreen SPF 30 If you don’t care for tinted, they also carry untinted that works just as well with the same beneficial ingredients.
• Zinc Oxide 17.67%: Offers broad-spectrum UVA/UVB protection, calms irritation, suitable for sensitive skin, neutralizes free radicals to prevent aging. Non-comedogenic, won't clog pores or cause acne.
• Aloe Barbadensis Leaf Extract: Soothing and moisturizing properties, calming irritated skin, reducing redness and providing hydration.
• Sodium Hyaluronate (a form of Hyaluronic Acid): Highly effective at attracting and retaining moisture in the skin, which can reduce the appearance of fine lines and make the skin look more supple.
Ilia Super Serum Skin Tint SPF 40
• Zinc Oxide 12%: Offers broad-spectrum UVA/UVB protection, as well as blue light, and pollution; calms irritation, suitable for sensitive skin, neutralizes free radicals to prevent aging. Non-comedogenic, won't clog pores or cause acne.
• Squalane: seals in moisture and boosts elasticity without clogging pores
• Hyaluronic Acid: draws hydration into skin to visibly plump and replenish.
• Niacinamide: minimizes the look of pores, smooths skin texture, and refines uneven tone.
I’m a huge fan of this serum! It’s skincare, mineral spf, serum all-in-one! And it has a light dewy finish I love. Added bonus-it’s vegan, non-comedogenic, safe for sensitive skin, and has no fragrance, and no silicone!
Clinique Even Better™ Makeup Broad Spectrum SPF 15 I just picked up this foundation last week and it’s proving to be on par with Ilia with similar results. But remember, it IS a foundation, not a sunscreen that acts like a foundation. I’m including it in this line-up because it does have spf 15- Octinoxate 5.90%, Titanium Dioxide 3.50%, Zinc Oxide 2.80%. It has Vit C that helps fight free radicals. It’s also free of:
o Fragrance
o Parabens
o Phthalates
o Synthetic colors
o Sodium lauryl sulfate
o Sodium laureth sulfate
With any sunscreen, remember to apply it while inside or in the shade and wait 20 minutes before going into the sun. And spf MUST be reapplied every 2-3 hours.
Step 5: Internal treatment (if needed)
If it’s severe or persistent, antifungal medication like Fluconazole may be needed. Always talk to a provider for this.
Helpful supporting ingredients
These won’t replace antifungals, but they help overall skin health:
• Azelaic acid (brightening + antibacterial)
• Lactic acid (gentle exfoliation + hydration)
• Phytic acid (very gentle + calming)
• Pyruvic acid (antimicrobial + soothing)
• Salicylic acid (clears pores and reduces buildup)
Makeup tips (because life still happens) Foundations and serums that work for me:
• Clé de Peau Radiant Cream Foundation spf 25 A skincare-based cream foundation with moisturizing, medium-to-full coverage that visibly perfects skin with a naturally dewy, lustrous finish.
• Ilia Super Skin Tint Serum (not a traditional foundation but acts like one)
• Clinique Even Better™ Makeup Broad Spectrum SPF 15 (see above)
Other important makeup tips
Clean your brushes! Not only does this keep your makeup clean (think powder blushes, eyeshadows, etc.), but it keeps bacteria off of your face.
I have enough brushes to get me through the week (if needed). Which means I won’t use the same brush twice until I’ve cleaned them. I use Johnson’s Baby Shampoo, and after I rinse them, I do a final “rinse” in distilled water with a few drops of dōTerra On Guard essential oil. After that final dunk, I swirl the brush in the palms of my hands to swirl out excess water, then lay flat to dry on a clean towel.
Here’s why I use On Guard for my makeup brushes:
Rosemary, clove, eucalyptus, cinnamon, and wild orange essential oils possess significant antimicrobial, antiseptic, and disinfectant properties. They are particularly effective when combined, with studies indicating this blend (often found in "protective" blends like On Guard) can inhibit bacteria like S. aureus and viruses such as influenza.
• Cinnamon Essential Oil: Strongest antimicrobial of the group, high in cinnamaldehyde, which inhibits food-borne pathogens.
• Clove Essential Oil: Very high in eugenol, providing high antiseptic/antimicrobial efficacy against various pathogens and fungi.
• Eucalyptus Essential Oil: Contains 1,8-cineole, which acts as a strong germicide and antiviral against influenza.
• Rosemary Essential Oil: Known as a broad-spectrum antibacterial and antiseptic.
• Wild Orange Essential Oil: Contains high levels of limonene, providing antibacterial, antifungal, anddegreasing properties.
Common Applications:
• Household Cleaning: Mix with water and vinegar for countertops.
• Air Purification: Diffuse in a room to reduce airborne bacteria.
• Surface Disinfection: Acts as natural germ-fighters.
When to see a dermatologist
If you’re unsure or it’s not improving, definitely see a derm. Fungal acne and acne vulgaris look similar—but they are treated completely differently.
I hope all of this information is helpful! I’m pretty sure my Microbiology and Anatomy & Physiology professors would be proud of me. Take care of your skin!
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