Fungal Acne (Malassezia Folliculitis)
If you keep getting small, uniform bumps (often itchy) that don’t respond to typical acne routines, you might be dealing with malassezia folliculitis — not “classic” acne. Use this hub to identify the pattern, avoid common traps, and follow a gentle starter routine.
Find your path
Answer a few quick questions to get the most relevant guide.
What best describes your bumps?
What triggers or worsens your bumps?
What do you need most right now?
Start by confirming the pattern
Misdiagnosis is the #1 reason people stay stuck. Check the comparison table below — fungal acne has uniform bumps, is often itchy, and doesn't respond to typical acne treatments. If it matches, scroll to the malassezia-safe routine.
See comparison tableThis looks more like regular acne
Mixed-size bumps (blackheads, whiteheads, cysts) without itch usually point to bacterial acne, not fungal. However, you can have both. If typical acne treatment isn't working after 6-8 weeks, consider the fungal angle.
Start with adapalene guideFix your barrier first
If everything stings, your skin barrier is likely compromised. Antifungal treatments on a damaged barrier will make things worse. Do a 1-2 week barrier reset with ultra-gentle basics, then reassess.
Start barrier resetPost-antibiotic fungal flare
Antibiotics can kill bacteria that normally keep malassezia yeast in check, allowing it to overgrow. This is a classic fungal acne trigger. A short course of antifungal treatment often helps — see the routine below and consider confirming with a derm.
Go to treatment routineFungal Acne vs Regular Acne
Understanding the differences helps you pick the right treatment approach.
| Aspect | Fungal Acne | Regular Acne |
|---|---|---|
| Appearance | Small, uniform bumps (1-2mm), all similar size | Mixed: blackheads, whiteheads, cysts, varying sizes |
| Itch | Usually itchy (~70% of cases) | Rarely itchy (can be painful) |
| Location | Forehead, hairline, chest, back, shoulders | T-zone, chin, cheeks, jawline |
| Cause | Yeast overgrowth in follicles | Bacteria + clogged pores + oil |
| Triggers | Sweat, humidity, antibiotics, occlusives | Hormones, stress, diet, comedogenic products |
| Treatment | Antifungals (ketoconazole, etc.) | Benzoyl peroxide, salicylic acid, retinoids |
All Guides & Resources
Start with these today, then follow the fungal acne cluster as it ships.
Closed comedones: how to clear
Includes a quick “how is this different from fungal acne?” check.
BHA 2%: how to use (without irritation)
Helpful if bumps are acne/comedone-driven — and a common overuse trap.
Adapalene: how to start
Retinoid basics for acne — and a signal if “acne-only” treatment isn’t working.
Over-exfoliated? 7-day barrier reset
If your skin stings, the first “fix” is often stopping the irritants.
Fungal acne cluster (shipping next)
Dedicated deep-dive guides coming soon.
Fungal acne vs acne: how to tell
Visual guide and self-check to differentiate between the two.
Fungal acne routine (AM/PM)
Step-by-step malassezia-safe routine for day and night.
Fungal acne-safe moisturizers
Product picks that won't feed yeast or trigger flares.
Ketoconazole face wash: basics + safety
How to use antifungal shampoo on your face without irritation.
Fungal acne-safe sunscreens
SPF options that protect without triggering breakouts.
Why fungal acne keeps coming back
Prevention strategies and maintenance routines.
Related from Other Hubs
Overlapping topics that may help your situation.
Starter routine
A malassezia-safe routine: keep it simple until bumps clear.
AM routine
- Gentle cleanse — sulfate-free, no oils (or water rinse)
- Malassezia-safe moisturizer — look for: squalane, glycerin, hyaluronic acid. Avoid: fatty acids (C11-C24), oils, esters, polysorbates
- Mineral sunscreen — zinc oxide based, avoid chemical filters with fatty alcohols
PM routine
- Gentle cleanse — remove sweat/sunscreen (micellar water if needed)
- Same moisturizer — or a lightweight gel if oily
- Optional: Antifungal — see treatment section below
Antifungal Treatment Options
If the basic routine isn't enough, consider adding antifungal actives.
OTC approach
- Ketoconazole 1-2% shampoo — Use as face mask 2-3x/week. Apply to damp skin, leave 2-5 min, rinse. Can be drying.
- Zinc pyrithione soap — Daily body wash for chest/back bumps. Leave on 1-2 min before rinsing.
- Sulfur-based wash — Alternative if keto irritates. 2-3x/week max.
Rx options (see a derm)
- Ketoconazole 2% cream — Apply to affected areas 1-2x daily for 2-4 weeks.
- Oral fluconazole — For stubborn or widespread cases. Usually 1-2 week course.
- Itraconazole — Alternative oral option if fluconazole doesn't work.
Important: Don't stop treatment too early. Continue for 1-2 weeks after bumps clear to prevent recurrence. If no improvement after 3 weeks, reconsider the diagnosis.
Ingredient Cheat Sheet
Malassezia yeast feeds on certain fatty acids and esters. Here's what to look for and avoid.
✓ Safe ingredients
Squalane (not squalene), glycerin, hyaluronic acid, niacinamide, urea, aloe vera, zinc oxide, sulfur, salicylic acid, azelaic acid. MCT oil (caprylic/capric triglyceride) is also generally safe.
⚠ Use with caution
Fatty alcohols (cetyl, cetearyl, stearyl) — some tolerate, others flare. Dimethicone — usually fine but can trap problem ingredients. Fermented ingredients — galactomyces, saccharomyces may trigger some.
✗ Avoid these
Oils: coconut, olive, jojoba, argan, rosehip (most plant oils). Fatty acids: oleic, lauric, palmitic, stearic, linoleic. Esters: isopropyl myristate/palmitate, glyceryl stearate. Polysorbates: polysorbate 20/60/80.
Pro tip: Use tools like Folliculitis Scout or Sezia to check if a product's ingredient list is malassezia-safe.
What not to do
These are the traps that make bumps persist for months.
Don’t “peel” it away
Scrubs + strong acid stacks can inflame the barrier and worsen texture.
Don’t add 5 new products
Change one variable at a time so you can actually learn what works for you.
Don’t ignore sweat + friction
Heat, helmets, tight caps, and workouts can aggravate follicle-based bumps.
When to see a derm
The fastest progress is correct diagnosis + the right prescription when needed.
Confirm the diagnosis
If bumps are persistent, itchy, and don’t respond to acne care, get checked for lookalikes.
Escalate if worsening
Rapid spreading, pain, swelling, pus, or systemic symptoms need clinician attention.
Be extra careful if pregnant
Some treatments aren’t pregnancy-safe. Always confirm with your healthcare provider.
Common questions
Quick answers that keep your routine simple and safe.
Is fungal acne actually acne?
The nickname “fungal acne” is common, but malassezia folliculitis is different from acne vulgaris. It’s driven by yeast in hair follicles, so classic acne-only strategies may not work (and can irritate you). The right plan depends on confirming the pattern and keeping your barrier calm.
Can I still use retinoids or acids?
Often yes — but timing matters. If you’re inflamed, itchy, or stinging, pause extra actives and stabilize your basics first. Once the skin feels calm for ~2 weeks, reintroduce one active at a time, slowly.
What's the fastest "first step"?
Start with the "how to tell" guide and a simplified routine. If you do choose an antifungal approach, keep everything else gentle and consistent so you can actually evaluate what's helping.
What triggers fungal acne flares?
Common triggers include excessive sweating, hot/humid weather, tight clothing or helmets, antibiotics that disrupt skin flora, and heavy occlusive skincare products. Knowing your personal triggers helps prevent recurrence.
How long does it take to clear fungal acne?
With proper antifungal treatment, you'll typically see improvement within 1-2 weeks. Complete clearing usually takes 3-4 weeks. If you don't see any change after 2-3 weeks, reconsider whether fungal acne is actually the issue.
Why does my fungal acne keep coming back?
Malassezia yeast naturally lives on skin — you can't eliminate it completely. Recurrence happens when you stop treatment too early, return to trigger products, or don't cleanse after sweating. Maintenance routines (weekly antifungal wash) help prevent flare-ups.
Can I use makeup with fungal acne?
Yes, but be selective. Avoid foundations with oils that feed yeast — particularly oleic acid and lauric acid. Mineral makeup and silicone-based products (dimethicone) are often safer choices. Always check ingredient lists against malassezia-safe databases.
Is ketoconazole shampoo safe on my face?
Ketoconazole shampoo (1-2%) used as a face wash 2-3x weekly is generally well-tolerated. Apply to damp skin, leave on 1-2 minutes, then rinse thoroughly. It may cause dryness, so follow with a simple moisturizer. Reduce frequency once cleared.
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Get a routine that fits your skin
If you’re stuck between “acne” and “something else,” a scan-based routine can help you choose a safer starting point and avoid irritation loops.