Fungal Acne Treatment: How to Identify and Clear It
February 6, 2026 · 10 min read
Fungal acne isn't actually acne at all—it's an overgrowth of Malassezia yeast in hair follicles that mimics acne. This is why standard acne treatments don't work (and can make it worse). Here's how to identify it and what actually clears it.
What Is Fungal Acne?
Fungal acne (technically called Pityrosporum or Malassezia folliculitis) is caused by an overgrowth of Malassezia yeast—a fungus that naturally lives on everyone's skin. When conditions allow it to proliferate excessively, it invades hair follicles, causing inflammation and bumps that look like acne.
Fungal Acne vs Regular Acne
What Causes Fungal Acne?
1. Heat, Sweat & Humidity
Malassezia thrives in warm, moist environments. Hot climates, heavy sweating, and wearing non-breathable clothing create ideal conditions.
2. Antibiotic Use
Antibiotics (oral or topical for acne) kill bacteria that normally keep Malassezia in check. This is why fungal acne often appears during or after antibiotic treatment for regular acne.
3. Occlusive Products
Heavy moisturizers, oils, and foundations containing fatty acids and esters that Malassezia feeds on. Many common skincare ingredients actually fuel fungal acne.
4. Weakened Immune System
Immunosuppression, chronic stress, poor sleep, and certain medications can allow Malassezia to overgrow.
How to Treat Fungal Acne
OTC Antifungal Treatments
Ketoconazole Shampoo (2%) as Body/Face Wash
How to use: Apply to affected areas, let sit 5-10 minutes, then rinse. Use daily for 2-4 weeks.
Why it works: Directly kills Malassezia yeast. The most effective OTC treatment.
Zinc Pyrithione Soap or Wash
How to use: Use as daily cleanser. Let sit 2-3 minutes before rinsing.
Why it works: Antifungal and antibacterial. Gentle enough for daily use on face.
Selenium Sulfide Shampoo (1%)
How to use: Apply as a mask for 5-10 minutes, rinse. Use 2-3 times per week.
Why it works: Reduces Malassezia population and controls oil.
Sulfur Treatments (3-10%)
How to use: Apply as a wash or mask. De La Cruz sulfur ointment is a popular option.
Why it works: Antifungal, antibacterial, and oil-absorbing.
Prescription Treatments
Oral Fluconazole
150-200mg weekly for 2-4 weeks. Systemic antifungal for stubborn cases. Requires liver function monitoring.
Oral Itraconazole
200mg daily for 1-2 weeks. Alternative systemic option for severe or widespread fungal acne.
Topical Ketoconazole Cream (2%)
Prescription-strength. Apply twice daily for 2-4 weeks. More effective than shampoo formulations.
Skincare Ingredients: Safe vs Unsafe
✓ Fungal Acne Safe
- Squalane (from olives)
- Glycerin
- Hyaluronic acid
- Niacinamide
- Salicylic acid
- Benzoyl peroxide
- Zinc pyrithione
- Sulfur
- Aloe vera
- Centella asiatica
✗ Feeds Malassezia (Avoid)
- Most oils (coconut, olive, jojoba)
- Fatty acids (stearic, oleic, lauric)
- Fatty acid esters (isopropyl myristate, etc.)
- Polysorbates (emulsifiers)
- Fermented ingredients (galactomyces, saccharomyces)
- Heavy occlusives (petroleum jelly in some cases)
- Certain ceramide formulations
💡 Pro tip: Use folliculitisscout.com or the Sezia website to check if specific products are fungal acne safe before buying.
Key Takeaways
- ✓ Fungal acne is caused by Malassezia yeast, NOT bacteria—regular acne treatments won't work
- ✓ Key signs: uniform small bumps, itchy, on forehead/chest/back, worsens with antibiotics
- ✓ Ketoconazole shampoo used as a wash is the most effective OTC treatment
- ✓ Many common skincare ingredients (oils, fatty acids) feed Malassezia and make it worse
- ✓ Stick to fungal acne safe ingredients (squalane, glycerin, hyaluronic acid, niacinamide)
- ✓ Oral antifungals are available by prescription for stubborn cases
- ✓ Prevention: shower after sweating, wear breathable clothing, avoid occlusive products
Track Your Fungal Acne Treatment with Pimpl
Fungal acne can be tricky to treat because many products make it worse. Pimpl helps you log every product you use and track which ones improve or worsen your skin—so you can build a truly safe routine.
- ✓ Log products and flag which are fungal acne safe
- ✓ Track breakout patterns to confirm your diagnosis
- ✓ Monitor progress as you switch to safe products
- ✓ Document your journey from misdiagnosis to clear skin