I get questions from my clients daily on skin conditions and see people asking skin care advice on social media. Many of the answers I see are scary and potentially damaging to the skin. I really feel like people need to be given proper skin care advise and not listen to Karen on Facebook, who tells them to rub their face with baking soda and lemon juice. I have put this skincare panel together to try and give people educated and knowledgeable advice from professionals. Thanks to my amazing panel and Nena Boucher from @paintedbynena who have taken the time to help me with this.
Question from my client-
Q: My 13 year old daughter has small tiny red bumps on her face and back, we tried antibiotics which didn’t really help. After research I am convinced she has something called Fungal Acne? This makes sense but my dermatologist and pharmacist say its Normal acne and she must continue with standard protocol which includes Roaccutane. I really want to first explore the fungal treatment route first. What would you suggest?
Information & research –
Fungal acne is called Pityrosporum Folliculitis/Malassezia Folliculitsis. This yeast loves oil and is different to classical acne, it causes little red bumps all uniform in appearance and stay as red pustules. Specifically areas of the forehead, nose and back which are high in oil activity.
You can have both at same time. Acne is caused by a high rate of oil production which means more fungal activity that can cause fungal acne. It should be very easy for Dermatologists to pick up on, but is easy to miss as it blends in with acne.
How do I know if I may have Fungal Acne?
- Your acne doesn’t respond to over-the-counter or prescription acne treatments, or they make the problem worse.
- Your acne feels itchy or burns to the touch.
- You have other signs of fungal overgrowth, like dandruff, tinea versicolor, psoriasis, eczema, etc.
- Little red bumps uniform in appearance and usually on the forehead.
The difference between Acne and Fungal Acne
Fungal Acne appears as inflamed, itchy, acne-like eruptions that are really pus-filled bumps. It shows up as breakouts in areas where you typically have a lot of oil – in your T-zone (forehead, nose, and chin), chest and back. The tell-tale difference is that fungal acne can be itchy, and regular acne is not.
Pityrosporum (malassezia) Folliculitis
How It Feels
Neutral to Painful and Inflamed
How It Looks
Any Combination of Whitehead, Blackheads, red bumps, skin coloured bumps, or deep cysts
Usually white or whitehead appearance surrounded by redness
Where You See It
Any combination of the forehead, nose, cheeks, chin, jawline, hairline, temples, neck, chest of back.
Oily areas – the T-zone
(forehead, nose, chin),
Chest and back.
Dermatologist’s Test Reveals
What Happens When You Use Acne Treatments
Improves or Disappears
How To Get Rid Of It
· Fix your gut
· Avoid inflammation prompting foods
· Address hormone imbalances
· Drink plenty of water
· Benzoyl peroxide
· Bentonite Clay Masks
· Salicylic Acid
· Topical Retinoids
· Topical Antibiotics
· Oral Antibiotics
· Fix your gut
· Cut down on sugar and carbs
· Bentonite Clay Masks
· Use chemical exfoliants (bakuchiol, lactic acid, salicylic acid)
· Dandruff Shampoo as face and body wash
· Anti-Fungal Cream
· Natural Antifungals (oil of oregano, clove, black walnut, etc.)
· Oral Anti-Fungal Medication
Skincare panel Advice -
Janet Pink - Founder of Pink Cosmetics, Flamingo moon & Just be Kind
This seems to be very under diagnosed, as I don’t think most people go to a Dermatologist or Doctor.
I have never heard of it until a few weeks ago! I have done tons of research from Doctors and Dermatologist as well as my own clients and this is my advice.
Don’t use oils, so no moisturizers with oil in them and most do have oil. Rather use a Gel moisturizer or pure squalane.
Use an anti-dandruff shampoo with zinc pyrithium/ketaconzoyl, lather on in shower and let it sit on the skin for 5 minutes and rinse off. Then do it a few nights/week as maintenance. Selsun Blue has been recommended by a few of my clients.
Use a chemical exfoliant on your skin. This keeps pores clear of dead skin cells, which trap oil and create a buffet table for Pityrosporum and Yeasts. Salicylic Acid and Lactic Acid.
Niacinamide. Sulphur containing ingredients also seem to help but don’t use for rosacea.
Our new skin shots range includes, squalane, niacinamide, lactic acid and salycyclic acid.
Also wash after sweating, don’t stay in gym clothes.
See your dermatologist. Ask specifically for testing for fungal acne. A simple test can save you loads of frustration, and you can start the right treatments. You may find that your acne is fungal, bacterial, or a combination of the two.
Advice from Ocular Acupuncturist and Founder of Alchemy elixzar - CBD skin range
Evaluate her diet first and see if she is not exposed to too much dairy, this seems to be a huge acne trigger. It is not just the milk but the cheese, yogurt, chocolate, etc., this all adds up to a substantial amount of diary every day which we don't actually realize.
Secondly, I would suggest that you address the GUT and put her on a good Probiotic, something like Ultraflora balance (R240+-) for months’ supply from Dischem, this product gets kept in the fridge at the Pharmacy. Please don't buy any over the counter probiotics, probiotics that are kept in the fridge are just so much more effective.
I would try and establish how acidic or alkaline her body is, this is based on what she eats. The easiest would be to get some alkaline powder and use this for a month and see if she reacts positively to this.
I would not suggest Roaccutane as a first approach.
Raine Tauber - International Makeup Artist
See a dermatologist. It’s far too easy to misdiagnose something based on internet research and potentially do more harm.
Dr Tarryn Jacobs - Dermatologist at Noviskin in Pretoria
Fungal acne also known as pityrosporum folliculitis is an infection of the hair follicles caused by a yeast. This yeast, (malasezzia furfur) lives on our skin but can become problematic in certain conditions, such as with high humidity.
Pityrosporum folliculitis can look similar to acne and it often underdiagnosed, but a dermatologist should be able to distinguish it based on a clinical examination. Sometimes it may be necessary to do skin scrapings for fungus if there is doubt of the diagnosis. This may be an avenue to pursue after a proper examination with your dermatologist
Dr Barbara van der Westhuizen- GP and founder of Creative and kin
It's often difficult to distinguish between hormonal acne and fungal acne. Usually we'll try a 1-3 month course of oral antibiotics, low dose, to see if we can prevent going onto the "heavier" things like Roaccutane or other options like the combined oral contraceptive in young women.
If it is in fact fungal, the options would be a local antifungal cream or topical antifungal shampoo like Selsun (only to be used on the body and not the face though) but it remains a difficult thing to treat. A good, balanced skincare regime is always a good place to start and good moisturisation along with any treatment is key. (I would very much take the lead from Dr Tarryn Jacobs' answers, as she is the expert here. I very quickly refer to a dermatologist if the skin condition is complex or not responding to first level of treatment.)
Before we post the panels advise we reach out on Social media to ask for people with this condition- These are some of the comments.
Has tried a few products, but nothing really works and gets her down.
I was recommended Selsun which is an anti-dandruff shampoo but chemical exfoliation (aha and bha) and retinol better in my opinion.
I get mine on my forehead and neck usually but with wearing a mask I have gotten it around my mouth / chin as well. I use a sulphur face wash at night- the Doctor Robaina one as well as a sulphur treatment I got from our local pharmacy. It helps with the itchy ness and hiding the bumps (I use a layer overnights so by morning it’s less visible as I can’t always hide my neck behind a scarf) also cortisone cream helps me with the itchiness as well. Hope that info helps
The thing that helped me the most was a habit that I had to develop, which was to stop touching my face, which was something I used to do unconsciously. I also found that using chemicals exfoliants in my routine helped amazingly, it did take a while but I consistently used products with low doses of AHA . I also tried using over the counter antibacterial ointments and creams which I didn’t feel helped, I also tried changing my diet and didn’t really see much difference with my fungal acne.
I have not yet found a product that works for me. A doctor once prescribed zineryt. I once had a prescription from a doctor but it also didn't work effectively as my acne has only gotten worse.
I’m currently still trying to get rid of mine, my doctor has given me antibiotic course for 3 months- I’ve been using it for 3 weeks now and it seems to be doing the trick but still lots of work to be done. I have been taking zinc tablets which is also really good for balancing and eliminating harmonies and all that. So that helps a lot and then I also use tea tree oil 3 times a week. But like I said I’m still currently trying to recover as well ☺️ but my main area is my forehead and doesn’t look too great but it’s slowly getting there
I started using a Clinique clarifying lotion it has Salicylic Acid. This I felt like this truly “cleansed” the acne inflamed area twice a day. In the mornings I followed this up with some fucidin on the inflamed areas and then a facial spray. Evenings I would start with fucidin on the inflamed areas and then follow with a light but moisture rich cream my diet played an almost equal role in my fungal acne inflammation I realised that my coffee intake almost doubled that of my water intake and realised these inflammations largely occurred around exam times at varsity when I lived off junk food (French fries, chocolate, coffee and red bull) and the above skincare cannot fully work without a change in my diet. I also had to learn to STOP touching my face
I used head and shoulders classic clean as a face mask every other day, once a month facial peels and introduce retinol to my skin care. I still have some scaring from my adult acne and flare ups now and then
Kenna Whittnel – biochemist
Simple Science Skincare Website