Fungal acne, and why acne treatment makes it worse
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The short answer
What is fungal acne and how is it different from ordinary acne?
Fungal acne is Malassezia folliculitis, a yeast overgrowth in the hair follicles that causes itchy, same-sized bumps on the chest, back and forehead. It needs antifungal treatment, and ordinary acne products alone often fail to clear it.
Evidence: Good How we grade evidence
If you have small, uniform, itchy bumps that every acne product has failed to budge, there is a decent chance you are treating the wrong thing.
What is fungal acne?
Fungal acne is Malassezia folliculitis, an overgrowth of a yeast that lives on everyone's skin, inside the hair follicles. It produces clusters of small bumps of roughly the same size, most often on the forehead, chest, upper back and shoulders. The giveaway is itch: ordinary acne is not usually itchy, and a 2020 review of Malassezia folliculitis describes an itchy eruption concentrated on the upper trunk. The same review links it to high heat, humidity and clothing, and some people notice it after a course of antibiotics, which reduces the bacteria that normally keep the yeast in check.
Why don't ordinary acne products clear fungal acne?
Ordinary acne products are aimed at bacteria and blocked pores, and fungal acne is driven by a yeast, so on their own they often fail. A 2026 review of fungal acne notes it is often mistaken for ordinary acne, which delays the right treatment and lets it persist for years, and that antifungal medication is the mainstay. Antibiotics can make it worse. Rich, oil-based moisturisers can feed it, because Malassezia uses certain oils and fatty acids, which is where the internet advice about specific ingredients comes from. The general principle is sound even if the ingredient lists circulating online are not always accurate.
How do you treat fungal acne?
Fungal acne is treated with antifungals rather than acne products. A ketoconazole or selenium sulphide shampoo used as a short-contact wash on the affected area is the usual first step and is available from pharmacies. Persistent cases are treated with oral antifungals prescribed by a GP, and in one trial of 62 patients oral ketoconazole combined with ketoconazole shampoo cleared the bumps in every patient given both. Reducing the conditions it likes helps too: shower and change soon after exercise, avoid sitting in damp clothing, and keep heavy occlusive products off the area while it settles.
Does fungal acne come back after treatment?
Yes, fungal acne often comes back, especially in warm weather. The 2020 review says treatment should include preventing recurrences, and many people use a maintenance wash once or twice a week. If you have been chasing this with acne products for months, that is a GP appointment worth making rather than another purchase. For the everyday products around it, a MyAgenix read builds a routine around your skin type.
Questions people ask
How can you tell fungal acne from normal acne?
Fungal acne tends to be itchy, with small bumps that all look about the same size, mostly on the chest, upper back, shoulders and forehead. Ordinary acne is rarely itchy and usually mixes blackheads, whiteheads and spots of different sizes. A GP can confirm fungal acne by looking at a skin sample under a microscope.
Can you use an antifungal shampoo on your face or body?
Many people use an antifungal shampoo as a short-contact wash, lathering it onto the affected skin for a few minutes before rinsing. Keep it away from the eyes, stop if it stings or irritates, and ask a pharmacist first if you are unsure whether the bumps are fungal.
What ingredients feed fungal acne?
Malassezia yeast uses certain oils and fatty acids, so rich, oil-heavy moisturisers and balms can make it worse. Lists of ingredients to avoid online are not always accurate, so a light, oil-free moisturiser is the simpler rule while the skin settles.
Is fungal acne contagious?
No. Malassezia is a yeast that lives on almost everyone's skin. Fungal acne happens when it overgrows in the hair follicles, usually because of heat, humidity, sweat or tight clothing, not because it was caught from someone else.
When should you see a GP about fungal acne?
If a pharmacy antifungal wash has not helped after a few weeks, if the bumps keep spreading, or if you have spent months on acne products without any change. A GP can confirm what it is and prescribe oral antifungal treatment when it is needed.
Sources
- a 2020 review of Malassezia folliculitis (pubmed.ncbi.nlm.nih.gov)
- 2026 review of fungal acne (pubmed.ncbi.nlm.nih.gov)
- one trial of 62 patients (pubmed.ncbi.nlm.nih.gov)
General information about skin, not medical advice. MyAgenix offers cosmetic guidance to help you choose products. It does not diagnose or treat any condition. For anything that needs treating, see a pharmacist, your GP or a dermatologist.