Stop Popping! Your Pimple Constellation May Not Even Be Acne

Here's what to know about these itchy whitehead lookalikes.

Welcome to The Spot, a monthly column tackling acne and our relationships to it. Here, we ask women how they deal with blemishes at home—and consult with skin care experts to find out what really works.

When we see red bumps on our skin, we’re quick to assume that we may be dealing with acne. However, before you go and reach for your trusty salicylic acid-based product, you may want to inspect it a little further. Just like how sebaceous filaments aren’t blackheads and milia aren’t whiteheads, certain red bumps might not be acne at all. Instead, they might be something known as fungal acne

Fungal acne sounds a lot scarier than it really is, so to break down what we need to know about identifying—and most importantly treating—it, we turned to a skincare expert. We spoke to board-certified dermatologist Marisa Garshck, M.D. to learn all about fungal acne.

What is fungal acne? 

Fungal acne is a medical condition known as pityrosporum or malessezia folliculitis. It refers to the overgrowth of normal yeast that leads to inflamed hair follicles that causes red bumps on the skin. 

Dr. Garshick says that fungal acne is more common in those who are immunosuppressed or immunocompromised. She also says that it may be more likely to occur in those who live in hot or humid environments and frequently wear occlusive clothing. Additionally, it can also occur in individuals who are currently taking or recently took antibiotics. 

How can you tell if you have fungal acne? 

To tell whether you might have fungal acne or not, Dr. Garshick says to look at the appearance of the bumps. She explains that fungal acne usually appears as uniform bumps on the chest, back, and shoulders. These red bumps also tend to itch and won’t be receptive to acne-fighting ingredients. If you’re still not sure about your condition, she suggests seeing a board-certified dermatologist who can help confirm whether you have fungal acne or not. 

What is the difference between fungal acne and bacterial acne?

Fungal acne often gets mistaken for bacterial acne, but there a few key differences that can help you differentiate between the two. As mentioned earlier, Dr. Garshick says that fungal acne is usually found on the chest, back, shoulder, and hairline, whereas bacterial acne is usually found on your face.

She also says that fungal acne is “monomorphic,” which means those red papules and pustules look similar to each other. Bacterial acne, in contrast, tends to appear with different types of bumps and comedones, aka whiteheads and blackheads. But, the biggest difference is that fungal acne itches—itchiness is not typical of traditional acne.  

How do you treat fungal acne?

Dr. Garshick says the key to treating fungal acne is looking for antifungal ingredients, such as selenium sulfide and pyrithione zinc, as opposed to traditional acne-fighting ones such as retinoids or benzoyl peroxide. Treatments, she says, include topical creams or gel or oral medication. She also recommends using certain shampoos as a body wash to help treat fungal acne on your body. 

“[Because fungal acne] is often located on the back and chest, sometimes it can be difficult to spread cream all over. The value of shampoo is that it can spread easily and—when it is left on for a period—has enough time to penetrate the skin,” she says. “[Also], it’s not generally as common to find true body cleanser with these ingredients; they are more commonly found in dandruff-fighting shampoos.” 

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She recommends a shampoo like Nizoral, which contains ketoconazole, and Selsun Blue, which contains selenium sulfide. She also likes Dove’s Dryness and Itch Relief Shampoo as it contains pyrithione zinc. 

She suggests putting shampoo on the general affected area and leaving it on for five to ten minutes before rinsing off. For topical creams and prescribed medicine, she says it’s best to consult with a board-certified dermatologist to determine the best course of treatment and to confirm you are treating the right condition.