Fungal Acne vs Closed Comedones: Major Differences

When it comes to fungal acne vs closed comedones, it’s important to understand that not all acne is the same.

There are different types of acne that plague us, such as the kind of acne caused by fungus and acne caused by skin debris and bacteria.

At first glance, the tiny bumps appear the same; however, with careful study, each condition differs in their presentation and treatment.

It’s important to recognize the differences in these little bumps so you can diagnose which type you have in order to treat it properly and to eradicate it quickly and effectively.

Just remember, these conditions can affect you at any stage of your life, not just your teen years.

The difference between fungal acne vs closed comedones

While they may seem similar, the main difference between fungal acne vs closed comedones lies in both the causes and the treatments.

Since fungal acne is caused by fungus, it requires treatments that reduce the amount of fungus in the skin microbiome.

Comedonal acne is caused by bacteria, excess oil, and clogged pores which requires treatments that kill acne bacteria as well as keep pores clear.

Read more to learn about both and figure out which one you’re dealing with!

What is fungal acne?

Fungal acne is not truly acne.

It is actually an overgrowth of a certain type of yeast/fungi, called Malassezia(malassezia yeast), in your hair follicles leading to a condition known as pityrosporum folliculitis or Malassezia folliculitis (1).

This yeast is a normal inhabitant of the skin, but in the case of fungal acne, there is an overgrowth of this yeast on the skin’s surface and in the follicles that causes tiny bumps to form.

The yeast feeds off of the oil (sebum) in our skin.

Symptoms of fungal acne

Signs of fungal acne worth noting are that it presents as monomorphic (same size) small red bumps (papules) or pus filled bumps (pustules) that present in small clusters on the skin’s surface and are often accompanied by itching.

These pimple-like bumps appear in oily areas of the body, such as the T zone (forehead, nose, and chin) and jawline of the face, chest, and back.

Oftentimes, these small red bumps look almost like traditional acne or milia which can make their diagnosis tricky.

Pityrosporum folliculitis may also appear in conjunction with other fungal infections and yeast causing conditions , such as dandruff or seborrheic dermatitis (2).

If you think you have fungal acne, we have a full, in-depth guide on how to get rid of it here.

How do I treat fungal acne?

Fungal acne cannot be treated with the same products that you treat traditional acne, because it is caused by different organisms.

It is an infection of the hair follicles caused by a fungus, not a bacteria.

Since fungal acne is caused by a yeast/fungi, you should treat it with an antifungal medication, such as topical antifungal creams, like ketoconazole, or oral antifungal medicines, like fluconazole, to eradicate the problem.

As with acne in the big picture, you should not try to pop the red bumps of fungal acne.

This can lead to worsening of the lesion, infection and scarring.

How do I prevent fungal acne

Once you have treated your fungal acne, you want to make sure it does not recur.

Since it is caused by an overgrowth of yeast and this yeast feeds off of your oil (sebum), you want to avoid things that can upset the balance in your skin and lead to a recurrent fungal infection (3).

1. Avoid tight clothing that can trap heat by restricting airflow which will lead to yeast/fungi overgrowth. Yeast loves warm places to grow. Wear loose breathable fabrics. Heat and sweat play a big part in the recurrence of this condition.
2. Shower frequently if you have a job that makes you sweat a lot or you live in a humid climate or you are outside during the warm time of the year. Yeast love wet places to grow, so keep excess moisture away from your skin.
3. Avoid eating excess carbohydrates because yeast thrive on sugars.
4. Use a dandruff shampoo (pyrithione zinc or selenium sulfide that contains keratin) weekly as a face and body wash to prevent yeast overgrowth in the location you’re experiencing a breakout. Leave it on for multiple minutes to let the ingredients get absorbed by your skin.

What is comedonal acne?

Traditional or true acne is a skin condition caused by dirt, oil and bacteria that clog your pores.

Pores are tiny openings on the skin’s surface that lead downward to your hair follicles.

Your hair grows up from the hair follicles and out through our pores.

Oil glands are attached to the pores and allow oil secretion to the surface of the skin.

When dirt, oil and dead skin cells get trapped in your pores, this creates comedonal acne (4).

If the pore is open, you will develop blackheads (open comedones).

Interestingly, the black color of these blackheads is caused by oxidation of the debris and sebum when it is exposed to air.

If the pore is closed, you will develop pustules (whiteheads or closed comedones or closed comedo).

The pus, which is caused by trapped bacteria and white blood cells, gives whiteheads their white color.

When bacteria gets trapped in the pores, this leads to inflammatory acne which appears as small red bumps (papules), large bumps (nodules) or cysts (blind pimple).

Inflammatory acne can be more difficult to treat and even cause symptoms such as pain.

Comedonal acne symptoms

Breakouts will present haphazardly in oily locations on the face and body, like the chest, upper arms and back, but not in clusters as seen in cases of fungal acne.

Comedones can even show up as a pimple in ear.

They are usually not accompanied by symptoms of itching, which is found in cases of fungal acne.

Also, clinical acne lesions can appear in different sizes and types in the same patient, which helps you distinguish it from fungal acne.

Very similar looking skin bumps gives the fungal acne look.

We have an ultimate guide to getting rid of comedones, here.

How do I treat comedonal acne?

There are a variety of treatment options that can lessen your breakouts, both over the counter treatments (OTC) and prescription.

Treatment is geared towards the acne type you have.

Combination therapy, including topical treatments and oral ones, may give the best results in more extensive cases.

Oral medications are usually reserved for inflammatory acne.

• Benzoyl peroxide – Benzoyl peroxide (BP) helps kill bacteria and cause exfoliation of dead skin cells to eradicate comedones. It may bleach the skin , so you may need to avoid its use in darker skin types. It can be used as a face and/or body wash.
• Salicylic acid – Salicylic acid (SA) is a beta hydroxy acid (BHA) that helps exfoliate dead skin cells as well to treat comedones. SA also has anti-inflammatory properties to help combat redness and swelling in mild cases of inflammatory acne. It can also be used as a face and/or body wash.
• Topical retinoids – Topical retinoids work well at exfoliating dead skin cells too, stopping excess oil production, and also helping fade brown spots that can appear after the pimple has resolved. Retinoids can also treat some types of acne scars.
• Topical antibiotics – Prescription topical antibiotics, such as erythromycin and clindamycin, work well at killing the bacteria that cause acne, P. acnes. Oftentimes, they are combined with BP, which leads to better results and prevents bacterial resistance to the antibiotic agents that can occur when antibotics are used alone.
• Oral antibiotics – Oral antibiotics, such as doxycycline and minocycline, work by not only killing bacteria causing acne, but also by reducing the inflammation associated with certain types of acne. If they cannot be tolerated, oral erythromycin or azithromycin has been used with some success.
• Azelaic acid – Topical azelaic acid helps get rid of dead skin cells and unclog pores. It also has anti-bacterial and anti-inflammatory properties. It should not be used in darker skin types as it can bleach the skin. This can often be found in certain azelaic acid serums, for example, The Ordinary azelaic acid serum.
• Glycolic acid – Glycolic acid is an alpha hydroxy acid (AHA) that helps exfoliate dead skin cells to help with acne breakouts. It also helps fade dark spots and lessen wrinkles.
• Anti-androgens – Certain oral medications, such as spironolactone, work to decrease androgen production, which are hormones responsible for excess sebum production that leads to acne (6).
• Birth control pills – Certain birth control pills have also been used to treat acne because they decrease androgens, which cause breakouts.
• Isotretinoin – Isotretinoin is an oral form of retinoids, which is reserved for only the most severe cases of acne because of its long list of transient side effects, such as dry skin/lips/eyes, depression, and joint pain; significant permanent long term problems, such as inflammatory bowel disease; and development of birth defects if taken while pregnant. This oral acne treatment works the same way as topical retinoids to treat acne, but it is just more potent and effective.
• Dapsone – Topical dapsone works to resolve acne breakouts by acting as an anti-inflammatory agent.
• Chemical peels or exfoliants – Chemical peels or exfoliants, that contain chemical exfoliators such as retinoids, salicylic acid and glycolic acid, work by removing dead skin cells, dirt and oil that clog pores. Chemical exfoliators are usually safer for novices than physical exfoliators.

How do I prevent acne?

Prevention is just as important as treatment for regular acne.

If you don’t take proper care of your skin, no treatment will help get rid of blemishes.

Here are some different things you can do to keep your skin healthy.

1. Cleanse – It is important to cleanse twice a day to remove dirt, oil and bacteria from the skin to prevent new acne from forming. You must also wash immediately after working out or sports.
2. Oil free products – It is important to use only non-comedogenic oil free skincare products to avoid clogging your pores and causing more breakouts. This includes soap, moisturizer, sunscreen, makeup and hair products. You must check the ingredients before you use any product on your skin.
3. Moisturize – It sounds counterintuitive, but patients with oily acne-prone skin need to moisturize twice daily after cleansing to avoid skin dehydration. If you don’t, your body will think it is dry and end up increasing sebum production which will cause more blemishes.
4. Healthy diet – It is important to avoid carbohydrates which lead to more breakouts. Even dairy can worsen acne in some cases (5).
5. Proper hygiene – Make sure all things that come into contact with your face are cleansed daily such as pillowcases, towels, washcloths, face masks, athletic equipment and cellphones. These things can harbor dirt and bacteria, which lead to more pimples. It is important to keep your hair clean, because greasy dirty hair that lays on your face will increase your chances of more breakouts. Clean your razors daily with alcohol and change them frequently. Also, do not pop pimples, as this can lead to worsening of the acne, infection and scarring. People think it will make acne go away quicker, but it will make it last longer. Also, getting regular facials by an esthetician can help keep your pores clean.

Closed comedones vs fungal acne conclusion

If you have been suffering for a long time and have not been able to get your fungal acne or regular inflammatory or comedonal acne under control and you have exhausted all OTC products, don’t give up.

The good news is your dermatologist can help you understand the difference between fungal acne vs closed comedones and get you on the right treatment plan.

You should seek evaluation and treatment by a board certified dermatologist, who can help you before you have permanent scarring.

Acne is not just a teenager problem, it affects all ages.

Sources

1. Rubenstein RM, Malerich SA. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. 2014 Mar;7(3):37-41. PMID: 24688625; PMCID: PMC3970831. Closed comedones vs fungal acne

2. Prohic A, Jovovic Sadikovic T, Krupalija-Fazlic M, Kuskunovic-Vlahovljak S. Malassezia species in healthy skin and in dermatological conditions. Int J Dermatol. 2016 May;55(5):494-504. doi: 10.1111/ijd.13116. Epub 2015 Dec 29. PMID: 26710919. fungal acne vs closed comedones

3. Vlachos C, Henning MAS, Gaitanis G, Faergemann J, Saunte DM. Critical synthesis of available data in Malassezia folliculitis and a systematic review of treatments. J Eur Acad Dermatol Venereol. 2020 Aug;34(8):1672-1683. doi: 10.1111/jdv.16253. Epub 2020 Apr 30. PMID: 32012377.

4. Zaenglein AL, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016; 74: 945-73.

5. American Academy of Dermatology website www. AAD.org

6. Smith RN, Mann NJ, Braue A, Makelainen H, Varigos GA. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol. 2007;57:247-256.