Fungal Acne vs Regular Acne: How to Tell the Difference

If your acne won't respond to typical treatments and feels itchy, you might be dealing with fungal acne rather than regular bacterial acne. While they look similar, these two conditions have different causes and require completely different treatments. Understanding which type you have is the first step toward clear skin.

What's the Main Difference?

Regular acne (acne vulgaris) happens when your pores get clogged with oil, dead skin cells, and bacteria. Fungal acne, technically called Malassezia folliculitis, is caused by an overgrowth of yeast that naturally lives on your skin.

The key difference: fungal acne is an infection of your hair follicles by yeast, while regular acne involves clogged oil glands and bacteria. This is why regular acne treatments often make fungal acne worse.

How to Tell Them Apart

Appearance and Pattern

Fungal acne shows up as small, uniform bumps that are all about the same size, appearing in clusters or patches. These bumps are typically 1-2mm in diameter and look very similar to each other. Regular acne varies in appearance with blackheads, whiteheads, pustules, and cysts of different sizes.

Location on Your Body

Fungal acne commonly affects areas that sweat more: your upper back, chest, shoulders, and forehead. Regular acne tends to show up on your face, especially in the T-zone (forehead, nose, and chin), though it can appear anywhere.

The Itchiness Factor

This is the biggest telltale sign. Fungal acne is often itchy, with studies showing that about 70% of patients experience itchiness. Regular acne typically doesn't itch, though it can be painful when inflamed. If your breakouts are itchy rather than painful, that's a strong indicator you're dealing with fungal acne.

Response to Treatment

If you've been using benzoyl peroxide, salicylic acid, or antibiotics without improvement, fungal acne might be the culprit. These standard acne treatments don't work on yeast and can actually make fungal acne worse by disrupting your skin's natural bacterial balance.

Why Regular Acne Treatments Don't Work on Fungal Acne

Fungal acne requires antifungal treatment because it's caused by yeast, not bacteria. Antibiotics used for regular acne can actually worsen fungal acne by killing off the good bacteria that normally keep yeast growth in check. This is why proper diagnosis is so important.

Treatment Approaches

For Fungal Acne

Fungal acne responds to antifungal treatments. Your dermatologist might recommend antifungal shampoos (like ketoconazole or selenium sulfide) used as a body wash, topical antifungal creams, or oral antifungal medications for more persistent cases. Treatment typically shows improvement within a few weeks.

For Regular Acne

Regular acne treatment includes topical retinoids, benzoyl peroxide, salicylic acid, and sometimes antibiotics or hormonal treatments. Your dermatologist can create a treatment plan based on your acne severity and type.

When to See a Dermatologist

See a dermatologist if:

- Your acne doesn't improve with over-the-counter treatments after 4-6 weeks

- You have itchy breakouts in uniform clusters

- Your breakouts appeared or worsened after taking antibiotics

- You're unsure which type of acne you have

A dermatologist can examine your skin, potentially take a sample for testing, and provide an accurate diagnosis. They can confirm whether you have fungal acne, regular acne, or another skin condition that mimics acne.

The Bottom Line

The main differences between fungal acne and regular acne come down to cause, appearance, and symptoms. Fungal acne presents as itchy, uniform bumps in clusters, while regular acne varies in appearance and typically isn't itchy. Most importantly, they require different treatments. If you suspect you have fungal acne, especially if regular acne treatments haven't worked, consult a dermatologist for proper diagnosis and treatment.