Different types of acne: bacterial vs. fungal acne

Most of us, myself included, have at one point encountered acne, whether in a mild or severe form. Acne can be very painful and weigh down your self-esteem as I have experienced it myself and know how damaging it can be. When you notice a pimple on your face and that the treatments you’re trying aren’t making any difference, it may be beneficial to try identifying the type of acne you’re dealing with to find a solution that can yield better results. Let’s take a look at the differences between bacterial and fungal acne, which can allow for clear identification and a more effective treatment plan.

Bacterial Acne

What is it?

Acne vulgaris, otherwise known as (bacterial) acne, is the most common acne type we have come to know. It refers to a wide array of acne types, some of which being cystic, papules, pustules, nodules, and comedones, commonly known as whiteheads and blackheads (Keri, 2018). As someone very guilty of picking at their acne, I hope you learn from my mistakes and avoid popping any of the above types of bacterial acne as it’s only going to cause more harm than good. Our skin microbiome contains many species of bacteria that are located in the epidermis (upper part of the skin) as well as the higher parts of the hair shaft (Sutaria, 2020). When our dead skin cells, hair, and sebum (oil) combine, they create a plug-like structure in the skin (Keri, 2018). This plug can either inflame or become infected with the bacterium Propionibacterium acnes ( also known as P. acnes), which gives rise to acne (Sutaria, 2020). This type of acne can appear on the face, neck, chest, or back as those areas have more sebaceous glands than other regions of the body (“Team Aspery, 2020”).

What causes it? 

This kind of acne is generally first encountered during adolescence due to an influx of a group of hormones called androgens, which increase sebum production that plays a role in acne formation (Keri, 2018). An increase in follicular hair growth also plays a role in acne formation as it allows plug formation that clogs the pores on the skin, which leads to more acne (Sutaria, 2020). The increase in these two factors exacerbates the plug formation process that typically causes teen acne; however, it can be experienced by various age groups (Higuera, 2019).

What are the possible treatments?

There are many different approaches to helping heal this type of acne; some of the most common are:

•     Lifestyle change: This refers to cutting out inflammatory food sources, which may include but are not limited to dairy, gluten, alcohol, sugary food, and oily foods (Cirino, 1986). These foods tend to have high sugar content, which causes blood sugar to rise faster than normal, which releases insulin (Cirino, 1986). This excess insulin in the bloodstream causes increased oil production, which, in turn, makes it easier to clog pores and develop acne (Cirino, 1986). For me, I find that cutting out chocolate and fast food while adding berries and drinking more water makes the most significant difference in my skin. Transitioning to a diet with complex carbohydrates, including fruits, vegetables, and legumes, is an excellent way of lowering bodily blood sugar, thus reducing oil production to help avoid clogging of pores (Cirino, 1986). Foods rich in zinc like turkey, quinoa, lentils, and seafood help with regulating metabolism and hormone levels, which in turn is helpful for acne reduction (Cirino, 1986).
•     Skincare routine: Some great ingredients to look for in skincare for acne include salicylic acid, benzoyl peroxide, and retinols.  Salicylic acid works by reducing the rate of dead skin cells which ensures that pores remain unclogged to prevent the formation of acne (Sutaria, 2020). Benzoyl peroxide works to kill acne-causing bacteria to help prevent lesions (Keri, 2018). Having used this before, I noticed my skin becoming drier, so ensure you are moisturizing to alleviate the dryness side effect. Retinol is a slightly stronger ingredient used to treat acne due to its ability to promote cell turnover by preventing the formation of dead skin cells that clog pores (Pai, 2020). Always be careful when you start using retinol as it can make your skin more sensitive and susceptible to peeling, as that was my experience. To deal with this, I used the retinol alternating days to give my skin a break. It is important to ensure these products are towards the top of the ingredient list as that entails a high concentration of active ingredients, thus yielding more effective results (Chia, 2017).
•     Oral medications: One of the most well-known of these is Isotretinoin, more commonly known as Accutane, which is a derivative of Vitamin A, making it a retinoid (Brannon, 2020). It works by reducing P. acnes and excessive sebum production in the sebaceous glands, which in turn lessens the amount of acne (Brannon, 2020). It is mainly used as a last resort when all other remedies do not show results as it has many side effects, some being dry skin, rash, nose bleeds, etc. (Brannon, 2020).

Fungal Acne

What is it?

Another subdivision of acne that is not commonly known is pityrosporum (Malassezia) folliculitis, otherwise known as fungal acne (Rostamian & Spruch-Feiner, 2020). There are some distinct features to differentiate between the two types of acne, some of which being that fungal acne causes an itching and burning sensation not experienced with bacterial acne. There is no point in attempting to “pop” fungal acne as it will not work the same as popping a whitehead-trust me on this one. Fungal acne tends to become easily irritated, and thus the skin turns red in the patches it appears in, and it can be triggered by overproduction of sweat as the yeast thrives in hotter climates (“Team Aspery, 2020”). When the fungus out numbers bacteria it will lead to overgrowth as it causes a stray from the balanced microbiome (Harth, 2020).

What causes it? 

Fungal acne occurs due to an overgrowth in yeast at the hair follicle, which in turn irritates the skin and causes white head bumps that appear similar to comedones, specifically whiteheads (Abelman, 2020). Fungal acne has many similarities to bacterial acne, some of the most prominent being placement in oily regions such as the T-zone (which includes the forehead, nose, and chin), chest, and back. Both occur in adolescent years due to increased sebum production, and both can contain pus (Levin, 2019). Fungal acne thrives in oil-prone areas since they serve as a growth medium leading to further inflammation around hair follicles, which produces the small bumps (Harth, 2020).

What are the possible treatments? 

Many individuals report frustration from acne treatments that are found inactive as they do not target the root cause of the fungal acne- targeting the yeast overgrowth. Due to this, many people with fungal acne struggle to find effective treatments as they may not be aware they have fungal acne; thus they do not look for specific solutions to address it. There are, however, many steps that can be taken to assist in clearing fungal acne, some of which being:

•     Enforcing dietary changes: Restricting consumption of sugary foods, simple carbohydrates, and alcohol would limit yeast production as the yeast would no longer have a food source (“Team Aspery, 2020”). Maintaining a balanced gut microbiome also plays a vital role in limiting yeast production; thus a well-balanced diet is recommended (Harth, 2020). When the yeast food source is removed, and the bacteria on the skin return to healthy levels, it will be unable to grow; thus the fungal acne rates lower (“Team Aspery, 2020”). Refraining from sugary foods has helped me see a slow and steady decrease in my fungal acne, which has helped smooth out my skin texture.
•     Antifungal agents: Fungal acne doesn’t respond to bacterial acne treatments as it does not target the yeast that generates the fungal acne. Some excellent agents, including sulfur, clotrimazole, ciclopirox olamine, and econazole nitrate, target the yeast growth and are much more effective (Levin, 2019). They work by disrupting the cell wall by targeting certain components that can cause phagocytosis (eating) of the fungus (Brown, 2010). Another great alternative is anti-fungal shampoo (such as Nizoral), which can be used as a mask treatment to help with the acne bumps as it contains an antifungal agent known as ketoconazole (Abelman, 2020). I have heard this treatment is a crowd favorite as it is inexpensive and effective.
•     Clothing fabric restrictions: synthetic clothing materials are not recommended as they can trap the oil, which would exacerbate the rate of fungal acne production (Khona, 2020). This acne is due to oil build up that is not able to be eliminated. Therefore breathable fabrics are best to combat this issue (“Team Aspery, 2020”). Sweat can also be another factor that triggers fungal acne thus it is recommended to shower after activities such as exercise and to remove such clothing to avoid flare-ups (Rostamian & Spruch-Feiner, 2020).

I recommend trying out some products with active ingredients that would address your acne. One of my all-time favorites is the Niacinamide 10% and 1% Zinc serum from the Ordinary. It works wonders for targeting acne scarring as well as being a preventative measure by helping balance sebum production. It’s important to note that the information provided in the article is purely for educational purposes and not meant to substitute the assistance of trusted medical professionals. If you are struggling with acne and feel that you may require a medical opinion, reach out to a trusted family doctor or dermatologist who will have the ability to address your concerns adequately.  

 References

Abelman, D. (2020, June 01). The 9 Best Products for Treating Fungal Acne. Retrieved July 03, 2020, from https://www.allure.com/gallery/best-fungal-acne-safe-products-pityrosporum-folliculitis-treatments

Brannon, H. L. (2020, May 14). Treating Acne With Isotretinoin (Formerly Accutane). Retrieved July 03, 2020, from https://www.verywellhealth.com/treatment-of-acne-with-isotretinoin-accutane-1068828

Brown, G. D. (2010, October 11). Innate Antifungal Immunity: The Key Role of Phagocytes. Retrieved July 04, 2020, from https://www.annualreviews.org/doi/abs/10.1146/annurev-immunol-030409-101229?requestedContent=related

Chia, J. (2017, October 23). Here's Exactly How to Read a Skin Care Product Label. Retrieved July 04, 2020, from https://www.allure.com/story/how-to-read-skin-care-ingredient-label

Cirino, E. (1986, January 08). Anti-Acne Diet: Get Rid of Acne by Eating Healthier. Retrieved July 03, 2020, from https://www.healthline.com/health/anti-acne-diet

Asprey, T. (2020, July 02). Fungal Acne is a Thing And You Could Have It (Maybe). Retrieved August 05, 2020, from https://blog.daveasprey.com/fungal-acne-treatment-pityrosporum-malassezia-folliculitis/

Harth, D. (2020, March 31). Fungal acne causes and treatments. Retrieved July 03, 2020, from https://www.mdacne.com/article/fungal-acne-causes-and-treatments-according-to-dermatologists

Higuera, V. (2019, August 20). Adult Acne: 10 Surprising Causes (and How to Get Rid of It): Everyday Health. Retrieved July 04, 2020, from https://www.everydayhealth.com/skin-beauty/acne/10-surprising-causes-acne-adults/

Keri, J., By, & Last full review/revision Dec 2018| Content last modified Dec 2018. (n.d.). Acne Vulgaris - Dermatologic Disorders. Retrieved July 02, 2020, from https://www.merckmanuals.com/en-ca/professional/dermatologic-disorders/acne-and-related-disorders/acne-vulgaris

Khona, M. (2020, March 18). Understanding Fungal Acne + Causes, Treatments, Dos & Don'ts. Retrieved June 29, 2020, from https://skinkraft.com/blogs/articles/fungal-acne

Levin, N. (2019, March 13). Folliculitis, Pityrosporum (Malassezia Folliculitis). Retrieved July 03, 2020, from https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/folliculitis-pityrosporum-malassezia-folliculitis/

Pai, D. (2020, June 11). Everything You Need to Know About Using Retinol for Acne. Retrieved July 04, 2020, from https://www.glamour.com/story/retinol-for-acne

Rostamian, M., & Spruch-Feiner, S. (2020, June 01). Ask a Dermatologist: How to Identify and Treat Fungal Acne. Retrieved July 03, 2020, from https://www.byrdie.com/fungal-acne-4843813

Sutaria, A. (2020, May 24). Acne Vulgaris. Retrieved July 04, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK459173/