Alex Hernandez, lead educator at Face Reality, offers her expert advice on fungal acne and tips to share with clients dealing with this skin condition.
If you have never heard of malassezia folliculitis, you’re not alone. This is an extremely common skin condition, but it is often incorrectly referred to as fungal acne. While malassezia folliculitis can look like acne vulgaris, it is not acne at all. As one of the most common acne imposters, malassezia folliculitis is also commonly referred to as fungal folliculitis and pityrosporum folliculitis, which are more accurate descriptions than fungal acne. Malassezia folliculitis and acne both occur in the pilosebaceous unit but unlike acne, which is caused primarily by retention hyperkeratosis, malassezia folliculitis is caused by an overgrowth of the yeast, malassezia.
An easy way to identify folliculitis (or fungal acne) are notable differences like a rash-like appearance, appears on an inconsistent basis or “comes and goes,” and it can often itch. How a lesion extracts is typically how the final decision is made between an acne lesion and folliculitis. If you are performing a treatment on a client with folliculitis, you will not be able to extract a true core from the lesion—it will just be a watery substance. There are several triggers to watch out for that could be causing your client’s folliculitis. Let’s go over triggers and some of our favorite treatment tips:
- Avoid emollient topical products. Thick creams and oils can cause these folliculitis breakouts. This is something especially common on the forehead and cheeks from a client’s hair care products. Culturally, there are some emollient haircare products that are hard to avoid like shea butter and coconut oil. You will always need to honor your client’s needs but as the professional, you will need to help them create solutions. For instance, wrapping hair at night too tightly and reusing that hair wrap multiple nights in a row can contribute to folliculitis located on the forehead and cheeks. If there aren’t any alternative products suitable to your client’s needs, you’ll need to be creative! Using a fresh hair wrap every night, keeping it as close to the hairline and off the forehead as much as possible, and frequent pillowcase washing will help reduce the occurrence of folliculitis. This goes for hats as well—remind your clients to wash their hats frequently with SLS and fragrance-free detergent.
- Balance the gut's microbiome. Your gut microbiome balances the microbiome in other parts of your body, including your skin. Someone who has been on long-term antibiotics can certainly have a disrupted gut microbiome, causing a breakout of malassezia folliculitis. It’s important that clients who must take a long course of antibiotics work with their doctor on choosing appropriate prebiotics and probiotics to balance the gut microbiome.
- Maintain a nutritious diet. The gut microbiome comes into play again but with nutrition. Moderation is key with foods high in sugar, yeast and alcohol. Big diet changes, for the worse, can bring on a buildup of malassezia. These foods do not need to be avoided indefinitely, but they should be consumed in moderation. Clients who have experienced issues with fungal folliculitis have reported that they can tell the difference quickly if they indulge more than normal on sugar-dense food.
- Avoid fabric softener, dryer sheets, and scented detergents. While fabric softener, dryer sheets, and scented detergents may make your laundry smell great, they can worsen various skin conditions. They leave a waxy substance on pillowcases, towels, and clothing that can clog the pores. This is something to be aware of for both acne and folliculitis. It is best to avoid detergents with heavy fragrance and fabric softeners altogether.
- Avoid wearing very restrictive clothing while in a sauna or working out. Sweat plus friction results in folliculitis. Tight workout clothes, sweat headbands, or hats in a hot kitchen are the perfect environment for folliculitis to take over. Think of anyone who is moving and sweating in warm weather, wearing the same visor or hat all week while they sweat out in the sun—this one of the most common causes of folliculitis in general. Avoid wearing very restrictive clothing while in a sauna or working out, change sweaty clothes or hats right away, and shower immediately after exercising.
One of the best ingredients to use for treating folliculitis topically is L-Mandelic Acid. This talented alpha hydroxy acid is exfoliating, brightening, anti-inflammatory, anti-bacterial, and anti-fungal. Serums are always the most potent way to use L-Mandelic Acid, but if your client can handle the addition of a L-Mandelic wash or scrub, that can help accelerate results. You will also want to be careful with your choice of moisturizer and sunscreen, remember to avoid very emollient topicals. A lightweight moisturizer containing specialty ingredients like anti-fungal Lilac Stem Cells and a physical zinc sunscreen make for a great combination to keep clients with folliculitis moisturized and protected.