Bacterial vs Fungal Acne?

Your Skin Microbiome and Acne

> What is acne, and how do fungal and bacterial acne differ?  Fungal and bacterial organisms are normal inhabitants of our skin. Just like our gut microflora, the skin microbiome is very important, complex and not well-understood (copyright Dr. Amin ;-) ). Acne is an inflammatory reaction against the contents of your hair follicles which include keratin, sebum, and bacteria/fungus. Whether or not the organisms are the cause or just bystanders in the acne is debated by doctors and scientists. It is my clinical experience that when the balance between bacteria and fungus (yeast, specifically) is disturbed, a skin rash such as acne or rosacea often develops. Helping to restore the balance by reducing the bacterial or fungal presence helps a lot. Sometimes, just reducing the inflammation around a pimple restores the bacterial and fungal balance. That's what a cortisone shot from your dermatologist can do without antibiotics or antifungals.

> Are there differences in the demographics of people affected by bacterial vs. fungal acne? Everyone is familiar with the bacterial acne; it is caused by a combination of hormones, blocked follicles, and certain bacteria, usually in teens but all throughout life. Fungal acne is associated with pityrosporum ovale, a yeast form that is present in 90% of people's skin. It looks similar to bacterial acne but is less common. It is often triggered by low immunity, high sugar levels, or recent antibiotic treatment. Long term steroid use can also cause fungal acne. 

> How do both conditions differ in how they present? Fungal acne often looks monomorphic, i.e. each pimple looks the same. Fungal acne usually occurs in a complex medical patient and in atypical distributions on the body. 

> What is your go-to treatment for fungal acne? And for bacterial acne? Treatment for bacterial acne is diverse and numerous. I like retinol containing products which are a derivative of vitamin A. Antiseptics like benzoyl peroxide are also useful. It is very important to use miniscule amounts of these medications since overapplication can cause severe chemical irritation that is worse than having acne. If these don't work, we will start antibiotics topically or orally. For fungal acne, focusing on the trigger is very important. Stopping the use of oils that may be causing overgrowth of yeast or tapering the use of steroid creams will help a lot. A few pills of antifungal medication or a week of antifungal cream will often cure the fungal acne. If a couple of weeks of a fungal treatment does not help your acne, you probably don't have fungal acne.

> Are there any ingredients patients with fungal and/or bacterial acne need to look out for in their skincare? Either because they help, or because they should be avoided.     Retinoids, azelaic acid, and adapalene all help open up the pores and balance bacterial and fungal growth. Benzoyl peroxide is an antiseptic that kills everything. In either case, it takes a few weeks for clinical improvement to occur. Ther is no overnight cure for acne. If you have a big pimple that needs to go away by tomorrow, call our office at 212-661-3376 for a quick acne injection. Avoid all types of oils, serums, gels that purport to cure acne. Most are not tested for efficacy or safety. An inexpensive moisturiser made specifically for the face such as Cervave or Neutrogena is good to help the skin heal. During an outbreak, it is best to avoid unnecessary sunscreens, makeups, etc.
Snehal Amin, MD

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