Fungal acne has been the cool kid in the skin care community for a while now. And it’s because almost everyone can relate in one way or another. People find it comforting that maybe – just maybe – their stubborn, recurring pimples that resist treatment aren’t acne, but a different beast entirely.
Though I enjoy testing out new products for fun, I generally don’t care much for gimmicky skin care trends and bandwagons: I’m not an easy target of marketing jargon, and I don’t like to do things just because everyone else is. In fact, I’m probably the least-easily peer-pressured person you’ll ever meet. So my initial thoughts hearing about something apparently everyone had now called “fungal acne” were, to sum it up, “Sure, Jan“.
I was being negative. My opinion was that most of these people were just desperate. After all, I couldn’t personally find many good quality photos of what severe fungal acne really looked like, so I assumed people were projecting and making assumptions. They would probably spend some time flirting with the idea, maybe trying a few treatments, then they’d go back to conventional acne products, making this just another learning step along the way to reaching their skin care goals. Good for them.
I tried my best to ignore the growing buzz around the topic because, well, I thought that getting invested would get my hopes up and have them dashed. I felt deep down that my skin was unsalvageable.
That was because, for the better part of my life, I’ve struggled with shocking skin. Not your typical ‘bad teenage skin’ either, but really awful stuff. It caused me so much emotional pain: both in cruel comments and my own negative self-worth. I’ve literally had a child ask me if I had chickenpox – yikes.
Even as I grew into skin care and found a good routine earlier than most and my skin improved, I’ve never had ‘good’ skin. My texture was never ever smooth, always slightly irritated and bumpy looking. No amount of makeup could cover it. It would drive me insane when friends said they couldn’t notice it, or my skin was fine (to try to make me feel better), but I’d do their makeup and feel the softness of their skin and compare it to mine, and I knew that something was wrong.
Even at its best and with perfect treatment, my skin would regularly relapse for seemingly no reason. Over time, I accepted that as my new normal.
But then the worst flare-ups I’ve ever had came, and I realised that I was dealing with something that had to be more than just run-of-the-mill breakouts.
Stubborn me still thought “there’s no way this fungal acne be real – these treatments can’t help me… right?“.
But thank goodness I eventually got down off my high horse – because I found that fungi HAVE been the cause of my severe ‘acne’, and I finally took the steps to be rid of it.
Here are all the juicy details: how my skin looked during the worst fungal infection of my life – from pre-breakout to the aftermath – and the cream that led to the prescription that’s kept me fungal acne free for two years.
What a fungal flare-up looks and feels like
Warning: Let’s hope you’re morbidly curious – this is yet another post that includes some super graphic, unflattering, real photos of my skin. You’re not looking at a filter or my good angles – this is the real deal and it’s ugly! Also, please excuse the many lip/nostril close-ups I’m about to expose you to.
The beginning stages and warning signs of an infection
The worst of the attacks came in waves.
Every cycle of these flare-ups would start the same – on an otherwise fine skin day, the absolutely tiniest of whiteheads would appear.
Maybe it was one or two, or up to ten, but they were pinprick sized and grouped together. I could easily scratch them off with a finger, leaving behind only a tiny red mark.
It was barely enough to take notice of. When you’ve suffered from terrible skin your whole life, you’d look at these and think “pfft, so what?”. And so would I.
The spread and worsening
Then, the next morning I’d wake up and my skin would feel rough. Really strange, like I’d got a layer of Elmer’s glue on and I just wanted to rub it off. It feels grainy and dry. When I looked in the mirror, my heart sank. I could see hundreds of teeny tiny inflamed whiteheads.
They might not look like much now, but by this stage after 6 separate episodes, I knew what was about to come – and I couldn’t do anything to stop it.
Thousands upon thousands of blisters sprouted and spread like wildfire.
They started and would be worst on my chin. They felt very rigid, and if I picked at them, they would pop dramatically and painfully, spitting out a small amount of firm pus (yuck) and leave behind an oozing red mark.
Picking at it would only make it spread faster, though. They traveled up my cheeks and even onto my forehead. They were so unbelievably itchy and painful.
The texture is appalling. Under strong lighting, you can see the deep swelling and damage being done to my skin.
No traditional acne treatments I’d put on my skin would touch it. It was just a matter of waiting it out.
If I had to guess, I’d say the amount of uninvited comments about how to fix my “acne” from near strangers at this point tripled. And believe it or not, my ever-loyal friends and coworkers would still try to convince me that it was barely noticeable, bless their hearts.
When I had to go to a highly important job interview looking like this, and it tanked my self-esteem, not to mention being a huge eyesore and undoubtedly a negative factor. Nobody wants to be known as the candidate that had the distractingly awful skin.
The aftermath and healing from an outbreak
Around 3-5 days from the initial outbreak, slow and painful healing began. New whiteheads stopped appearing and old ones dried up into a crusty, sore layer. The texture slowly began to flatter and small areas of skin returned to a more normal colour.
I would be left with highly vulnerable post-inflammatory erythema and some hyperpigmentation that took weeks if not months to clear. For someone like me who has struggled with a compulsive skin picking disorder, this can wreck my relationship with my skin and bring me right back down again.
… and repeat
The worst part about all of this? Just weeks or even days later, the first few tiny bumps crop up and I know I’m in for it all over again. I would never fully heal, and even my best days were bumpy and red.
At this point, I still didn’t understand what was causing these extreme breakouts unlike any I’d seen on other people.
It’s absolutely draining mentally to know that your skin is about to go through a horrendous experience, and not to be able to do anything to stop it and having no idea WHY it’s happening.
The symptoms that made me suspect I had a fungal infection
Fungal infections look and act differently between people, depending on the location, fungi, and just your body’s reaction, so it can be tricky to spot. If it’s not on your mind, you might not recognise the signs.
For me personally, the tip-offs were:
- There were sudden periods of my acne becoming distinctly worse and more widespread than seemed normal (as you’ve just seen photo evidence of).
- I had a red, bumpy skin texture even between my pimples and even on a good day.
- My lips, especially around the edges, would feel thick like they have a layer of dead skin, and itch all day.
- Sometimes my chest would break out in red dots, most often after exercising.
- No amount of anti-acne treatment would touch the endless deep, sore pimples and the tiny whiteheads!
- My skin surprisingly got worse after taking a course of antibiotics.
- I had had a fungal skin infection (seborrhoeic dermatitis) before.
The solution that finally began clearing my fungal folliculitis
After trying every other avenue, and unable to stand the itch and frustration, I gave what seemed like a crazy idea a try.
I applied topical antifungal cream on my face – and it worked.
That’s right – I really used a Clotrimazole cream (specifically Canesten) designed for athletes foot, ringworm, thrush (ew) etc. and popped it on twice a day in place of moisturiser.
Just bit by bit, my skin looked less angry. Not perfect, but much improved.
I waited it out until I had one more bad flare up a couple of weeks later that the cream didn’t touch. That finally pushed me over the end and I rushed to a doctor during the worst of it, who took one look at my skin and started listening to me and taking me seriously.
What the doctor prescribed: Fluconazole 50mg oral capsules
I told my GP everything: about all my symptoms, showing her my photos and logs, and speaking about taking antibiotics in the past that made it worse, and the minor success of the antifungal cream. I’m so grateful for her open mind and willingness to listen. She and I together decided to give oral antifungals a try. Specifically, Fluconazole 50mg capsules taken once a day for two weeks.
Within days, my skin looked already better than it had pretty much ever looked since I was 13.
Not just ‘good’ – or what I used to think was good – but amazing. Radiant. Smooth and calm. I literally cried.
All the pain and stress and failed acne treatments fixed with a simple doctor’s visit.
I wish it was easier and that there was a way to cure it at home. While I think prevention and minor treatment can be done at home with a certain routine, for a severe, recurring case like mine, the best thing I did was to move on from at-home treatments to seeing a doctor. I’m sure that my meticulous documentation of the progress of the flare-ups – in notes and photos on my phone – helped the doctor understand the issue to diagnose it properly.
What is fungal folliculitis/fungal acne?
To understand that, you first have to know that our skin is covered in tiny organisms. Think bacteria, mites and yes – fungi. That’s totally normal. What’s not normal is any one of these taking over and over-populating the skin. At high levels, anything will begin to cause issues.
The fungi that live on our skin
A huge number of fungi grow in the world and on our skin – without us even noticing! They include:
…and hundreds more!
Causes of fungal overgrowth
Everything that makes up our skin flora lives in harmony. A wide range of organisms – from bacteria to even mites – share the surface, feeding on our skin cells and oils, and usually causing few problems.
Fungal infections where the numbers grow too large can happen for a few reasons:
- Eradication of other organisms like bacteria, such as when you take antibiotics, can give fungi the room to become too strong and overtake the natural balance.
- Imbalanced hormones or a predisposition to certain skin types and conditions like extreme oiliness, low cell turnover, and eczema can feed fungal overgrowth or allow infections to take hold quickly in broken skin.
- Finally, lifestyle choices such as hygiene habits, activities like sports, and even certain environments just lend themselves well to fungi. Think of being hot, sweaty and humid. Anything that creates excess heat, oil, or moisture – especially if it’s not washed off quickly – can promote fungal overgrowth.
Why is fungal folliculitis so hard to treat?
Fungal folliculitis actually commonly referred to as pseudo-acne. Many teens develop the condition and don’t respond to traditional acne treatment and kind of just get… left behind. Because acne is so common, many doctors don’t take the time to consider it could be something else.
Also, oral antifungals can be hard on organs of the body so many medical practitioners are reluctant to prescribe them without proven attempts at a traditional antibacterial acne regimen.
There’s a general lack of awareness around fungal acne, so it’s important to educate yourself, keep track of what treatments you’ve tried and what you’ve not, and be an advocate for trying something new if you think it might be what’s plaguing you.
Photos of my skin after the course of antifungals
Here’s what you’ve all been waiting for – here’s how my skin looked one month after starting my course of antifungals.
You can still see some inflammation from the healing but it’s night and day compared to what I was dealing with before. My other products had a chance to work, I could treat regular bacterial acne without fear of sending the fungal infection into overdrive, and mostly I could finally relax again.
Photos of my skin now: two years fungal acne free
And now, in 2020, my skin still isn’t perfect – and will probably never be, partially thanks to the high-quality camera lens I now see it through – but just LOOK at the difference as compared to at its fungal-acne worst!
A fungal acne friendly skin care routine?
Believe it or not, I still don’t follow a “special” routine to keep my fungal acne at bay. After the course of antifungals, I’ve not had any problems like that ever again. I think once you’re at the point that I was, a doctor is the only person who can help you get back on your feet. Now when I spot a few little suspicious whiteheads or red dots on my chest, a few days of clotrimazole cream and giving my skin a break from any of my oil-based products is enough to get rid of it again.
In addition to those, I make sure to always shower straight after exercising, dry off thoroughly, and wash my towels and sheets extremely often. Also, after a traumatic toenail injury in late 2018, I contracted a fungal infection of the toenail, which is a whole beast in and of itself. While I’m still treating it to this day, I’m very cautious not to cross-contaminate by touching my feet then any other part of my body without washing my hands.
I have to thank F.C. over at Simple Skincare Science blog. He has made the famous Malassezia Folliculitis post that I referenced many times during my research. It’s one of the most informative posts I can recommend to you all. There’s fascinating explanations of the science behind why we get fungal acne, what products feed it and what products prevent it. If you’re struggling with recurring infection, and looking to build a foolproof anti-fungal routine to remove any possible trigger ingredients, that’s the place to go.
This post isn’t to congratulate myself, to convince you to go on medication, or to say that every case of stubborn acne is fungal – but rather to say that an open mind is always the best way to solve any problem. You might end up like me, and find a solution you never even thought possible.
I’ve come to terms with the fact that fungal acne could be something I just manage and keep a wary eye on for the rest of my life – but that’s ok. I can’t wait to see where I go from here without fungal flare-ups as bad as that ever holding me back. I’ve developed an awesome skin care routine and strategies to rely on to keep me motivated and on track. I hope you find a solution that helps you love your skin as well!
If you’re in need of guidance to take better care of your skin, or you’re curious to see more of the habits that got me to where I am now, I’ve compiled them all into an 80-page guide for the skin care beginner. The Strategic Skin Program means you can all follow the same steps as me at home! I’ve included tons of advice, quizzes, motivation, myth-busting and so much more – so check it out!