Itchy – that was the first thing I noticed about the small pimple-like bumps littering my forehead. So incredibly itchy that my fingers rarely left my face, even in sleep. From a smatter of red bumps, the eruption continued to grow angrier and darker, rendering my usual skincare routine useless. Plain tap water was my only relief, until the internet told me the thing living on my forehead was yeast.
And I had been unintentionally feeding it. What seemed like a bad acne breakout was an infection caused by Malassezia, a fat-loving yeast. The most frustrating part about this beast is that it is a happy camper. It will stay put for years, dodging all your regular acne treatments till you find a way to starve it.
“Sometimes people with this condition think they have recurring acne and try to treat it as they would regular acne. This makes it easy to miss it,” Dr Anna Zakhozha, specialist dermatologist at 7 Dimensions Medical Centre in Dubai, told Gulf News.
Sometimes people with this condition think they have recurring acne and try to treat it as they would regular acne. This makes it easy to miss it.
Malassezia folliculitis is notoriously underdiagnosed. If the cluster of pimples spotting your cheeks and brow refuses to clear up, then you most likely have a fungal problem. With insight from skin experts and a fellow Malassezia trooper, we come bearing secrets to achieving a less bumpy forehead.
Is it fungal acne?
Online skincare circles have resorted to calling it ‘fungal acne’ because the skin condition looks so much like zits. Dermatologists prefer the more accurate, scientific term pityrosporum or Malassezia folliculitis.
Yeast is ever-present on our skin, but when it starts sinking into the hair follicles and quickly multiplies, that’s when the situation gets hairy. As is the nature of yeast, it thrives in warm and humid climate – if your summers have gotten particularly hot, this could be one of the many causes.
It cannot be called acne; this term is misleading. Malassezia folliculitis is a condition characterised by monomorphic (having one form) papules and pustules, often on the chest, upper back and face.
Dr Snehal Desale, specialist dermatologist at Prime Hospital Dubai, says overgrowth of yeast results in an acne-like eruption on the skin: “It cannot be called acne; this term is misleading. Malassezia folliculitis is a condition characterised by monomorphic (having one form) papules and pustules, often on the chest, upper back and face.”
Ways to tell the two apart
Distinguishing Malassezia folliculitis from regular acne is no Herculean task. Check for the absence or presence of these two symptoms:
- Look for any signs of whiteheads (closed comedones) and blackheads (open comedones). Dr Zakhozha says that ‘fungal acne’ lacks comedones in its growth. Instead, there might be some papules, which have no visible pus, and pustules, big zits with fluid.
- Your pimples are unusually very itchy, while acne is not. There is a constant ticklish sensation under your skin.
In some cases, people take years to reach a conclusive diagnosis. An anonymous 20-year-old student shared with Gulf News how it took her six years before she sought professional treatment. Diagnosed at the age of 19, the Dubai resident thought “it was normal acne” till her specialist conducted a lab test for the stubborn bumps crowding her brow.
“My dermatologist had to burst a pimple on my forehead, take a swab test and then monitor it overnight – for both bacteria and fungi. Three days later she found the yeast had grown, so she called to tell me that I had fungal acne.”
Why do I have it?
Since the yeast needs fatty acids to grow, it surfaces more often on oily skin types in teenagers and adults. Dr Desale adds that men with greasy skin are especially prone to Malassezia. Other risk factors could include something as innocuous as sweating.
Here is a rundown by Dr Zakhozha:
- You live in a hot, humid climate, making for the perfect yeast-growing environment.
- Your skin tends to release more oil than most, which is called high sebum production.
- You’ve been sweating a lot in tight clothes.
- Your sunscreen and moisturiser are too fatty, and they’re blocking your skin from breathing.
- You have recently used an antibiotic – antibacterial prescribed to beat bacteria in severe acne. Yes, your acne treatment is probably not doing wonders for your fungal condition. (If it helps, my Malassezia erupted around the time I added Tretinoin into my skincare routine.)
- You use oral steroids, like prednisone.
- Or, you’ve just had a laser hair removal treatment done.
Stress and fatigue also play a role in exacerbating fungal acne.
How do I treat it? Short answer: Starve the yeast
Seeing an experienced dermatologist is your best bet, who will prescribe you either oral or topical treatments. But if you’ve taken to internet like me for quick answers, then I do have specialist-backed advice for you. Follow this mantra to beat Malassezia at home: Invest, revamp and avoid.
Rule 1: Invest in antifungal products
Applying a thin forehead mask of anti-dandruff shampoo did wonders for me. Anti-dandruff essentially means antifungal, so it contains your key yeast-fighting ingredient ketoconazole. This agent stops the fungus from reproducing.
“At home, you can treat this condition with ketoconazole shampoo. It will get cured in a few weeks’ time,” said Dr Desale.
At home, you can treat this condition with ketoconazole shampoo. It will get cured in a few weeks’ time.
Our anonymous interviewee was first prescribed oral antifungal medication, which broke her out into an allergic reaction on the cheeks. On seeing her second skin specialist, the student finally cleared her skin with the help of a ketoconazole shampoo.
Application: On a clean, dry face, I would layer a dollop of the pink-coloured shampoo over my fungal bumps, keeping it on for 15 minutes before washing it off. Because it is so drying, I applied the mask only once every morning for a week.
Tip: Follow up with a Malassezia-safe moisturiser to combat the dryness.
Rule 2: Revamp your skincare
Once you’ve woken up the yeast, there is no going back. Malassezia folliculitis is known for its stubborn trait – the yeast will keep coming back for food. Your answer, then, is to literally starve it. This means cutting out any skincare product that has fatty acids and oils in its formula.
Dr Zakhozha says to scan the ingredients label on the back of your products and avoid the following: Laurice acid, Myristic acid, Tridecylic acid, Palmitic acid, Stearic acid, Oleic acid and Linoleic acid.
Build a new repository of cleanser, body wash, shampoo, moisturiser and even cosmetics that are Malassezia safe. A shea butter hair cream, for instance, can easily transfer from your hairline to brow and re-trigger fungal acne.
Tip: Choose products made from as few ingredients as possible. Avoid scented items to reduce the chances of sensitivity.
Rule 3: Avoid sugar and oil in food
Dr Zakhozha said: “Balance your sugar. When your blood sugar is up and down, it leads to surges of insulin. These surges of insulin start a hormonal cascade that winds up making your skin oilier.”
Balancing blood sugar means eating some protein or healthy fat with every meal, choosing wholegrains instead of white grains and consuming fibre-rich vegetables and fruit.
Another dietary advice comes from Dr Desale, who says oily food is bound to increase the oil on your face.
As long as you follow the three golden rules, you will find that fungal acne is as quick to go as it is to grow. Remember to steer clear of any oily skincare product that could feed it. And don’t worry, Malassezia is not contagious.