Yeast Acne (Fungal Acne): Causes, 7 Types Dermatologists Tell Apart, How It Differs from Regular Acne, Topical and Oral Treatment, and Why It Keeps Coming Back
Yeast acne, or fungal acne (Malassezia folliculitis, formerly Pityrosporum folliculitis) is inflammation of the hair follicles caused by Malassezia yeast. This yeast lives normally on everyone's skin but can overgrow and settle in the follicles. The rash appears as small red bumps or tiny pustules 1–3 millimeters wide, all looking alike, itchy, and most common on the back, chest, shoulders, upper arms and hairline. This differs from regular acne (acne vulgaris), which is caused by blocked oil glands and bacteria.
The problem dermatologists see most often is a patient who has treated it as ordinary acne for months, with acne creams and antibiotics, yet the bumps do not improve and sometimes increase. Antibiotics kill bacteria, not yeast, and they also remove the bacteria that keep yeast in check. This article divides yeast acne into 7 types by location and cause, with ways to recognize it yourself, the medicines doctors actually use (names, strengths and duration), and how to lower the chance of recurrence.
What does yeast acne look like?
Features that help a doctor tell yeast acne from regular acne at a glance.
All the same size: small red bumps or pustules 1–3 millimeters wide, almost all identical, unlike regular acne where large and small lesions are mixed.
No blackheads or whiteheads: no comedones, which are where ordinary acne begins.
Itchy: most patients feel itching, especially after sweating, exercise or in hot weather. Regular acne tends to hurt rather than itch.
In clusters: ten to dozens of bumps appear at the same time in one area.
Location: upper back, chest, shoulders, upper arms, neck, hairline and forehead. It rarely appears in the middle of the cheeks the way hormonal acne does.
Rarely pitted or scarred: the inflammation is shallower than in ordinary inflammatory acne, but scratching can leave dark or red marks.
What causes yeast acne?
Malassezia yeast loves oil and moisture. When the skin allows it to grow quickly, it settles in the follicles and breaks down the oil there into irritating free fatty acids, which inflame the follicle and form bumps. Common factors include the following.
Hot, humid weather and sweat: this is why it occurs year-round in Thailand and often flares from the hot season through the rainy season.
Tight, non-breathable clothing: synthetic workout clothes, thick uniforms, and lying on a damp mattress for long periods.
Antibiotics: especially tetracyclines such as doxycycline, taken for weeks to treat acne. The drug reduces the bacteria that normally compete with yeast, so the yeast takes over.
Steroids: both oral and topical, including creams that contain steroids without you knowing.
Oily skin and oil-containing products: heavy sunscreens, facial oils, and sunscreens or lotions containing certain plant oils, which feed the yeast.
Weakened immunity: diabetes, people taking immunosuppressants, organ transplant patients, people with HIV.
Age: most common from the teens to about age 40, because the oil glands are most active.
Yeast acne is not contagious and does not mean you are unclean. This yeast is already on everyone's skin; the problem is simply that there is too much of it at certain times.
How is yeast acne different from regular acne?
A short comparison that doctors use for initial sorting.
Bump size: yeast acne 1–3 mm, all the same · regular acne mixed sizes, from small heads to large nodules.
Blocked pores: yeast acne none · regular acne always present.
Main symptom: yeast acne itchy · regular acne painful.
Location: yeast acne back, chest, shoulders, hairline · regular acne mainly the face.
Response to antibiotics: yeast acne no improvement or worse · regular acne improves within 6–8 weeks.
Response to antifungals: yeast acne itching eases within 3–7 days · regular acne no change.
In real life, many patients have both at once: regular acne on the face and yeast acne on the back or forehead. Seeing some blocked pores mixed in does not rule out yeast acne, and the doctor will treat both parts together. Read more about blocked pores at What causes clogged pores.
Quick 5-point check: are your bumps yeast acne?
If you answer yes to 3 or more, yeast acne is quite likely and you should have a doctor confirm it.
Small bumps of similar size, with no blackheads or whiteheads
Itchy, especially after sweating
Located on the back, chest, shoulders or hairline more than on the cheeks
Started within a few weeks of antibiotics, steroids, or time in hot, stuffy conditions
Treated as regular acne for more than 4–8 weeks without improvement
Yeast acne type 1: on the back and chest
Appearance: small red bumps and pustules spread over the upper back, middle of the chest and shoulder blades, often dozens of them. The skin around the bumps may look shiny and oily.
Cause: these are the areas with the most oil glands and the most sweat, and clothing covers them all day. It is common in people who exercise and do not shower and change right away.
Severity/urgency: not dangerous, but itchy and disruptive to daily life. Heavy scratching leaves dark marks, and the bumps can become infected with bacteria.
When to see a doctor: bumps do not decrease within 2 weeks of basic care, keep spreading, or large painful pustules are mixed in.
If you are not sure what type of acne is on your back, read more at What causes back acne.
Yeast acne type 2: on the forehead and hairline
Appearance: small itchy bumps lined up along the hairline, forehead and temples, in some people spreading to the nose and chin. Usually accompanied by oily skin and fine scale.
Cause: the scalp is the body's largest reservoir of Malassezia yeast. People who also have dandruff or seborrheic dermatitis often get yeast acne on the forehead. Wearing hats, helmets or headbands for long periods makes it worse.
Severity/urgency: not dangerous, but often mistaken for heat rash or hormonal acne and treated incorrectly.
When to see a doctor: no improvement within 4–6 weeks of regular acne treatment, or thick dandruff and red patches on the eyebrows and beside the nose.
Forehead bumps have many causes. See how to tell them all apart at What causes forehead acne, and if you also have scale on the scalp, read What causes dandruff.
Yeast acne type 3: on the neck, shoulders and upper arms
Appearance: small itchy red bumps on the back of the neck, upper back, shoulders and outer upper arms. Some people get them in lines where bag straps or bra straps sit.
Cause: friction and trapped moisture from bag straps, backpack straps, long hair resting on the neck, and sweaty collared shirts.
Severity/urgency: not dangerous, but it must be told apart from keratosis pilaris on the upper arms, which is rough, non-itchy bumps that do not respond to antifungals.
When to see a doctor: when you are unsure what kind of bumps they are, or self-care has not helped within 2 weeks.
Neck bumps can be several different conditions. Read more at What causes neck acne.
Yeast acne type 4: after antibiotics or steroids
Appearance: many small itchy bumps appearing together within a few weeks of starting a medicine, usually on the chest and back, sometimes on the face.
Cause: tetracycline antibiotics used for acne, and steroids taken or applied, change the balance of microbes on the skin so yeast grows quickly. These bumps are often lumped in with "steroid acne", and part of what is called that is in fact yeast acne.
Severity/urgency: not directly dangerous, but never stop a prescribed medicine on your own, especially oral steroids taken for another illness. Stopping suddenly can be dangerous.
When to see a doctor: tell the prescribing doctor when new itchy bumps appear after starting a medicine. The doctor will consider adjusting the current medicine or adding an antifungal.
Yeast acne type 5: in people with weakened immunity or diabetes
Appearance: bumps spread more widely than usual and may extend to the lower trunk, arms and legs, with more pustules than red bumps, and they return quickly after stopping treatment.
Cause: poorly controlled diabetes, immunosuppressants after organ transplant, chemotherapy, or HIV infection make it harder for the body to keep yeast under control.
Severity/urgency: moderate, because a rash that looks like yeast acne in this group can be a different infection, such as eosinophilic folliculitis, seen in people with HIV.
When to see a doctor: see a doctor from the first episode. Do not treat it yourself with over-the-counter medicine, and have your blood sugar checked if you have never done so.
For common skin problems in people with diabetes, read more at Skin conditions caused by diabetes.
Yeast acne type 6: together with regular acne
Appearance: the face has blocked pores and inflamed acne of various sizes, while the forehead, hairline or back has itchy bumps of identical size mixed in.
Cause: oily skin is a shared factor for both conditions, and some regular acne medicines make yeast acne more prominent.
Severity/urgency: not dangerous, but it is one of the leading reasons for "I've treated my acne for ages and it won't go away."
When to see a doctor: if after a full 8–12 weeks of standard acne treatment one area improves but another does not budge, have a doctor assess whether yeast acne is hiding underneath.
If you are not sure which type of inflamed acne you have, read more at What causes inflamed acne.
Yeast acne type 7: together with tinea versicolor or seborrheic dermatitis
Appearance: small itchy bumps on the back and chest, together with pale or brown patches with fine scale (tinea versicolor), or red greasy scaly patches at the eyebrows, beside the nose and on the scalp (seborrheic dermatitis).
Cause: all three conditions come from the same Malassezia yeast, differing only in which layer of the skin the organism occupies.
Severity/urgency: not dangerous, but it shows the patient's skin is very favorable to yeast, so it recurs easily and a long-term prevention plan is needed.
When to see a doctor: when you have several of these at once, because the doctor will choose medicines that control them all together.
Read about conditions caused by the same yeast at What causes tinea versicolor and What causes seborrheic dermatitis.
How does yeast acne differ from other similar bumps?
Bacterial folliculitis: pustules around hair shafts, more painful than itchy, usually on the legs, buttocks and armpits, and responds to antibiotics. Learn how to tell the organisms apart at How to tell the cause of folliculitis.
Hot tub or swimming pool folliculitis (Pseudomonas folliculitis): appears 1–2 days after soaking, in areas covered by a swimsuit, and usually clears on its own in 7–10 days.
Heat rash (miliaria): clear or tiny red bumps that appear right after sweating and settle within a few hours to 1–2 days in a cool place. Yeast acne lasts for weeks. Read more at What causes heat rash.
Keratosis pilaris: small rough bumps on the upper arms and thighs, not itchy, not pustular, present for many years.
Eosinophilic folliculitis: very itchy, with bumps spread over the face, chest and arms, seen in people with HIV or weakened immunity, and needs a biopsy.
Acne from medicines or chemicals: such as steroid acne, high-dose B vitamins, or certain anti-seizure drugs. The bumps are the same size and look like yeast acne, and the doctor will review the medication history as well.
How do doctors diagnose yeast acne?
Most dermatologists diagnose it from the look of the bumps, their location and the history. If it is unclear, further tests are done.
Scraping or squeezing a bump for microscopy: using potassium hydroxide (KOH) solution or staining, which shows many round yeast cells. It takes only a few minutes and is not very painful.
Wood's lamp: in some people the bumps glow yellow-green. This supports the diagnosis, but a negative result does not rule the condition out.
Skin biopsy: done only when the rash is atypical, does not respond to treatment, or the patient has weakened immunity.
Treatment trial: if the features fit, the doctor may give an antifungal for 1–2 weeks. If itching clearly eases within 1 week, that helps confirm the diagnosis.
What topical medicine is used for yeast acne?
Topical treatment is the main treatment when there are not many bumps, and it is continued to prevent recurrence. Medicines dermatologists commonly use are as follows.
Ketoconazole 2% shampoo or lotion: used like a soap on the affected area while the skin is wet, left on for 5 minutes, then rinsed off, once daily or every other day for 2–4 weeks. It is the most widely used because it is easy to apply even over a large area such as the back.
Selenium sulfide 2.5% shampoo or lotion: used in a similar way, left on for 5–10 minutes. It may irritate thin skin and can bleach fabric. It should not be used on broken skin.
Ketoconazole 2% cream, econazole 1% cream or ciclopirox 1% cream: applied thinly 1–2 times daily for 2–4 weeks. Suitable for small areas such as the forehead and hairline.
Zinc pyrithione 1–2% soap or shampoo: weaker, used as an add-on or for long-term prevention.
What decides whether topical treatment works: cover the whole area rather than dabbing individual bumps, leave it on long enough, and keep using it for the full course even after the itching has gone. If the bumps have not decreased by at least half after 2–4 weeks of full use, the doctor will consider adding an oral medicine.
Topicals that do not help or make it worse: antibiotic acne products such as clindamycin do not help yeast acne, and steroid-containing creams make yeast grow faster. Benzoyl peroxide has little effect on yeast and should not be the main treatment.
To learn how each group of antifungal creams differs, read more at Antifungal creams: which one to choose.
What oral medicine is used for yeast acne?
Oral medicine is used when the bumps are widespread or severe, when topical treatment has been used fully without improvement, or when it recurs often. Oral medicine works better than topical because it reaches the base of the follicle more effectively.
Itraconazole: a commonly used dose is 200 milligrams once daily after a meal for 7 days, and some patients are continued for 2–3 weeks by the doctor. It interacts with many medicines, such as statin cholesterol drugs and some heart medicines, and is not used in people with heart failure.
Fluconazole: 100–200 milligrams once daily for 1–3 weeks, or 300 milligrams once weekly for 2–4 weeks, at the doctor's discretion.
Oral ketoconazole: doctors no longer use it for yeast acne because of a higher risk to the liver than the two medicines above.
What to know before taking an oral antifungal: always tell the doctor about the medicines you take, liver disease, heart disease, and pregnancy or breastfeeding, because most oral antifungals are not used in pregnant women. For long courses the doctor may check liver function.
Doctors usually prescribe the oral medicine together with a topical, then have you continue the topical after the oral medicine ends to reduce the chance of recurrence. Choosing the medicine, dose and duration is the doctor's job, and you should not buy oral antifungals to use on your own.
If you have both yeast acne and regular acne, how is it treated?
Doctors usually calm the yeast acne first with an antifungal for 1–3 weeks, then go on to manage the regular acne.
If an antibiotic must be used for acne, the doctor may have you wash the back and chest with an antifungal shampoo alongside it throughout the course.
Topical retinoids such as adapalene can be used as usual for blocked pores on the face, but they do not treat yeast acne.
Patients with severe acne on isotretinoin may develop yeast acne as well, and the doctor will add an antifungal as appropriate.
How many days until yeast acne goes away?
First 3–7 days: clearly less itching is the first sign that the medicine is targeting the right problem.
2–4 weeks: red bumps and pustules settle almost completely.
4–8 weeks: dark or red marks left from scratching gradually fade. Marks do not mean the disease is still there.
If new bumps keep appearing after 4 weeks, return to the doctor to reassess whether the diagnosis is right or another condition is mixed in.
Can yeast acne go away on its own?
In some people with mild cases whose cause has gone, for example moving from a hot, stuffy place to a cool one or stopping antibiotics, the bumps may settle on their own within several weeks. In most people, however, if the triggers remain, the bumps come and go for months. Using the right antifungal clears it much faster than waiting, and reduces dark marks from scratching.
Why does yeast acne keep coming back?
Malassezia is a resident organism of the skin. Medicine only reduces its numbers and does not remove it permanently.
The original triggers are still there: hot, humid weather, sweat, oily skin and stuffy clothing.
Stopping medicine too early once the itching goes, while the yeast in the follicles has not been reduced enough.
Going back to antibiotics or steroid-containing creams.
Prevention methods doctors use: wash with ketoconazole 2% or selenium sulfide shampoo 1–2 times a week on an ongoing basis, especially in the hot and rainy seasons. In people who relapse very often, the doctor may give a preventive-dose oral medicine at intervals, such as once a week or 1–2 times a month.
Skin care to reduce yeast acne
Shower and change clothes right after sweating, especially after exercise. Do not leave sweat-soaked clothes on for more than 30 minutes.
Choose breathable clothing: cotton or fabrics that wick sweat well, loose enough not to squeeze the back and chest.
Change pillowcases and bed sheets regularly, at least once a week.
Choose light-textured products: gel or lotion sunscreens and moisturizers that are not very oily, and avoid facial oils and heavy balms on affected areas.
Wash your hair regularly. If you also have dandruff, use an antifungal shampoo on your hair too, because the scalp is a major source of the yeast behind forehead yeast acne.
Do not pick or squeeze. Squeezing does not remove the yeast, and it only makes inflammation and dark marks last longer.
To choose a foam or cleanser for acne-prone skin, read more at How to choose an acne face wash.
What should you not eat with yeast acne?
Advice to cut sugar, flour, bread or fermented drinks to "starve the yeast" has no medical evidence behind it. The yeast on skin feeds on oil in the follicles, not on the sugar we eat, so cutting these foods does not clear yeast acne.
What does make a real difference:
In people with diabetes, keeping blood sugar well controlled helps reduce every kind of fungal skin infection.
Foods that make you hot and sweaty, such as very spicy food or alcohol, may increase itching in some people.
You do not need to avoid seafood or eggs, because they are unrelated to yeast acne, unless you truly have a history of allergy to that food.
Warning signs to see a doctor promptly
Bumps spread rapidly within a few days or appear all over the body
Fever, large pustules, severe pain, or a swollen, red, warm lump, which may be a secondary bacterial infection
You have diabetes, weakened immunity, or are taking immunosuppressants
No improvement after a full 4 weeks of antifungal treatment
Other rashes at the same time, such as a red peeling rash, mouth sores, or unexplained weight loss
Common myths about yeast acne
"Yeast acne comes from being unclean" — not true. It occurs in people who shower several times a day. The main factors are moisture, sweat and certain medicines.
"It spreads if you share towels" — it is not contagious, because everyone already has this yeast.
"The harder you scrub, the faster it clears" — scrubbing irritates and inflames the follicles more.
"A stronger antibiotic will cure it" — the opposite. Antibiotics are one of the causes that make yeast acne worse.
"Once it's gone you can stop the medicine" — yeast acne returns quickly without ongoing prevention. Washing with the medicated shampoo 1–2 times a week helps a lot.
In brief
Yeast acne (Malassezia folliculitis) is follicle inflammation from yeast on the skin, not acne caused by bacteria.
Telltale signs are small bumps of 1–3 mm, all the same size, itchy, with no blocked pores, on the back, chest, shoulders and hairline.
Main triggers are heat and humidity, sweat, antibiotics, steroids and weakened immunity.
The main topical is ketoconazole 2% shampoo, washed on and left for 5 minutes for 2–4 weeks. Oral options are itraconazole or fluconazole as prescribed by the doctor.
Itching should ease within 1 week and bumps settle within 2–4 weeks.
If it recurs often, prevent it by washing with the medicated shampoo 1–2 times a week and keeping skin from staying damp.
Frequently asked questions about yeast acne
What is yeast acne, and how is it different from ordinary acne?
Yeast acne is follicle inflammation from Malassezia yeast (Malassezia folliculitis), which lives on everyone's skin but has overgrown. It differs from ordinary acne in that the bumps are small and all the same size, 1–3 millimeters, itch more than they hurt, have no blackheads or whiteheads, and appear on the back, chest, shoulders and hairline more than the cheeks. Importantly, it does not clear with antibiotics or ordinary acne medicine and needs an antifungal. Dermatologists can usually tell from the look of the bumps, and confirm by scraping a bump for microscopy when it is unclear.
What causes yeast acne?
Yeast acne occurs when skin conditions let Malassezia yeast grow fast enough to settle in the follicles. Common factors are hot, humid weather, heavy sweating without showering and changing clothes, tight non-breathable clothing, oily skin, heavy oil-based products, weeks of antibiotics for acne, steroid use, and weakened immunity such as poorly controlled diabetes. Yeast acne is not caused by dirt and does not pass from person to person.
Can yeast acne go away on its own?
It can in some mild cases once the trigger is gone, for example after stopping antibiotics or moving to a cooler climate. In most people, though, if sweat, dampness and oily skin stay the same, the bumps come and go for months. The right antifungal eases itching within 3–7 days and settles the bumps within 2–4 weeks, which is much faster than waiting, and it also helps reduce dark marks from scratching.
How is fungal acne treated, and which medicine is used?
The main treatment is an antifungal. For mild cases, wash the affected area with ketoconazole 2% shampoo or lotion while the skin is wet, leave it for 5 minutes, then rinse, once daily or every other day for 2–4 weeks, or apply an antifungal cream 1–2 times daily. For more severe or frequently recurring cases, the doctor may prescribe oral itraconazole 200 milligrams a day for about 7 days, or fluconazole at the dose the doctor sets, then continue a topical to prevent recurrence. The choice of oral medicine requires the doctor to review current medicines and underlying conditions first.
What should you avoid eating with yeast acne, and do you need to cut sugar?
There is no evidence that cutting sugar, flour, bread or fermented foods clears yeast acne, because the yeast on skin uses oil in the follicles as food, not sugar from our diet. You also do not need to avoid seafood or eggs, except people with diabetes, who should keep blood sugar well controlled because high sugar makes fungal skin infections easier. What really helps is reducing dampness, showering and changing clothes after sweating, and finishing the antifungal as the doctor advises.
Why does fungal acne on the back come back after treatment?
Fungal acne on the back returns often because Malassezia is a resident organism of the skin. Medicine reduces its numbers but does not remove it permanently. If you stop the medicine as soon as the itching goes while sweat, oily skin and stuffy clothing stay the same, the yeast regrows within a few months. The prevention dermatologists recommend is washing the back with ketoconazole 2% or selenium sulfide shampoo 1–2 times a week on an ongoing basis, especially in the hot and rainy seasons, and in people who relapse very often the doctor may give a preventive-dose oral medicine at intervals.
Related reading: for other itchy follicle bumps see What causes folliculitis · for bumps on the buttocks see What causes buttock acne · for all skin conditions see Skin conditions explained by dermatologists
Written by Dr. Patara Voravutinon, Dermatologist · Last reviewed November 2, 2026
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