Acne is one of the most common skin conditions globally, affecting people of all ages, although it is most often associated with adolescence. However, acne is not a one-size-fits-all issue. It appears in different forms, has various underlying causes, and is frequently misdiagnosed. Dermatologists often encounter confusion, particularly when distinguishing between hormonal acne and fungal acne.
Acne occurs when hair follicles become clogged with oil (sebum) and dead skin cells, which leads to pimples, blackheads, whiteheads, or deeper cysts. Hormonal acne, often referred to as adult acne, flares due to hormonal shifts, especially in women during menstruation, pregnancy, or conditions like Polycystic Ovary Syndrome (PCOS). This form of acne typically appears on the lower face, including the jawline, chin, and neck, and is characterized by painful pimples or cysts. Although hormonal acne is most commonly associated with women, men can also experience it due to higher levels of testosterone. Testosterone stimulates the sebaceous glands, leading to clogged pores and breakouts, which can occur on the face, back, and shoulders.
Fungal acne, also known as Malassezia folliculitis, is caused by a yeast that infects the hair follicles. This form of acne presents as itchy, uniform pustules, often appearing on the forehead, chest, and back. Fungal acne thrives in environments with high humidity, sweat, and poor hygiene. Tight clothing and scalp yeast can also contribute to flare-ups.
Comedonal acne is another common form, particularly among teenagers and makeup users. It features blackheads and whiteheads, primarily on the T-zone of the face (forehead, nose, and chin). This type of acne is often caused by poor skin hygiene, makeup residue, or oil buildup from exposure to pollution and sweat.
It’s essential to recognize that various types of acne can occur simultaneously. A person may experience hormonal, fungal, and comedonal acne all at once, especially if they have poor hygiene, use heavy makeup, or have underlying hormonal imbalances.
Hormonal acne is characterized by deep, painful cystic or pustular breakouts concentrated on the lower face. However, it can also appear on other areas, such as the back and chest. On the other hand, fungal acne is marked by small, itchy, uniform pustules, typically appearing on the upper body, especially around the forehead, chest, and scalp area. One of the key distinctions of fungal acne is its distribution, which is generally more focused on the upper body.
Preventing hormonal acne involves maintaining a consistent skincare routine with gentle cleansing and oil-free moisturizers. Managing stress and avoiding frequent face-touching are also important, as these habits can introduce bacteria and worsen breakouts. For individuals experiencing hormonal fluctuations, addressing conditions like PCOS with lifestyle changes, including diet and exercise, can help manage symptoms.
Preventing fungal acne requires good hygiene practices and keeping the skin dry, especially after sweating. It’s also important to avoid tight clothing, wash hair regularly to prevent fungal transfer, and ensure the skin remains dry. People living in hot, humid environments are more susceptible to fungal acne, as the yeast thrives in such conditions.
Certain foods, such as high-glycemic foods (like biscuits, soda, and chocolate), dairy products (milk, cheese, yogurt), and greasy, deep-fried foods (chips, mandazi), can exacerbate acne, although they do not directly cause it. These foods can act as catalysts for someone already prone to breakouts.
Misdiagnosis is common, especially with the rise of self-diagnosis via social media or hearsay. It’s recommended to photograph the skincare products being used and consult with a dermatologist for proper guidance. Understanding the specific type of acne is critical to effective treatment. Treatments for hormonal acne may include topical retinoids, antibiotics, or hormonal therapies such as birth control pills or spironolactone. Fungal acne, however, requires antifungal creams or oral medications, as traditional acne treatments are ineffective. Comedonal acne can be managed with proper cleansing, non-comedogenic products, and gentle exfoliation.
By understanding the specific type of acne, individuals can avoid ineffective treatments and achieve clearer skin with the right guidance and care.
