Several skin complaints, including acne, are caused by a yeast infection, meaning that to cure acne you need to first resolve the overgrowth of yeast. One type of acne caused by a yeast infection is called pityrosporum folliculitis and is particularly prevalent in teenagers and in men.

Symptoms of pityrosporum folliculitis include chronic, itchy, red pustules on the back and chest, with some people also developing pustules on the neck, shoulders, upper arms and (rarely) the face.Folliculitis describes any condition where an infection (or other factor) causes inflammation of the hair follicles. Infectious organisms can include viruses, fungi, yeast and bacteria, with Staphylococcus aureus the most common cause of folliculitis.

The inflammation, itchiness and irritation associated with acne are not caused by bacteria and fungi themselves, but are a result of the immune system’s attempt to eradicate these microorganisms. Some germs do, however, release chemotaxins that redirect this immune response to healthy areas of skin, keeping the immune system cells away from the infectious organism.

Malassezia and Acne

Acne caused by yeast infection is usually a result of Malassezia, a group of yeasts that grow on the skin, usually on the foreead and chest, but rarely on the sides of the face. Hair follicles contain plentiful sebum, meaning that Malassezia are often found in pores on the scalp.

These yeasts feed on sebum inside the pores and in doing so they convert the useful fatty acids in sebum into other fatty acids that can cause skin irritation.

Although often present on the skin, these yeasts do not normally cause problems. It is only when they grow in large numbers deep inside the pores of the skin that acne and other symptoms arise. Acne caused by yeast infection is most common in middle-aged adults and younger children.

The most common cause of acne in teenagers is bacterial infection with Propionibacterium acnes. P. acnes and Malssezia do not normally inhabit the same pore. In fact, Malassezia may displace the acne bacteria and help prevent the formation of pimples. However, the use of antimicrobial products can also kill Malassezia and lead to an overgrowth of P. acnes.

Conversely, the use of these agents may eradicate normal and unproblematic levels of P. acnes and encourage a yeast overgrowth leading to worsening acne.

Diagnosis of Acne Caused by Yeast Infection

Establishing the real cause of acne is essential as antibacterial agents will not work if acne is being caused by a yeast infection, and antifungal agents will not help clear a bacterial infection with P. acnes. So-called treatment-resistant acne may actually be the result of a yeast infection rather than an infection with P. acnes that is unresponsive to antibacterial agents. Repeated use of antibiotics can also lead to antibiotic resistance, so identifying the culprit behind acne is key.

An adult aged 30 or older who has persistent acne that is unresponsive to antibiotic treatments may consider discussing the possibility of an overgrowth of Malssezia as the true cause of their symptoms. This is especially the case if symptoms seem to worsen when taking tetracycline, an antibiotic that can actually make yeast infections worse.

Itchiness is more likely with Malassezia, and the blemishes are more commonly found on the chest, arms, back, shoulders, and neck where there is more hair than on the face. Under a Wood lamp, lesions caused by Malassezia will show up as blue or white, and these pustules contain white or yellow pus.

Risk Factors for Yeast Infection

Some people are more prone to yeast infections, including:

• Anyone with diabetes
• People receiving radiation or chemotherapy
• Anyone being treated for Cushing disease, Hodgkin disease, HIV, or Crohn’s disease
• People taking immunosuppressants after organ transplant
• Anyone who regularly uses heavy cosmetics, insect repellent or sun screen.

Treating a Yeast Infection and Acne

Treating a yeast infection may involve the use of microdermabrasion and exfoliation with natural chemical peels such as salicylic acid or fruit acids. This helps to open up pores and flush out the yeast. Product applicators should be washed between uses so as to avoid reinfecting the skin.

Antifungal face washes can also help if folliculitis is caused by a yeast infection. For example, try using anti-fungal coconut oil as a moisturiser base, alongside tea tree oil. Caprylic acid (the natural antifungal in coconut) can also be bought as a powder or liquid and added to a skin lotion, wash or gel.

In addition, it can help to take an oral probiotic supplement, ideally a multistrain formula, to help fight infection from the inside. This can also help prevent the overgrowth of Candida, another yeast that may trigger acne by increasing inflammation and systemic toxicity.

Systemic Candida infection is rare, usually only affecting people with a severely compromised immune system, in whom it often proves fatal within a week of infection. However, the prevalence of Candida in the gut and mouth is higher in people with skin conditions such as acne, compared to people with healthy skin.

Candida may aggravate acne, eczema, psoriasis and atopic dermatitis, but topical applications of antifungals are not likely to have any benefit when Candida overgrowth is the culprit. This is because the problem exists at the level of the gut, with the yeast infection causing inflammation and a more rapid antibody response to Candida elsewhere in the body, including in the skin.

Oral antifungals can help relieve acne caused by a yeast infection and are usually highly effective at clearing Candida. Supportive probiotics, anti-Candida supplements and dietary modifications can also help keep Candida in check. For example, cutting out refined sugar and reducing intake of simple carbohydrates is recommended (this can also help the skin by supporting better blood sugar regulation).

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