Fungal Acne vs Hormonal Acne: Key Differences Explained

Introduction

Acne is frustrating, in any form, at any age. You wake up every morning, look at yourself in the mirror, desperately try to see if those stubborn bumps on your skin have disappeared magically.

Well, you’re not alone. Acne is one of the most common skin struggles, affecting over 9.4% of people globally—making it the 8th most prevalent disease in the world.

However, not all breakouts are the same. In fact, 1 in 3 cases of what looks like ‘regular acne’ is actually a fungal infection–and using the same skincare creams could be making things even worse.

Why? Fungal acne thrives on the same products meant to treat hormonal or bacterial acne. So, the problem might not be in your skincare product, but a case of mistaken identity.

Fungal acne (a sneaky fungal infection inside your pores) and hormonal acne (an internal imbalance) are master imposters. They disguise themselves as everyday pimples but demand entirely different solutions. Confusing the two can cost you time, money and leave your skin even angrier than ever.

In this guide, we’ll break down the key differences between these two acne doppelgangers, from their unique triggers to the telltale symptoms, so you can finally give your skin what it needs to heal.

What is Acne?

Acne is a chronic skin condition where the pores of your skin get clogged with excess oil, dead skin cells, and bacteria.

Clogged pores cause inflammation, which leads to blackheads, whiteheads and pimples. Pimples are pus filled, sometimes painful bumps on your skin. The medical term for acne is Acne Vulgaris.

There are several types of acne, with fungal and hormonal acne being the most prevalent ones.

What is Fungal Acne?

Fungal Acne, as the name suggests, is caused by an overgrowth of yeast—specifically Malassezia, a type of fungus naturally found on the skin.

Contrary to its name, it’s not true acne but a fungal infection formally known as Pityrosporum folliculitis (or Malassezia folliculitis).

This condition develops when Malassezia yeast overpopulates hair follicles, feeding on oils (sebum) and triggering inflammation.

Unlike bacterial acne, fungal acne flourishes in warm, humid environments and is often aggravated by sweat or oily skincare.

Signs and Symptoms

• Appearance: Clusters of small, uniform red bumps (1-2 mm), which sometimes grow and become whiteheads or tiny pustules.
• Texture: Tiny, raised bumps that feel rough, resembling sandpaper.
• Itchiness: Persistent itching, especially after sweating, or in humid conditions.
• Location: Commonly appears on the forehead, chest, upper back, and shoulders.
• Triggers: Worsens with occlusive skincare (example: heavy creams), antibiotics, or synthetic fabrics.

What is Hormonal Acne?

Hormonal acne is a specific type of acne vulgaris triggered by hormonal fluctuations inside your body, particularly androgens like testosterone.

These hormones stimulate excess sebum production, which clogs pores and creates a breeding ground for acne-causing bacteria (C. acnes)

Hormonal acne is more common in women, often linked to menstrual cycles, pregnancy, and conditions like PCOS, and typically it follows a cyclical pattern.

Closely tied to the body’s endocrine system, hormonal acne can persist well into adulthood, far beyond adolescence.

Signs and Symptoms

Appearance: Deep, inflamed cysts or nodules (often painful) alongside smaller papules and pustules.

Texture: Tender, under-the-skin bumps that rarely come to a head.

Location: Concentrated on the lower face—jawline, chin, and neck, in a “beard-like” distribution.

Pattern: Flares predictably around menstruation, during stress or with hormonal shifts (for example, pregnancy and menopause).

Linked Symptoms: Oily skin, irregular periods, or hair thinning, especially in cases of PCOS.

Related Blog: Acne Marks vs Acne Scars: What They Are and How to Get Rid of Them

Key Differences between Fungal and Hormonal Acne

Aspect	Fungal Acne	Hormonal Acne
Medical Term	Malassezia folliculitis (fungal infection)	Acne vulgaris (hormonally driven subtype)
Root Cause	Overgrowth of Malassezia yeast in hair follicles	Androgen-driven excess sebum production + clogged pores
Texture/Shape	Small, uniform, raised bumps (1–2 mm) that may be itchy or have a pustule-like appearance	Larger, more cystic and painful bumps, often deeper and slower to heal
Symmetry	Clustered, symmetrical (e.g., both sides of forehead)	Often one-sided or localized (e.g., jawline)
Response to Heat	Worsens in hot, humid weather or after sweating	Unaffected by temperature; linked to hormonal cycles
Age Group	Teens and young adults (but can occur at any age)	Peaks in teens (puberty) and adults (20s–40s, especially women)
Skincare Reactivity	May worsen with oily or greasy skincare products or products containing alcohol	Worsens with pore-clogging ingredients but improves with anti-inflammatory or hormonal treatments
Diagnostic Clues	Itching, lack of response to antibacterial treatments	Cyclic flare-ups, linked to hormonal disorders
Treatment Focus	Antifungals (e.g., ketoconazole), avoiding yeast-feeding ingredients	Hormone regulation (e.g., birth control, spironolactone), retinoids

Quick Self-Check

• If your acne itches and resists antibacterial treatments, it’s most likely to be fungal.
• If your breakouts are painful or spike right before your period, they’re probably hormonal.

Now that you know how to differentiate between the two, let’s further explore the triggers, diagnosis and treatment options.

What Causes Fungal vs. Hormonal Acne

Fungal Acne Triggers

• Heat & Humidity: Delayed showering after sweating, tropical climates.
• Skincare Saboteurs: Thick creams, oils, or products with fatty acids.
• Antibiotics: Disrupts the skin’s microbiome, letting yeast thrive.

Hormonal Acne Triggers

• Androgen Surges: Puberty, menstrual cycles, PCOS, or Menopause.
• Stress: Cortisol spikes increase oil production.
• Diet: High glycemic foods or dairy products (for some people).

How to Diagnose Them: Fungal vs Hormonal Acne

Fungal Acne

• A dermatologist may perform a KOH test (scraping skin to check for yeast).
• Clues: Itchy bumps that resist benzoyl peroxide or antibiotics.

Hormonal Acne

• Diagnosis usually involves tracking breakouts with menstrual cycles.
• Blood tests are done to hormone levels. For example, testosterone and DHEA-S (a hormone linked to adrenal function).

Treatment Options

For Fungal Acne

1. Antifungal Washes: Use shampoos with ketoconazole or zinc pyrithione as body washes.
2. Topical Creams: Clotrimazole or terbinafine.
3. Avoid Feeding Yeast: Skip oils, fatty alcohols, and occlusives (for example, coconut oil and shea butter).

For Hormonal Acne

• Hormonal Therapy: Birth control pills, spironolactone.
• Topical Retinoids: Unclog pores and reduce inflammation (for example, adapalene).
• Lifestyle Tweaks: Stress management, and healthy, low-glycemic foods.

Also Read: What Is Acne Conglobata and How Is It Treated?

Prevention Tips

Fungal Acne

• Wear breathable fabrics like cotton and linen.
• Maintain good hygiene and shower immediately after sweating.
• Use fungal-safe moisturizers like squalane and glycerin.

Hormonal Acne

• Balance hormones with a nutrient-rich (zinc, omega-3s) diet.
• Avoid comedogenic makeup.
• Track cycles to anticipate flare-ups.
• Drink lots of water.

Myths Debunked

Let’s address some common myths and misconceptions associated with these acne types:

Myth 1: “Fungal acne is contagious.”

Truth: Infection causing fungus is already present on your skin. So, no need to quarantine.

Myth 2: “Hormonal acne only happens to teenagers.”

Truth: 50% of women in their 20s and 30s struggle with hormonal acne.

Myth 3: “Fungal acne happens because you are dirty.”

Truth: Malassezia yeast naturally lives on everyone’s skin. Overgrowth happens due to favorable conditions like sweating, humidity, or oily skincare—not just because you have poor sense of cleanliness.

Myth 4: “Hormonal acne means your hormones are ‘broken’.”

Truth: Hormonal acne doesn’t always signal a disorder. Even healthy bodily changes like puberty and menstruation can trigger breakouts.

When to See a Dermatologist? – H2

Knowing when to seek professional help is important for effective management and treatment. Here are some signs that you should consult a dermatologist immediately:

Persistent acne: If over the counter treatments fail after 4-6 weeks.

Health conditions: If you suspect PCOS. (e.g., irregular periods, hair loss).

Severe or Painful Breakouts: If you have deep, cystic lesions with painful inflammation.

Scarring or Emotional distress: If your acne is affecting your self-esteem and emotional wellbeing.

Don’t Wait: Chronic acne rarely resolves on its own. Visiting a dermatologist can be your shortcut to clearer skin.