Whiteheads and blackheads are both forms of acne vulgaris, differing primarily by whether the pore remains open or closed to the atmosphere. A blackhead, or open comedone, occurs when sebum and keratinised skin cells clog a pore; the dark colour is not dirt, but rather the result of melanin oxidation when exposed to oxygen [1]. In contrast, a whitehead, or closed comedone, occurs when the same debris is trapped beneath the skin's surface by a narrow opening, preventing oxidation and resulting in a flesh-coloured or white bump [2].
Fungal acne is a misnomer, as it is clinically defined as Malassezia folliculitis, an infection of the hair follicle caused by an overgrowth of yeast rather than bacteria [3]. Unlike traditional comedones, fungal acne typically presents as monomorphic (uniform) small, itchy papules and pustules, often appearing in clusters on the forehead, chest, or back [4]. While whiteheads and blackheads respond best to comedolytic agents like salicylic acid, fungal acne requires antifungal interventions to resolve the underlying yeast colonisation [3].
From a histopathological perspective, acne vulgaris involves the pilosebaceous unit's inflammatory response to Cutibacterium acnes and sebum overproduction [1]. The differentiation between open and closed comedones is determined by the distension of the follicular orifice. In Australian climates, high humidity can exacerbate these conditions by increasing sebum fluidity and sweat-induced follicular occlusion [5].
Malassezia folliculitis differs significantly as it involves the genus Malassezia, a lipophilic yeast that is part of the normal skin flora but becomes pathogenic under specific conditions, such as immunosuppression or an altered skin microbiome [3]. The yeast secretes lipases that break down skin oils into irritating fatty acids, leading to the characteristic itchy inflammation that distinguishes it from the non-pruritic nature of standard whiteheads and blackheads [4].
For those looking to address the underlying congestion that leads to these comedones, our Surface Purify BHA cleanser was formulated with Salicylic Acid to gently clarify and minimise the build-up within the pore. To maintain a healthy environment for the skin's natural defence against breakouts, some of our customers find that pairing a deep cleanse with the microbiome support of our Balance Biome Crème helps to encourage a clearer, more balanced complexion.
FAQ
How can I tell if my breakouts are fungal acne or regular whiteheads?
The best indicators are itchiness and uniformity. Fungal acne is almost always pruritic (itchy) and the bumps are typically the same size and shape, appearing in rows or clusters [3]. Regular whiteheads vary in size, are rarely itchy, and are often accompanied by blackheads or deeper inflammatory cysts [2]. If standard Australian anti-acne treatments like benzoyl peroxide fail to work, Malassezia may be the culprit [4].
What are the best ingredients to treat blackheads and whiteheads?
Salicylic acid, a lipid-soluble beta-hydroxy acid (BHA), is considered the gold standard for treating comedonal acne in Australia. It penetrates the pore to dissolve the 'glue' holding dead skin cells together [1]. Retinoids, such as adapalene, are also highly effective as they regulate cellular turnover, preventing the initial formation of the microcomedone [2]. High-quality Australian sunscreens should always be used alongside these actives to protect the sensitised skin [5].
Can using the wrong moisturiser cause fungal acne?
Yes, Malassezia yeast thrives on specific fatty acids (with carbon chain lengths C11–C24) often found in skincare oils and moisturisers [3]. Using heavy, occlusive creams or oils like coconut oil can provide the fuel necessary for yeast overgrowth, particularly in hot, humid Australian environments [5]. Choosing 'fungal acne safe' or oil-free moisturisers can help minimise the risk of flares [4].
References:
[1] Zaenglein AL, et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. 2016;74(5):945-973. doi:10.1016/j.jaad.2015.12.037
[2] Thiboutot D, et al. New insights into the management of acne: An update from the Global Alliance to Improve Outcomes in Acne group. Journal of the American Academy of Dermatology. 2009;60(5):S1-S50. doi:10.1016/j.jaad.2009.01.019
[3] Rubenstein RM, et al. Malassezia (Pityrosporum) Folliculitis. The Journal of Clinical and Aesthetic Dermatology. 2014;7(3):37–41.
[4] Cohen PR, et al. Malassezia (Pityrosporum) Folliculitis: Incognito no more. Current Dermatology Reports. 2018;7(4):255-261. doi:10.1007/s13671-018-0238-6
[5] Sinclair R, et al. Management of acne in the Australian healthcare setting. Australasian Journal of Dermatology. 2018;59(3):183-191. doi:10.1111/ajd.12781
