Ask a Skin Care Biologist is a regular OUMERE blog post where cellular biologist and OUMERE CEO answers your skin care questions
Question: I have had acne for several years, and what caused my acne, I believe, was the long-term use of chemical peels, microdermabrasion, micro needling and using drying and inflammatory skin care. Which all took a toll on my skin. Anti-acne products and medication didn’t work for me. While I was searching online for solutions I came across some blogs and forum posts that discussed fungal acne. What is fungal acne and did I have it?
Fungal acne does not exist. There is either bacterial acne or hormonal acne. There are many skin conditions that have a similar appearance to acne but are a different ailment.
Acne is the result of the hormonal and/ or bacterial-caused overproduction of sebum, compounded with an impaired skin barrier and microbiome, leading to the buildup of bacteria, increased inflammation, and pimples. This is why teenagers get acne (hormonal) and those who disrupt their skin biome get acne (bacterial).
Fungal skin conditions do exist, it is just not a type of acne.
Pityrosporum folliculitis is an example of a skin disease that is caused by a fungal infection, has the appearance of acne, but is not a type of acne. Pityrosporum folliculitis occurs when yeast (pityrosporum) sinks into hair follicles and uses this space to breed and multiply. The result is red, irritated skin and an acne-like breakout. If you have a fungal infection, your skin will have a rash consisting of itchy red nodules, often with pus buildup.
Images of folliculitis, Sun et al. (2017)
Acne may accompany a fungal infection, which is also a source of confusion for those seeking treatment.
The primary reason why Pityrosporum folliculitis doesn’t seem to get better using traditional methods is because it won’t react to antibiotics (because yeast is not bacteria), and the culprit sits in the hair follicle, which can be difficult to remedy. And the longer you go without proper treatment, the more the yeast will multiply, compounding the issue.
Some people have a propensity to fungal infections on their skin. The risk factors include:
- Living in a humid environment
- Sweating profusely (more than just from the gym, but sweating constantly due to your work, being overweight, particular medications, and certain illnesses)
- Immune disorders that reduce your ability to resist infection
- Certain medications such as oral steroids and oral contraceptions. And also overuse of antibiotics because certain beneficial bacteria fight off yeast.
You can also get a fungal infection from using infected skin care/makeup, or introducing infection into your skin via derma rollers, or unclean skin care tools (jade rollers) or makeup brushes.
If you feel as though you have tried everything and your skin is not improving, it is possible that you have a fungal infection, but it is not acne.
To improve a fungal infection, you can see your doctor to determine if an anti-fungal medication will be best for you. I also recommend the use of chemical exfoliation to improve your skin barrier.
Question: After reading your blogpost about micro needling I decided against scheduling subsequent treatment. I’ve had 6 microneedling treatments with PRP. My face was very red and inflamed for over a week. I had a series of four treatments in my late 30s. I am now 40. Should I anticipate damage from this in the future and is there anything I can do now other than avoid additional treatments? Should PRP injections be avoided?
Microneedling does significant damage to the skin with every procedure. Often people will habitually use the treatment because they believe it has made their skin firmer or thicker, however this is the creation of scar tissue and the hardening of skin. Skin will thicken with damage, and this is often seen in those who have experienced long-term unprotected sun exposure, and the leathery, thick skin as the result.
How micro needling works is it punctures the skin to create small scars. To repair the damage caused by the microneedle, the wounded tissue over expresses collagen to create a matrix. In healthy skin which secretes collagen naturally, collagen matrices result in a soft, plump appearance. In damaged, scarred skin, the collagen matrix that forms has a hardened texture and a rougher quality. The result is a thick leathery skin.
Thickened, leathery skin is caused by prolonged, unprotected sun exposure.
If your skin already feels different from micro needling , the damage is already being done.
The best thing to do is what you have already done: stop microneedling.
And to prevent any further damage, stay away from injections and other harsh treatments. They have no legitimate scientific basis.
Stick to gentle skin care every day, and I also recommend micro current procedures done by a trained professional.
Question: I have read your posts and research on the damaging effects of vitamin C serums, and have also seen improvement in my skin after I stopped using them. Why, if they’re so bad, do so many skin care brands have them in their line?
“There are two ways to be fooled. One is to believe what isn’t true; the other is to refuse to believe what is true.”
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An, M. K., Hong, E. H., Cho, E. B., Park, E. J., Kim, K. H., & Kim, K. J. (2019). Clinicopathological differentiation between Pityrosporum folliculitis and acneiform eruption. The Journal of dermatology.
Sun, K. L., & Chang, J. M. (2017). Special types of folliculitis which should be differentiated from acne. Dermato-endocrinology, 9(1), e1356519.
Verhaegen, P. D., Van Zuijlen, P. P., Pennings, N. M., Van Marle, J., Niessen, F. B., Van Der Horst, C. M., & Middelkoop, E. (2009). Differences in collagen architecture between keloid, hypertrophic scar, normotrophic scar, and normal skin: an objective histopathological analysis. Wound Repair and Regeneration, 17(5), 649-656.
Winters, R. D., & Mitchell, M. (2019). Folliculitis. In StatPearls [Internet]. StatPearls Publishing.