Not all acne is the same, and treating it like it is can lead to flare-ups, scarring and wasted time. What looks like a breakout could be hormonal, bacterial or fungal in nature. Each has its own triggers, patterns and treatment options.
This article breaks down the key differences between fungal, bacterial and hormonal acne, so you can take the next step towards the right treatment.
What is hormonal acne?
Hormonal acne is driven by internal shifts in hormone levels that increase oil production, thicken the skin’s outer layer and clog pores, creating the ideal environment for inflammation. This typically appears around the jawline, chin and lower cheeks, with breakouts that are often deep and slow to resolve. It may not form a visible whitehead but can leave lingering marks behind.
What causes hormonal acne? Common triggers include menstrual cycles, perimenopause, pregnancy, stopping or starting contraception and conditions like polycystic ovarian syndrome (PCOS). Stress, poor sleep and certain medications can also contribute to the condition.
While hormonal fluctuations are the primary drivers, dietary factors may also play a role in modulating its severity. Specifically, high-glycaemic index (GI) foods and dairy products have been associated with increased acne severity in some individuals.
Unlike other types of acne, hormonal breakouts don’t always respond to topical treatments alone, as the issue starts beneath the surface. A medical assessment is often needed to address the root cause and support long-term skin health. Treatment may include oral contraceptives, anti-androgen medications like spironolactone or topical retinoids — depending on individual needs and suitability.
What is bacterial acne?
Bacterial acne is characterised by red, inflamed spots — including papules, pustules and sometimes nodules or cysts. These breakouts may occur anywhere oil builds up: face, chest, back or shoulders.
What causes bacterial acne? Usually, it’s due to an overgrowth of the skin’s natural bacteria, most often Cutibacterium acnes (formerly Propionibacterium acnes). These bacteria live on everyone’s skin, but when pores become blocked by oil and debris, it can multiply and trigger inflammation.
Bacterial acne is most common during puberty, but adults can also experience it due to environmental stressors, product build-up or skin barrier disruption. Using the wrong skincare, particularly heavy or occlusive products, can also aggravate it.
Mild bacterial acne can often be effectively managed through a consistent skincare regimen. Utilising products formulated to reduce bacterial presence on the skin, regulate sebum production and maintain clear pores can significantly improve symptoms. Early and appropriate intervention is key to preventing progression and supporting overall skin health.
For persistent or moderate-to-severe acne, medications may be required. Topical antibiotics like clindamycin or erythromycin can reduce bacteria and inflammation. Oral counterparts like doxycycline, minocycline or sarecycline are common next steps. Remember that any prescription-based treatment should be determined by your medical practitioner based on your individual skin presentation, history and clinical assessment.
What is fungal acne?
Despite the name, fungal acne isn’t acne at all. It’s a condition known as Malassezia folliculitis, caused by a yeast overgrowth in the hair follicles. It often looks like acne, and that’s where the confusion starts.
Fungal acne features small, itchy and uniform bumps, often across the chest, shoulders and back. Unlike bacterial or hormonal acne, these don’t vary much in size or type. They also appear in clusters and often feel more irritating than painful.
What causes fungal acne? Humid weather, wearing tight or sweaty clothing, compromised immune function and the use of certain antibiotics or corticosteroids are all potential causes. Fungal acne also thrives in damp conditions — which is why it’s more common in warmer climates or during summer.
Many try to treat fungal acne with standard acne products, which can potentially make it worse. Because it’s a yeast issue, not a bacterial one, it responds best to targeted antifungal therapies.
Antifungal agents like ketoconazole, clotrimazole or selenium sulphide are commonly used, often in the form of creams applied to affected areas. For more persistent or widespread cases, oral medications like fluconazole or itraconazole may be prescribed, as they have demonstrated efficacy in clearing Malassezia folliculitis. It’s important to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan.
Fungal, bacterial acne vs. hormonal acne — summary of differences
Spotting the difference between acne types isn’t always straightforward, especially when the symptoms overlap. However, understanding how they behave beneath the surface can help guide appropriate treatment.
Here’s how fungal, bacterial and hormonal acne differ:
| Category | Hormonal acne | Bacterial acne | Fungal acne |
|---|---|---|---|
| Triggers | Internal hormone fluctuations | Pore-clogging and overgrowth of C. acnes bacteria | Overgrowth of Malassezia species |
| Appearance | Deep, cystic breakouts on the lower face | Inflamed red bumps, pustules, blackheads | Small, uniform bumps that often itch |
| Common locations | Chin, jawline, lower cheeks | Forehead, cheeks, back, chest | Upper back, shoulders, chest |
| Response to treatment | Often requires internal treatment or hormone support | May respond to topical or oral antibacterial therapies | Needs antifungal treatment, as standard acne products may worsen it |
When comparing fungal, bacterial acne vs hormonal acne, remember that the primary distinction lies in the root cause. Bacteria and yeast live on the skin, while hormones operate from within. Knowing which type you’re dealing with can help you choose the most appropriate treatment and avoid ineffective or aggravating products.
Book a consultation for your acne problems at Advantage Skin Clinic
Hormonal, bacterial and fungal acne may share similarities, but they’re very different below the surface. Treating them effectively starts with knowing precisely what you’re dealing with.
At Advantage Skin Clinic, we take the time to professionally assess your skin and identify what’s driving your breakouts. From there, we’ll recommend a treatment plan tailored to your specific skin needs.
Treatment options may include laser therapy to target inflammation, LED therapy to support healing and chemical peels or facials to deeply cleanse your skin and remove impurities. Each plan is developed with your skin type, medical history and long-term goals in mind — and delivered by experienced dermal professionals.
Book a consultation today to speak with our experienced team and take the next step towards healthier skin.