When Killing Germs Goes Wrong
Many acne care products advertise that they kill germs on contact (they usually don’t) or that they get rid of all the germs on your skin after just a few uses (they never do). New information from scientific researchers at Konkuk School of Medicine in Korea even suggests that trying to get rid of all the germs on your skin is not a good thing.
The Real Relationship Between Acne Bacteria And Acne
The microorganism most clearly identified with acne is a species of bacteria known as Propionibacterium acnes. Most inflamed blemishes (pimples, papules, nodules, and cysts) are infected with Propionibacterium acnes. The bacteria themselves, however, don’t cause the inflammation and irritation we associated with acne. Redness, swelling, itching, and pain are actually caused by the immune system’s reaction to these bacteria. The germs are capable of releasing “decoy” chemicals known as chemotaxins that can redirect inflammation away from bacteria and to healthy skin.
Propionibacterium acnes is only one of about 2,000 different species of bacteria that ordinarily live on the skin. It’s only a problem when it gets trapped in pores. Bacterial infection is not the first step on acne. Before there is infection, there is hyperkeratinization1. That means, the skin cells lining the walls of a pore grow too rapidly, and trap skin oils and bacteria inside. If there is no hyperkeratinization, there is no infection.
Fighting infection just reduces the need for the immune system to respond to it, at least in the case of Propionibacterium acnes. It’s a different matter when the microorganism growing unchecked in a pore is a yeast of the genus Malassezia.
Yeast And Acne
Malassezia is a group of yeasts that can grow on the skin. Usually, microorganisms in this group don’t cause skin problems unless they grow in large numbers deep inside pores, and they usually don’t penetrate pores at all. If these yeasts do grow inside a pore, they feed on sebum2. This natural oil made by the skin contains fatty acids that lubricate the skin. The yeasts break down these useful fatty acids into other kinds of fatty acids that can irritate the skin.
Malassezia can grow anywhere on the body, but they are more common on the forehead and chest than they are on the sides of the face. They usually don’t grow on the cheeks at all.
The Korean researchers mentioned earlier3 in this post discovered that yeast and acne bacteria usually don’t coexist in the same pore. Malassezia seems to displace Propionibacterium acnes so that pimples do not form. Killing all the microorganisms on your face may kill some of the microbes that keep acne bacteria from taking over a pore.
Malassezia can also cause skin problems, usually a condition called folliculitis. You are most likely to get Malassezia bacteria in pores from which hairs grow. You are less likely to develop folliculitis on your face (and essentially never on your forehead).
Blemishes caused by acne bacteria are most common in teenagers. Blemishes caused by yeast infections are most common in middle-aged adults and in small children. And sometimes “deep seated” acne may not be caused by acne bacteria at all.
Not Acne, But Yeast
The Korean researchers believe that treatment-resistant acne may not really be acne at all. Sometimes skin blemishes that don’t respond to acne treatment may actually be caused by yeast.
This means that getting rid of persistent acne may sometimes require anti-fungal treatment instead of antibiotic treatment4. The clindamycin, tetracycline, minocycline, doxycycline and other antibiotic medications that are used to treat acne won’t work when the problem is a yeast infection. In fact, by killing the natural competitors of yeast infections, they leave more food and oxygen for the yeasts to grow and may even make skin problems worse.
If you are an adult 30 years of age or older and you have not had success in treating acne that just won’t go away, ask your doctor if you might not actually have a yeast infection. Malassezia infections of the skin typically are itchy. They are more likely to occur on the chest, arms, back, shoulders, and neck than on the face.
These yeast infections are filled with a white or yellow “pus.” They tend to grow in hair follicles. They can be identified by a blue or white glow when they are examined under a device known as a Wood lamp.
The harder you try to treat an infection you don’t have, the more likely you are just to accumulate side effects. Many adults who have persistent “body acne” or persistent blemishes on their faces get treatments that will never do them any good. If you have not been able to get adult acne under control, don’t try to eradicate all the microbes from your face. Try to eradicate the right microbes from your face by treating yeast infections when yeasts are the problem5.
Frequently Asked Questions About Yeast Infections That Appear To Be Acne
Q. Are there any people who are at special risk for yeast infections of the skin that are often misdiagnosed as acne?
A. Diabetics and people receiving radiation or chemotherapy often get yeast infections. Treatments for Cushing disease, Hodgkin disease, or HIV, infliximab therapy for Crohn’s disease, and immune suppressants taken after receiving an organ transplant all increase the likelihood of yeast infections. Coating the skin with cosmetics, insect repellants, or sunscreen also gives yeast a favorable environment for growth.
Q. Can you have both acne and yeast infections?
A. Yes, these can coexist6, but you will likely have them on different locations of your body.
Q. Are there any acne medications that make yeast infections worse?
A. Yes. Tetracycline for acne will actually make yeast infections worse.
Q. Are there any home remedies for yeast infections of the skin?
A. Microdermabrasion and exfoliation with beta-hydroxy acid (salicylic acid) will open up pores that are clogged with yeast. If you use a microdermabrasion cloth, it is especially important to sterilize it between uses so you do not reinfect your skin.
- Platsidaki E., Dessinioti C. Recent advances in understanding Propionibacterium acnes (Cutibacterium acnes) in acne. F1000Research. 2018;7.
- Thayikkannu A.B., Kindo A.J., Veeraraghavan M. Malassezia—Can it be Ignored?. Indian Journal of Dermatology. 2015;60(4):332-9.
- Song Y.C., Hahn H.J., Kim J.Y., Ko J.H., Lee Y.W., Choe Y.B., Ahn K.J. Epidemiologic Study of Malassezia Yeasts in Acne Patients by Analysis of 26S rDNA PCR-RFLP. Annals of Dermatology. 2011;23(3):321-8.
- Rubenstein R.M., Malerich S.A. Malassezia (Pityrosporum) Folliculitis. The Journal of Clinical and Aesthetic Dermatology. 2014;7(3):37-41.
- Ayers K., Sweeney S.M., Wiss K. Pityrosporum folliculitis: diagnosis and management in 6 female adolescents with acne vulgaris. Archives of Pediatrics and Adolescent Medicine. 2005;159(1):64-7.
- Gaitanis G., Magiatis P., Hantschke M., Bassukas I.D., Velegraki A. The Malassezia Genus in Skin and Systemic Diseases. Clinical Microbiology Reviews. 2012;25(1):106-41.
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