Fungal acne: Herbal skin care formulation strategies for Malassezia folliculitis - Taste of Herbal Skin Craft

I shared a story of a friend of mine, whose GP blamed her for causing herself a fungal skin infection by making and using an unpreserved cream. In the article I elaborate on why (in that particular case) it was an extremely unlikely scenario.

However, there are other mechanisms through which improperly indicated and used skin care products can exacerbate an existing fungal skin infection, namely, “fungal acne”.

Let me tell you more.

Acne vulgaris vs. Malassezia folliculitis

Fungal acne is a bit of a misnomer. The proper name for this infamous skin condition is “Malassezia folliculitis” (MF).  In other words, inflammation of hair follicles due to overpopulation of Malassezia yeasts.

There are some similarities between acne (acne vulgaris – AV) and MF. For example, they:

• Are both inflammatory diseases.
• Affect the same anatomical location of the skin. And,
• They both present with “pimples” (with a varied degree of severity).

However, while the hallmark of acne is overgrowth of a bacterium species (C. acnes), MF is caused by overgrowth of yeasts. Of course, the pathophysiology of both conditions is way more complex than that, but this will do us for now.

As a result of the main difference, the skin care and treatment strategies of the two conditions are quite different. Get the diagnosis and products mixed up and you can outright aggravate the skin condition.

Although accurate diagnosis may be difficult at times (not exactly helped by the fact the two conditions may coexist on the skin [1] ), there are further differences in clinical presentation of AV and MF. While AV typically present as lesions of various maturity (from black dots to papules, to pustules), MF is typically seen as a cluster of uniform red bumps. Additionally, an itchy presentation is characteristic of MF. [2]

Before I unpack formulation strategies, let’s explore M. yeasts in a little more detail – it will prove crucial for our skin care ingredients choice.

N.B. MF will present differently in a melanin-rich skin.

Malassezia yeasts

Malassezia yeasts are classified as human commensal residents and opportunistic pathogens. [3] That means they are a part of a healthy human skin microbiome (and an outright dominant component of the human dermal mycobiome), but when conditions for their growth are just perfect, grow they do and can contribute to several skin pathologies. M. yeasts thrive in particular in hot and humid environments, but immune suppression, disrupted skin barrier or imbalanced cutaneous microbiome are common factors that contribute to their overgrowth.

To date, 18 M. species have been characterized. Different species contribute to different skin disorders. In humans, MF is primarily linked to M. globosa, M. restricta, M. furfur, and M. sympodialis. [4] Apart from MF, M. yeasts are a common contributor to:

• tinea versicolor,
• seborrhoeic dermatitis,
• dandruff,
• and can also be a part of a clinical picture of atopic dermatitis and acne. [3]

Indeed, in clinical practice, skin disorders don’t always fit into neat boxes but commonly present as overlapping diagnoses. [1]

Malassezia yeasts depend on lipids

Unlike the majority of yeasts, who derive energy from carbohydrate sources, Malassezia yeasts are lipid-dependent organisms. Within the skin, they hydrolyze triacylglycerols present in the sebum and consume thus created free fatty acids which are crucial for their proliferation. [5]

Over time, M. yeasts cause changes in the sebum composition, contributing to the cutaneous lipid imbalance, which subsequently leads to disrupted skin barrier and promotes inflammation. [6]

You will find plenty of academic articles, which report that M. yeasts consume preferentially saturated fatty acids. [6] And while this statement seems to be the consensus, there are also many studies, that confirm that M. yeasts cares about the saturation status of a fatty acid way less than we think. Even original studies done decades ago clearly show that M. yeasts can also successfully assimilate unsaturated fatty acids. [7], [8]

Saturated or not, M. yeasts can only live off fatty acids with carbon chain lengths of 12 carbons and more. Fatty acids with 8 or 10 carbons in their carbon chain, do not cause the yeast’s proliferation. [7], [9]

This finding is crucial for our formulation strategies that I will discuss next. 

Skin care and topical treatment strategies for fungal acne

Conventional treatment of MF includes topical application of azole antimycotics. However, just like certain bacteria, M. yeasts are slowly developing resistance to these types of medicines. Furthermore, as a naturopath you will not want to (nor will you be able to) formulate with these APIs. As a herbal medicine practitioner, you will naturally want to turn your attention to herbs. Of course, you may not be a practitioner at all, and are simply looking to formulate a skin care product, that will support the skin without aggravating fungal acne. 

Herbs with antifungal action

There are plenty of herbs with antifungal action, which you can work with. They come from all parts of the world, so you should be able to find at least one that is common in your region.

Calendula (C. officinalis), is one of the most common “skin herb”, which also exhibits antifungal activity. I did not find any particular references that would explore Calendula for the treatment of M. yeasts overgrowth (Calendula is more commonly indicated for Candida species) [10], but it may be a good start.

Similarly, Tabebuia impetiginosa (known as Pau d’arco) is another herb commonly indicated as a broad-spectrum antifungal. [11]

Backhousia citriodora (Lemon myrtle) is a tree native to Australia, with leaves particularly rich on volatile oils. Citral is one of the major components, which has been tested specifically on M. yeasts and showed inhibition of their growth. [12]

Another well-known plant that was proved to inhibit the growth of M. yeasts is Boswellia sacra (Frankincense). [13] Rosemary and ginger are last two examples I will mention. [14] [15]

Herbal skin care formulation for "fungal acne"

If you are a skin care formulator, you may be tempted to start with the easiest option: Make and use a calendula infused oil and add a few drops of frankincense or lemon myrtle essential oil. If you are a naturopathic practitioner, you may be more inclined to take advantage of one of your commercially available cream bases and mix them with a tincture of one of the plants cited above.

The problem with both approaches?

Particularly the first product will be a feast for M. yeasts! But there are issues with the second product, too. Read on to find out why.

Botanical oils are food for Malassezia yeasts

Essentially all botanical oils, be it almond oil, olive oil, hemp oil or argan oil, contain fatty acids with chain length C12-C24, which M. yeasts thrive off. They will be even more excited about tallow, with its large proportion of saturated fatty acids. (You can learn in great detail about the particular fatty acid profiles of botanical oils and what they tell us in Oily Craft, and read a full-length independent research article about Tallow.)

While it is clear that the first formulation idea must be discarded, what can possibly be wrong with the other one?

In Australia at least, all commercially available pre-made cream bases contain a portion of botanical oils that support M. yeasts growth. Chances are that if you add a sufficient amount of antifungal extracts into such a cream base, they will outweigh the feast the botanical oils supply. But of course, it is a fine balance between stability, sensitivity and effectiveness.

So, what other options do you have?

Make your own Malassezia-safe tailored cream base!

One that allows for addition of an appropriate amount of suitable herbal extracts, offers tailored support to the overall presentation of your client, and is made using Malassezia-safe oil and ingredients. 

The only oil that not only does not feed M. yeasts, but outright inhibits their growth is MCT oil. [8], [16] MCT stands for "medium chain triglycerides" and is also referred to as “fractionated coconut oil”. Thanks to its unique fatty acid profile, it will not cater to M. yeasts.

But it's not just the oil; you will have to further consider that: 

• Some emulsifiers support the growth of M. yeasts, too!
• Other ingredients in the cream should fit into the overall presentation picture of MF.
• If you plan to craft your own herbal extracts, you will need to consider what type of a solvent will match the herbal constituents with antifungal action.
• Finally, you will need a solid understanding of the actual making process to make sure your herbal cream stays stable.

Herbal Skin Craft

Herbal Skin Craft will provide you with everything (and much more) you need to know to master this!

It’s first part will take you on an adventure of skin biology and how to pair certain presentations with the right product. The second part will teach you how to make tailored cream bases and herbal creams. Finally, the third part covers general chemistry principles that govern the crafting of herbal extracts suitable for dermal application. 2026 live edition is now open for enrollments and I will be delighted to share it with you! If you have any questions, get in touch here.

References

[1]    A. Paichitrojjana and T. Chalermchai, “The Prevalence, Associated Factors, and Clinical Characterization of Malassezia folliculitis in Patients Clinically Diagnosed with Acne Vulgaris,” Clin. Cosmet. Investig. Dermatol., vol. 15, pp. 2647–2654, 2022, doi: 10.2147/CCID.S395654.

[2]    M. Green, A. M. Feschuk, N. Kashetsky, and H. I. Maibach, “Clinical characteristics and treatment outcomes of Pityrosporum folliculitis in immunocompetent patients,” Aug. 01, 2023, Institute for Ionics. doi: 10.1007/s00403-022-02506-0.

[3]    D. Iacovozzi, S. Carradori, A. Osmanović, C. T. Supuran, C. Capasso, and A. Angeli, “Managing Malassezia species and related infections: new insights into recent natural and synthetic antifungal compounds and their mechanism of action,” Aug. 01, 2026, Springer Nature. doi: 10.1007/s11030-026-11526-1.

[4]    N. V. Chalupczak and S. R. Lipner, “Malassezia Folliculitis: An Underdiagnosed Mimicker of Acneiform Eruptions,” Sep. 01, 2025, Multidisciplinary Digital Publishing Institute (MDPI). doi: 10.3390/jof11090662.

[5]    Y. Cheng et al., “Research Progress on the Exacerbation of Lipid Metabolism by Malassezia and Its Impact on the Skin Barrier Function,” Apr. 01, 2025, Multidisciplinary Digital Publishing Institute (MDPI). doi: 10.3390/cosmetics12020067.

[6]    F. J. Navarro Triviño, J. P. Velasco Amador, and I. Rivera Ruiz, “Seborrheic Dermatitis Revisited: Pathophysiology, Diagnosis, and Emerging Therapies—A Narrative Review,” Oct. 01, 2025, Multidisciplinary Digital Publishing Institute (MDPI). doi: 10.3390/biomedicines13102458.

[7]    M. N. Porro, S. Passi, F. Caprill, P. Nazzaro, and G. Morpurgo, “Growth requirements and lipid metabolism of Pityrosporum orbiculare,” Journal of Investigative Dermatology, vol. 66, no. 3, pp. 178–182, 1976, doi: 10.1111/1523-1747.ep12481919.

[8]    P. Mayser, P. Haze, C. Papavassilis, M. Pickel, K. Gruender, and E. G. Ho, “Differentiation of Malassezia species: selectivity of Cremophor EL, castor oil and ricinoleic acid for M. furfur.”

[9]    P. F. Wilde and P. S. Stewart, “A Study of the Fatty Acid Metabolism of the Yeast Pityrosporum ovale,” 1968.

[10]    K. Shahane et al., “An Updated Review on the Multifaceted Therapeutic Potential of Calendula officinalis L.,” Apr. 01, 2023, Multidisciplinary Digital Publishing Institute (MDPI). doi: 10.3390/ph16040611.

[11]    J. Zhang, S. T. Hunto, Y. Yang, J. Lee, and J. Y. Cho, “Tabebuia impetiginosa: A comprehensive review on traditional uses, phytochemistry, and immunopharmacological properties,” Sep. 01, 2020, MDPI AG. doi: 10.3390/molecules25184294.

[12]    Y. T. Liu, M. H. Lee, Y. S. Lin, and W. L. Lai, “The Inhibitory Activity of Citral against Malassezia furfur,” Processes, vol. 10, no. 5, May 2022, doi: 10.3390/pr10050802.

[13]    V. Di Stefano, D. Schillaci, M. G. Cusimano, M. Rishan, and L. Rashan, “In vitro antimicrobial activity of frankincense oils from boswellia sacra grown in different locations of the Dhofar region (Oman),” Antibiotics, vol. 9, no. 4, Apr. 2020, doi: 10.3390/antibiotics9040195.

[14]    M. M. Hashem et al., “Rosemary and neem: an insight into their combined anti-dandruff and anti-hair loss efficacy,” Sci. Rep., vol. 14, no. 1, Dec. 2024, doi: 10.1038/s41598-024-57838-w.

[15]    K. A. S. A. S. I. A. and S. A. Ahmad, “INVESTIGATING ZINGIBER OFFICINALE RHIZOME’S PHYTOCHEMICAL MAKE-UP AND BIOACTIVITY: A COMPARISON OF AQUEOUS AND ETHANOL EXTRACTS FOR ANTIFUNGAL, ANTI-INFLAMMATORY, AND ANTIBACTERIAL PROPERTIES,” J. Anim. Plant Sci., vol. 34, no. 6, pp. 1450–1460, 2024.

[16]    M. K. M. PA. Papavassilis C, “Medium-chain triglycerides inhibit growth of Malassezia: implications for prevention of systemic infection.,” Crit Care Med., vol. 27, no. 9, pp. 1781–1786, Dec. 1999.