Hormonal vs fungal vs bacterial acne: how to tell the difference
The reason your acne treatment 'isn't working' is usually that you're treating the wrong kind. Benzoyl peroxide does nothing for fungal acne. Antifungals do nothing for hormonal cysts. Here's how to tell what's actually on your face.
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Take a clear photo and let a scanner compare
A pattern-recognition scanner will tell you in seconds whether your distribution matches hormonal (jaw and chin), fungal (forehead and chest), or bacterial (T-zone) presentation. Faster than scrolling through Reddit threads at 1am.
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Hormonal acne: jawline, chin, cyclical
Deep, painful, under-the-skin bumps along the jaw and chin that show up the week before your period (or constantly, if your androgens are high). They don't have a whitehead. Treatment: topical retinoids, spironolactone (prescription), or hormonal birth control. Squeezing makes it worse for weeks.
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Fungal acne (Malassezia folliculitis)
Tiny, uniform, itchy bumps on the forehead, hairline, chest, and back. They all look the same size. They get worse after sweating or oily hair products. Treatment: ketoconazole shampoo used as a 5-minute face mask 2-3 times a week. Will not respond to benzoyl peroxide or salicylic acid.
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Bacterial acne (classic C. acnes)
The one you grew up with. Mixed sizes, whiteheads and blackheads, oily T-zone, no specific cycle. Treatment: benzoyl peroxide 2.5% (the actual workhorse), salicylic acid, and adapalene. The cheap stuff works, fancy serums don't add much.
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When it's none of the above
Rosacea (flushing, no whiteheads), perioral dermatitis (small bumps around the mouth, often from steroid creams or fluoride toothpaste), and keratosis pilaris (rough bumps on cheeks and arms) all get misdiagnosed as acne. If two weeks of correct treatment changes nothing, see a dermatologist instead of buying another serum.
Acne isn't one disease — it's a category. Get the diagnosis right and the right treatment is usually cheap and fast. Get it wrong and you'll burn through $300 in serums wondering why nothing is working.
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