- Only cystic acne is associated with a sensation of itchiness.
- However, other non-acne conditions – such as those caused by fungal and bacterial infections – can mimic the symptoms of acne and make you want to scratch.
- Acne treatments can also dry out the skin, making it more likely to peel and itch.
- Anti-fungal and antibacterial treatments can, therefore, soothe itchy, inflamed skin as can several home remedies designed to moisturize and target the cause of itchiness.
If you have acne, it’s highly likely you’ll experience itching at some point. While we usually associate acne with spots, whiteheads, blackheads and painful inflammation, some forms are more prone to itchiness and irritation. Other skin conditions can also cause a sensation that might compel you to pick and scratch your acne.
But what’s causing that irritation? And how do you resist the itch (and treat it, so it doesn’t come back)? Keep reading to discover everything you need to know about itchy acne.
Types of Acne That Cause Itching
If itchy acne is ruining your day, you’re not alone. Recent evidence suggests up to 70% of acne sufferers report itchiness and that mild to moderate itching is particularly common in teenagers with acne. That doesn’t mean you should ignore it – itchiness usually indicates your skin is dry and irritated, so it’s essential to understand what’s causing it. Let’s start by taking a closer look at the forms of acne that are more likely to make you scratch.
What we call ‘Fungal acne’ isn’t really acne at all. It’s caused by the excessive growth of a yeast that lives on everyone’s skin called Pityrosporum or Malassezia, which then causes folliculitis – an inflammation of the hair follicles that results in a red rash that’s prone to itchiness.
Fungal acne is often mistaken for bacterial or hormonal acne. You’ll know you have it if you see uniformly sized and shaped red or pink bumps, often with clusters of tiny whiteheads, appearing in places where your body produces a lot of oil – your T-zone, on your chest, shoulders and back.
Pityrosporum or Malassezia folliculitis can occur when you:
- Wear clothes that don’t let your skin breath
- Perspire a lot (yeast loves wet, warm conditions)
- Have oily skin and using oily skin care products
- Have a compromised immune system
- Eat a lot of sweets (yeast loves sugar and carbs)
- Use steroids (prescribed or otherwise), antibiotics, or birth control pills.
A severe form of acne, cystic acne creates large, painful lumps deep beneath your skin’s surface and inflamed eruptions sometimes filled with pus. A tingling, itchy sensation often accompanies the condition.
Cystic acne begins with pores clogged with dead skin cells, which then become infected with bacteria. As the pore becomes more inflamed, tender pustules form. If they burst, the bacteria can spread to other pores, causing further breakouts to occur.
Cystic acne requires a trip to your dermatologist, who will likely prescribe topical treatments and antibiotics, including Isotretinoin. A word of warning, however – over-applying topical therapies to the cyst can make your skin drier, making it itchier.
Other Causes of Itchy Acne
There are other reasons you might be itchy – not all of them bad. Under the right circumstances, a tell-tale itch might mean your acne treatment is working. Let’s take a look at two other causes of itchy acne.
Sometimes that itchy feeling can be a sign that your acne treatment is working well. Wounds that are healing often itch because more cells are growing around them and attaching to pull the wound shut.
Also, as scar tissue forms, smooth, hard growths called keloids are created. These can irritate your skin even further. The nerve fibers in your skin detect this activity and release chemicals called histamines that tell your spinal cord to scratch.
Reaction to topical treatments
Some people experience side effects to their acne treatment. Don’t worry, these are usually mild, and dermatologists claim it’s extremely rare to experience a severe reaction.
Many acne treatments can dry out your skin, including those containing salicylic acid, benzoyl peroxide, and retinoids. Excessive use of such products can result in a mild form of dermatitis that makes your skin peel and itch.
If you experience itching, swelling or burning sensation after using your acne medication or treatment, you may be allergic to a specific ingredient it contains. If so, you should stop using the product immediately. While severe allergic reaction to acne products are rare, seek medical attention immediately if you experience the following signs:
- Difficulty breathing
- Swelling in the throat, face, lips or tongue
- A hive-like rash
- Feeling faint.
Treatments for Itchy Acne
If you’re currently finding it difficult to resist the itch, help is at hand. There are many over-the-counter treatments, prescriptions and home remedies that can soothe your irritated skin quickly. The following section describes your main options.
As the name suggests, antihistamines block the release of histamines – the chemicals that make your brain more alert and tell it to scratch. They’re mainly used to treat allergies and hay fever but are also quite useful for skin rashes, redness and inflammation because they sedate your impulse to itch.
Because fungal acne looks so much like acne, many try applying conventional acne treatments to clear it up. Anti-fungal therapies, however, will prove more successful and the good news is, once they start to work, you’ll notice a rapid improvement in your skin and complexion.
If your fungal acne is mild, your dermatologist might prescribe an anti-fungal and antibacterial body wash that contains sulfur to reduce the build-up of yeast on your skin. If after four weeks, the infection still hasn’t cleared up, your doctor may prescribe oral anti-fungal medication.
Hot tip: Try working up a sweat the day after you take your anti-fungal oral medication. Because it’s secreted through the sweat glands, the treatment will be transferred to your skin, making it more effective against your fungal acne.
If your itchy acne proves resistant to over-the-counter topical treatments, your dermatologist may give you prescription-strength medications to help clear it up faster. The medication prescribed will depend on the type of itchy acne you have.
The first line of attack for moderate to severe itchy acne are oral antibiotics. Tetracycline or macrolide are often chosen because they stop bacterial growth and soothe inflammation. You’ll only take them for a short time, and it’s a good idea to combine them with over the counter topical retinoids and benzoyl peroxide – studies show this reduces the risk you’ll develop a resistance to the antibiotics.
For those with a severe case of itchy acne that doesn’t respond to other treatments, oral isotretinoin is particularly effective. A derivative of vitamin A, it decreases your production of sebum to limit conditions in which fungal acne and bacterial folliculitis thrive. However, it does have potentially serious side effects so your dermatologist will monitor your progress closely while you’re on it.
Common over-the-counter topical treatments for acne can also help tame your itchiness by making it harder for fungal and bacterial infections to thrive. These include:
- Retinoid creams, gels and lotions. Topical retinoid treatments are derived from vitamin A and include adapalene, tretinoin and tazarotene. Applied to the affected area at night, they help clear your pores of sebum, bacteria, yeast and dirt. They can cause irritation and sun-sensitivity in large doses, so you’ll need to acclimatize your skin to them gradually and use a high SPF sunscreen during the day to prevent sunburn.
- Salicylic acid and azelaic acid. Salicylic acid in cleansers, creams and gels help prevent your hair follicles from being plugged, so may be useful in targeting folliculitis. Naturally occurring Azelaic acid is antibacterial – when used as a cream, it treats itchy acne effectively. Both can cause minor skin irritation, which could make you itch more, so use as directed.
- Dapsone. Great for inflammatory acne, Dapsone gel decreases swelling and fights bacteria. It’s particularly useful for female adult-onset acne but can cause dryness, so it’s important to combine it with a moisturizer twice daily.
Home Remedies to Relieve Itchy Acne
You can alleviate mild forms of itchy acne with simple home remedies, or you could combine these with over-the-counter and/or prescribed medications to help combat the urge to scratch. Here are some natural products to try.
Studies show aloe vera extract’s astringent and antibacterial can help combat acne, while its saponins target redness and infection. It can penetrate the pores efficiently and help clear out dead skin cells, dirt and sebum.
Aloe vera extract can regulate the skin’s pH, restoring balance to your sebum production and reduce the appearance of scarring by promoting skin cell regeneration. It’s also very soothing to help prevent itching.
Try not to scratch your itchy skin – it will only make matters worse. Scratching a healing acne wound is a bad idea, as you risk damaging the new tissue and making the healing process even longer.
You can also re-introduce bacteria from your hands and fingers into the wound, infecting it and kick-starting the whole breakout process again.
Ice or a cold compress
Cold compresses and ice feel wonderful against itchy skin and can help you stop scratching long enough for your body to heal. When pimples are inflamed and sore, try clearing pores with a warm treatment for 5 to 10 minutes followed by applying ice for 1 minute to decrease the swelling.
Just remember, if you’re putting ice against your skin, always wrap it in a thin, clean cloth first. Direct application can cause skin damage, resulting in dryness, peeling and more itching.
You can supplement itchy acne treatments for your chest or back with an anti-dandruff shampoo – its anti-fungal properties can provide relief from itching and help clear up pimples caused by pityrosporum folliculitis.
Similar Skin Conditions That Cause Itching
Some skin conditions can mimic itchy acne. Check the following to see if your symptoms might be caused by one of them.
Like fungal acne, folliculitis caused by a build-up of bacteria looks like acne but isn’t. When bacteria like Staphylococcus aureus infects hair follicles, the result can be small red, bumps that you’ll probably want to scratch.
Bacterial folliculitis is relatively common and can be caused by:
- Bathing in hot tubs (also known as hot tub folliculitis)
- Rubbing your skin often
- Contact with someone or something that has the bacterial infection
- Being obese
- Wearing tight clothing when it’s hot and humid
- Shaving or waxing.
To avoid a bacterial imbalance on your skin, don’t forget to remove wet or restrictive clothing after exercising, avoid shared or public hot tubs that aren’t rigorously cleaned and maintained, and always using a clean, sharp razor when you shave.
You can gain relief from the itch of bacterial folliculitis by applying warm compresses. Use a cleanser that contains benzoyl peroxide to keep your skin free from bacteria. If these measures don’t work, you may need to ask your dermatologist to prescribe antibiotics.
Bacterial folliculitis can cause hair loss, scarring and pigmentation or – in the worst-case scenario – boils to form beneath your skin.
Perioral dermatitis is a red, scaly or bumpy inflamed rash that occurs around your mouth, sometimes spreading to the nose, eyes and forehead. Sometimes the bumps exude a clear discharge, and you can feel a mild itching and burning sensation in the affected area.
It’s more common in women aged 16 to 45 years of age but can afflict those of all ages. Experts don’t yet understand what causes perioral dermatitis. However, it’s thought it may appear after bacterial or fungal infections, strong topical steroid use, heavy skin creams that contain petrolatum or paraffin, or nasal sprays containing corticosteroids.
Treatments include topical and oral antibiotics, acne medications (adapalene or azelaic acid) and immunosuppressive creams.
An autoimmune condition, eczema or atopic dermatitis, causes your skin to lose moisture and have trouble making the fats and oils it needs to stay healthy. It tends to fun in families and can accompany other allergies, asthma symptoms or hayfever.
Eczema often presents differently across individuals. It can appear as small bumps, rough skin, or red or brown patches that sometimes swell, ooze and get crusty. However, the most common symptom is itchiness, which is why some mistake it for itchy acne.
What we think of as itchy acne often isn’t acne at all, but a concurrent skin condition caused by a fungal or bacterial infection or a reaction to harsh acne treatments and medications. Symptoms of tingling or itchiness accompany only cystic acne. It’s essential to understand the cause of your impulse to scratch to treat it accordingly because scratching can slow the healing process and reintroduce infection to your acne lesions.
- Forest, J.M. & Rafikhah, N. (2014). Aloe vera Juice and Acne Vulgaris: A Placebo-Controlled Study. Asian Journal of Clinical Nutrition, 6(2), 29-34. doi:10.3923/ajcn.2014.29.34
- Lim, Y., Chan, Y., Yosipovitch, G. & Greaves, M. (2008). Pruritus is a common and significant symptom of acne. Journal of the European Academy of Dermatology and Venereology, 22, 1332-1336. doi:10.1111/j.1468-3083.2008.02828.x
- Reich, A., Trybucka, K., Tracinska, A., Samotij, D., Jasiuk, B., Srama, M., & Szepietowski, J. C. (2008). Acne itch: do acne patients suffer from itching? Acta dermato-venereologica, 88(1), 38–42. doi:10.2340/00015555-0355
- Rubenstein, R. M., & Malerich, S. A. (2014). Malassezia (pityrosporum) folliculitis. The Journal of clinical and aesthetic dermatology, 7(3), 37–41. ncbi.nlm.nih.gov/pmc/articles/PMC3970831/
- Sun, K. & Chang, J. (2017). Special types of folliculitis which should be differentiated from acne. Journal of Dermato-Endocrinology, 9(1). doi:10.1080/19381980.2017.1356519
- Walsh, T.R., Efthimiou, J. & Breno, B. (2016). Systematic review of antibiotic resistance in acne: an increasing topical and oral threat. The Lancet, 16(3), 23-33. doi:10.1016/S1473-3099(15)00527-7