When Acne Isn’t Actually Acne: The Gut, Skin and Microbiome Connection
Could your persistent breakouts be telling you something more than what’s happening on the surface?
When breakouts continue despite a carefully chosen skincare routine, it can be frustrating. You may have tried different cleansers, exfoliants, acne treatments and professional facials, only to find that your skin keeps returning to the same problems.
Sometimes, the answer lies in reconsidering what we are treating.
While acne vulgaris is influenced by hormones, excess sebum, inflammation and the skin microbiome, other conditions can closely resemble acne.
Two worth understanding are Helicobacter pylori (H. pylori), a bacterium associated with stomach infection, and Malassezia, a yeast naturally found on the skin.
They are very different organisms, but both highlight an important principle: not every breakout should be treated as conventional acne.
Continuing my education in skin health
Recently, I had the opportunity to attend a professional training session with Dr Charles McKibbin, Medical Director of The Skin Doctor WA
Dr McKibbin is a highly regarded GP specialising in primary care dermatology. He holds the Royal Australian College of General Practitioners’ Recognition of Extended Skills in Dermatology, a formal distinction reflecting advanced skills in this area.
Training opportunities such as this reinforce an important message: skin concerns are not always straightforward, and understanding the difference between conditions that look similar can make a significant difference to how they are managed.
At Sole Revival, I am committed to continually expanding my knowledge. Respect the skin, educate with honesty, treat with purpose.
So let’s dive in and have a look at what could be going on with the skin.
First up the Demodex mites, (Tiny Mites Living on Your Face, totally normal )
It might sound like something out of a sci-fi movie, but right now, thousands of tiny, eight-legged creatures are living comfortably inside your facial pores. Meet Demodex mites—microscopic organisms that call the human face home.
They are invisible to the naked eye, measuring just a fraction of a millimeter, and they are tucked away inside your hair follicles and oil glands. Their favorite food? Your skin’s natural oil (sebum) and dead skin cells. For the vast majority of us, these little bugs are completely harmless "commensals," meaning they live peacefully alongside us without causing a single problem. In fact, almost every adult on earth has them.
However, things can get bumpy If your immune system changes, or your skin starts overproducing oil, the Demodex population can skyrocket. When millions of them overcrowd your pores, it triggers an inflammatory reaction known as demodicosis. This overgrowth is heavily linked to rosacea and a type of breakouts that looks exactly like standard acne but doesn't respond to traditional acne medication. It can cause your face to feel rough look intensely red, and break out in tiny, itchy pus-filled bumps. So, while a normal amount of face mites is just a natural part of human biology, an explosion of them can be the hidden culprit behind stubborn, angry skin.
Helicobacter pylori: Exploring the stomach and skin connection
H. pylori is a spiral-shaped bacterium that can colonise the stomach lining. It is associated with gastritis, peptic ulcers and other gastrointestinal conditions.
Researchers have investigated whether H. pylori infection may also be associated with inflammatory skin conditions, including acne and rosacea.
Some studies have reported associations between H. pylori infection and acne vulgaris. However, it is important not to assume that persistent acne is evidence of a stomach infection.
Gut microbiome and skin health
The relationship between gut health and skin inflammation is an evolving area of research, often referred to as the gut–skin axis. We are learning more and more about how the gut microbiome changes may influence skin conditions.
Nutrient absorption
H. pylori infection can affect gastric function and may be associated with deficiencies in certain nutrients, particularly vitamin B12 and iron.
Nutritional deficiencies can affect general health and, in some circumstances, skin health, and hair health.
Malassezia folliculitis: The breakout that can look like acne
This is a particularly important condition to recognise.
Malassezia, previously known as Pityrosporum, is a yeast that naturally lives on the skin. Under certain conditions, it can proliferate within hair follicles and cause a condition called Malassezia folliculitis.
Often informally called “fungal acne”, it is not actually acne vulgaris.
How can you recognise the difference?
Malassezia folliculitis commonly presents with:
Small, similar-looking bumps or pustules.
Noticeable itching.
Clusters across the forehead, hairline, chest, shoulders and upper back.
A lack of blackheads and whiteheads.
Conventional acne, by comparison, often includes a mixture of blackheads, whiteheads, inflamed pimples and sometimes deeper nodules.
These differences can provide useful clues, although a professional assessment is needed to confirm the diagnosis.
You can read more about this condition through DermNet’s clinical information on Malassezia folliculitis.
Why can antibiotics make things worse?
Antibiotics are sometimes prescribed for acne vulgaris.
However, prolonged antibiotic use can alter the normal bacterial balance of the skin and may contribute to conditions that favour Malassezia folliculitis.
Antibiotics can also be associated with other acne-like follicular eruptions, so worsening breakouts during treatment should not automatically be attributed to yeast.
This is one reason why persistent or worsening breakouts during acne treatment deserve reassessment.
If a treatment is not working, it does not necessarily mean that your skin needs a stronger version of the same treatment.
It may mean the original diagnosis needs reviewing.
Why the treatment approach matters
These conditions require different management strategies.
H. pylori
H. pylori is diagnosed and treated by medical practitioners.
Treatment generally involves a combination of medicines, including acid suppression and antibiotics, selected according to current medical guidelines and individual circumstances.
It is not appropriate to treat suspected H. pylori independently or assume that eradication will clear acne.
Malassezia folliculitis
Management may involve antifungal treatments, including topical preparations or prescribed oral medication.
A dermatologist can confirm the diagnosis and determine the most appropriate treatment.
Traditional acne products alone may not resolve this condition and, in some circumstances, can aggravate irritation.
What this means for your skin at Sole Revival
At Sole Revival Skin & Body Clinic, I believe effective skin treatment begins with understanding the skin rather than simply treating what we see.
Persistent breakouts can have multiple contributing factors, including hormones, barrier disruption, skincare products, inflammation and underlying dermatological conditions.
This is why a customised approach matters.
Sometimes the most beneficial next step is not another exfoliation, peel or active ingredient.
It may be stepping back, reviewing your skin history, identifying possible triggers and recognising when medical assessment is appropriate.
The takeaway: If persistent skin concerns occur, we need to think about the root cause, what is driving this? Sometimes we need to rethink and seek medical assessment to help understand what’s going on in the cells.
Treat with purpose. Educate with honesty. Respect the skin.
Because beautiful skin is not about doing more. It is about understanding what your skin actually needs.
A note from Jules
Your skin deserves an informed approach, not endless trial and error.
Jules O’Driscoll
BA Hons Complementary Healthcare
Sole Revival Skin & Body Clinic
Winthrop, Western Australia
This article is intended for general educational purposes and does not replace medical advice or diagnosis.
Further reading and references
