Body acne can be really frustrating to manage. The most important first step is accurate diagnosis. Many patients referred to me for persistent body acne have often been misdiagnosed. This is concerning due to the high risk for scarring from body acne.
To be truly acne, you should be able to find a background of clogged pores or comedones, also known as whiteheads and blackheads. Acne will start with clogged pores that then become inflamed. On the body, the common triggers are physical blockage of the pores. Body gear for sports such as football and lacrosse can physically block the pores. Thicker products such as oil based moisturizers or hair gels can also directly clog pores. If this is severe it may require oral antibiotics or Accutane to clear. At the very least a topical retinoid is important to minimize scarring.
Believe it or not, most cases of persistent body acne sent to me are actually a form of folliculitis or infected hair follicles. Hair follicles can become infected by bacteria or yeast or other causes.
When people talk about “sweat acne” they are usually mislabeling their breakouts as acne when they actually have folliculitis.
The key ways to tell the difference between folliculitis and acne:
1. Folliculitis tends to be more extensive- extends down the length of the back
2. Folliculitis tends to have pus bumps based around hair follicles as opposed to clogged pores or comedones.
Sweating can allow bacteria to dive into pores and trigger this type of folliculitis. Many people harbor staphylococcus on their skin- in their noses, under their arms or in the fold between the hip and the groin. When they sweat a lot, the bacteria spreads from these areas and triggers flares. It's important to know this because antibiotics by mouth for an extended period of time may be more helpful.
Another persistent cause is yeast that gets into our pores- pityrosporum folliculitis. On social media I have seen this referred to as 'fungal acne'. I have seen people flare with this after sunburns or sweating as well. This is treated with a different antibiotic or antiyeast agent by your dermatologist.