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Q. What can be done for treating chest acne?

Answered by
Dr. Payal Chauhan
and medically reviewed by Dr.Nithila A
This is a premium question & answer published on Jun 15, 2019

Hello doctor,

I am an 18-year-old male, and for over two years, I have been dealing with a lot of chest acne. I have been told it is folliculitis. I have gone to three different derms who have just prescribed me Benzoyl peroxide washes, sodium washes, Doxycycline, and a bunch of different creams but nothing helped.

It has impacted the quality of my life, and I am not sure what else to do anymore. I have been doing a lot of research on fungal acne, and I feel like this is the problem I have. Even though I mentioned this to my dermatologist, she said she thinks it is more bacterial and said to see if it would improve by prescribing me new creams, and that I would maybe have a culture test done later on to see if it is fungal acne. Do you have any tips or recommendations on what I can do to solve my problem? Or does this look like fungal acne?

Dr. Payal Chauhan

Dermatology Venereology


Welcome to

I understand your concern. It looks to me like Pityrosporum folliculitis. Some people call that fungal acne too. Does it itch? Please take the following medications for three weeks. Kindly consult your doctor to discuss the suggestion and take the treatment with consent.

1. Capsule Itraconazole 100 mg after dinner once a day.

2. Ketoconazole, 2 % Cream, apply twice a day.

Treatment plan:

1. Capsule Itraconazole 100 mg once a day after dinner
2. Ketoconazole 2% Cream apply twice a day

For 3 weeks

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Thank you doctor,

I have shown my chest to other dermatologist but proceeded to treat me if I had bacterial acne. Before I start the treatment plan you sent me, by the picture, does it also look like pityrosporum folliculitis? If you were able to see it. I mostly experience the itching when I get out of the shower. Also, what other symptoms could make a 100 % confirmation that it is pityrosporum folliculitis and not bacterial acne.

Dr. Payal Chauhan

Dermatology Venereology


Welcome back to

The primary differential diagnosis for pityrosporum folliculitis usually is truncal acne or superficial bacterial folliculitis. For acne, you need comedones as the primary lesions and no itching in most of the cases. It is difficult to differentiate bacterial folliculitis from pityrosporum folliculitis, but there are some clues like the areas rich in sebaceous glands like chest, upper back, forehead are the most common sites for P folliculitis, it has more itching, does not respond to antibiotics, may be associated with other features of implicating fungus like dandruff and finally good response to antifungals.

About the last one, it is called a therapeutic trial, if one is not responding to the proposed diagnosis, bacterial folliculitis in your case, treatment for other differentials is given and then see the response. Please start the treatment and follow-up after three weeks, and I hope you will get better.

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