Why does the rash appear on the back and chest?
There are especially many sebaceous glands on the back, shoulders and décolleté, and the skin is denser than on the face. The secretion of the glands is actively secreted, and the mouth of the follicle is easily clogged with horny scales. Add heat, sweating and tight clothing that doesn't allow air to pass through and constantly rubs against the skin, and you get the perfect environment for inflammation. Hormones play an important role: androgens enhance the work of the sebaceous glands, so the peak occurs in adolescence, and in women, exacerbations are often associated with the cycle.
- High density of large sebaceous glands
- Hormonal stimulation of sebum secretion
- Friction of straps, backpack, sportswear
- Heat, humidity, prolonged sweating
- Thick synthetic clothing
- Fatty creams and body oils
What is often confused with acne
Not all back rashes are acne. Fungal folliculitis is very similar: small, uniform itchy nodules of the same size without blackheads, which worsen in the heat and after sweating and do not respond to conventional acne treatment. Bacterial folliculitis occurs, including after swimming. Sometimes the rash is caused by medications, including hormones and some B vitamins. Distinguishing between these conditions is important because their treatment is fundamentally different, and it can be difficult to do on your own.
- Fungal folliculitis - small itchy nodules of the same type
- Bacterial folliculitis
- Drug rashes
- Hidradenitis with painful nodules in the armpits and groin
- Follicular keratosis with rough nodules without inflammation
Body skin care
Care does not replace treatment, but significantly improves the result. You should wash every day and be sure to immediately after training, without leaving wet clothes on your body. Gentle cleansers without aggressive scrubs are suitable: mechanical friction increases inflammation and spreads infection. It is better to rinse your hair by bending forward so that the remaining balm does not flow down your back. Clothes chosen are loose, breathable fabrics. The sun temporarily dries out the rashes, but then strengthens them and strengthens the spots, so sunbathing as a treatment method is not worth it.
- Shower immediately after sports, change wet clothes
- Gentle cleansing without harsh scrubs or washcloths
- Rinse off hair conditioner while leaning forward
- Loose clothing made from breathable fabrics
- Non-comedogenic body products
- Do not extrude elements
Survey
In most cases, the diagnosis is made during examination, and tests are not necessary. An examination is prescribed when there are signs of hormonal imbalance or the picture is atypical. For women with irregular cycles, excess hair growth and male pattern hair loss, the doctor will check androgen levels, including total and free testosterone and DHEA sulfate, and may also refer to a gynecologist and endocrinologist. If a fungal nature is suspected, a scraping is performed. Histological examination is extremely rarely required.
- Examination by a dermatologist with assessment of severity
- Total and free testosterone - according to indications
- DHEA sulfate for suspected adrenal androgen excess
- Assessment of the menstrual cycle, consultation with a gynecologist
- Scraping for fungi if folliculitis is suspected
- Review of medications taken
Treatment
Treatment is selected by a dermatologist based on severity. For mild forms, external agents are used: retinoids, benzoyl peroxide, azelaic acid; for inflammation, external antibiotics are used in combination. The products are applied to the entire affected area, and not point-by-point, and are used in a course of several months: the first improvements are noticeable after 6–8 weeks. For moderate and severe forms, the doctor may prescribe systemic therapy - a course of antibiotics, sometimes hormonal correction in women, and for severe nodular acne - a systemic retinoid under strict control. Self-medication with antibiotics is unacceptable.
- Topical retinoids and benzoyl peroxide
- Azelaic acid
- Combined external agents with a short course antibiotic
- Systemic antibiotics as prescribed by a doctor
- Hormonal therapy in women according to indications
- Systemic retinoid for severe forms under medical supervision
- Correction of spots and scars after inflammation subsides