What is the treatment for folliculitis (inflammation of the hair follicles) causing acne on the chest?

From the Guidelines

Folliculitis acne on the chest should be treated with benzoyl peroxide and topical retinoids as first-line therapy, according to the most recent guidelines 1. When managing folliculitis acne on the chest, it is essential to consider the recommendations for acne vulgaris, as the treatment approaches share similarities.

• The guidelines recommend multimodal therapy combining multiple mechanisms of action 1.
• Benzoyl peroxide is strongly recommended for patients with acne, with a moderate certainty of evidence 1.
• Topical retinoids are also strongly recommended, with a moderate certainty of evidence 1.
• Fixed-dose combination topical retinoid with benzoyl peroxide is recommended, with a moderate certainty of evidence 1. For mild cases, starting with benzoyl peroxide wash (5-10%) used daily in the shower, leaving it on for 2-3 minutes before rinsing, and topical retinoids applied twice daily can help reduce bacteria and inflammation.
• It is crucial to keep the area clean and dry, avoid tight clothing that traps sweat, and change out of sweaty clothes promptly after exercise.
• Using non-comedogenic body lotions if needed and avoiding hot tubs and pools until the condition improves can also help. If symptoms worsen, develop pus-filled bumps, or don't improve within two weeks of home treatment, consulting a healthcare provider is necessary, as prescription-strength treatments or further evaluation to rule out other skin conditions may be required 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION: Erythromycin Topical Solution should be applied over the affected areas twice a day (morning and evening) after the skin is thoroughly washed with warm water and soap and patted dry. Acne lesions on the face, neck, shoulder, chest, and back may be treated in this manner. INDICATIONS AND USAGE: Erythromycin Topical Solution is indicated for the topical treatment of acne vulgaris.

• Erythromycin Topical Solution can be used to treat acne lesions on the chest.
• The medication should be applied twice a day after washing the skin with warm water and soap.
• It is indicated for the topical treatment of acne vulgaris, which includes folliculitis acne 2, 2.

From the Research

Folliculitis Acne on Chest

• Folliculitis acne on the chest is a type of inflammatory disease that affects the pilosebaceous unit of the skin, primarily involving the face and trunk 3.
• It can cause permanent physical scarring, negatively affect quality of life and self-image, and has been associated with increased rates of anxiety, depression, and suicidal ideation 3.
• The treatment of folliculitis acne on the chest may involve topical therapies such as retinoids, benzoyl peroxide, azelaic acid, and/or combinations of topical agents 3, 4.
• For more severe disease, oral antibiotics such as doxycycline or minocycline, hormonal therapies such as combination oral contraceptive agents or spironolactone, or isotretinoin may be recommended 3, 5.
• Isotretinoin has been shown to be effective in treating severe recalcitrant nodular acne, as well as acne that produces scarring or significant psychosocial distress 3, 5.

Treatment Options

• Topical retinoids, such as tretinoin, have been shown to reduce acne lesion counts by 63% compared to baseline 3.
• Combination topical therapy, such as clindamycin 1%-benzoyl peroxide 5% gel, has been shown to be efficacious and well-tolerated in the treatment of acne 4.
• Oral isotretinoin has been shown to be the most effective treatment in folliculitis decalvans, with 90% of patients experiencing stable remission during and up to two years after cessation of treatment 5.
• Gram-negative folliculitis, which may occur in acne patients, can be treated with isotretinoin (0.5-1 mg/kg daily for 4-5 months) 6.

Considerations

• The occurrence of Gram-negative folliculitis should be considered in acne patients in whom oral treatment with tetracyclines has not resulted in a significant improvement of acne lesions after 3-6 months' treatment 6.
• The common use of antibiotics as first-line therapy in folliculitis decalvans needs to be re-evaluated critically, and oral isotretinoin should be considered as a valid treatment alternative 5.