Acne vulgaris on the chest: what helps?

What does chest acne look like?

Chest acne often affects the upper trunk. A useful clue is comedones, the medical name for blackheads and whiteheads, alongside other kinds of spots. Several types can appear together, so treatment should match the breakouts rather than treating every bump as the same thing.12

Why does acne develop on the chest?

Acne develops when hair follicles become blocked with excess oil and dead skin cells. Bacteria can grow inside the blocked follicles, causing inflammation and pus. Hormone changes, certain medicines, and skin or hair products that make skin greasy can contribute. Sports clothing and equipment can also contribute to breakouts. Blackhead colour is not dirt, and scrubbing does not solve the blockage.134

How should you care for chest acne?

1. 1Wash the affected skin twice daily with a gentle cleanser. Avoid scrubbing, which can irritate skin and worsen acne.
2. 2Ask a pharmacist about a topical acne treatment such as benzoyl peroxide or salicylic acid. Topical means a medicine applied to the skin.
3. 3Choose skincare labelled noncomedogenic. Remove any makeup used on the chest at the end of the day.
4. 4Wear loose, breathable clothing, especially during exercise or sweating.
5. 5Leave spots alone. Picking and squeezing can cause scars.

Noncomedogenic means a product is designed not to clog pores, which is a more useful job description than 'luxury'.1

Which treatments help, and how long do they take?

For blackheads and whiteheads, a retinoid helps keep pores clear. Adapalene is one retinoid available without a prescription in some settings. Benzoyl peroxide washes help reduce the acne bacteria on skin. Benzoyl peroxide and salicylic acid are also used for inflamed pimples. These are general acne treatment options, not a reason to use every active ingredient together.3

Give treatment six to eight weeks to work for blackheads, whiteheads or pus filled pimples. If these breakouts are not improving, see a dermatologist about a different treatment. Do not wait through that trial period if you already have deep lumps or scarring. Nodules and cysts extend deep into skin and often leave permanent scars; earlier treatment helps reduce that risk.3

Could the bumps be something other than acne?

Not every chest breakout is acne vulgaris. Malassezia folliculitis, inflammation around hair follicles associated with yeast, can cause small, similar looking superficial bumps and pustules on the upper trunk. Heat rash can follow heat and sweating, while hot tub folliculitis can appear in areas covered by a bathing costume after hot tub exposure. These patterns are clues, not a diagnosis. If the bumps remain stubborn despite acne treatment, a dermatologist can check whether they are acne at all.24

When should you get medical help?

See a GP if self treatment is not helping, you have many spots, breakouts are deep or painful, scars are developing, or acne is affecting your mental health. Hot, swollen skin with redness can signal infection and also needs medical assessment. Redness can be harder to see on brown and black skin.1

Very large lumps, bumps that connect under the skin, draining areas, or clusters of blackheads deserve prompt assessment. A rare severe form called acne conglobata can affect the chest and cause connected cysts, abscesses and tunnels beneath the skin. It does not clear without treatment and can leave substantial scars. A clinician examines the skin and medical history; draining sores sometimes need a swab to check for infection.5

Prescription options include topical retinoids, topical or oral antibiotics, hormonal treatment, and isotretinoin. The choice depends on the type and severity of acne. For acne conglobata, isotretinoin is the main treatment and a course can last five to seven months or longer. Other medicines or procedures are sometimes needed alongside it to control inflammation and protect against further scarring.15

Can hormonal treatment help stubborn chest acne?

Women with stubborn chest or back acne can discuss hormonal treatment with a dermatologist, particularly if lower face, jawline or neck acne is also persistent. Options include certain birth control pills and spironolactone. Birth control pills can treat blackheads, whiteheads, pimples and deeper acne. Spironolactone is not prescribed for acne in men because of its side effects. Both treatments require a prescription and a health assessment.6

Improvement with the pill generally takes two to three months. Spironolactone can reduce breakouts and oiliness within a few weeks. Before spironolactone, blood tests are needed; early appointments are usually every four to six weeks while the dose is increased.6

Use the products in your treatment plan consistently, rather than making the bathroom shelf an audition room.6

Tell your dermatologist about medicines, supplements and any history of blood clots, high blood pressure, heart disease or migraines. Birth control pills increase the risk of blood clots, heart attack and high blood pressure. Spironolactone can cause menstrual changes, breast tenderness, dizziness and increased urination. Avoid potassium supplements and coconut water while taking it. Contact the prescriber right away for signs of a serious side effect, such as cramping in an arm or leg.6

Pregnancy can change which acne treatments are suitable, so review your plan with your clinician. If you can become pregnant, birth control is essential while taking spironolactone because exposure during pregnancy can cause serious birth defects.46