Can sweat cause pimples and acne?

Sports and fitnessSweating from a hot and humid climate or from exercising and working your body hard can cause a type of acne called pityrosporum folliculitis. I see a lot of this sweat acne in my dermatology practice both during the summer and during the school year when athletes are training and competing in their sport.

Pityrosporum folliculitis is a tough and stubborn form of acne to treat because some people’s skin is just prone to it.  What happens is that a normal skin yeast that grows on most everybody’s skin (Malassezia) starts to overgrow in the pores. For some people, their pores don’t fight the yeast very well and so it easily takes off.  A little heat and sweat and – poof, the yeast ‘parties on’ causing pimples.

The treatment depends on how severe the acne is.  For my patients, I always recommend an anti-yeast cleanser and my favorite ingredient for that is pyrithione zinc. These cleansers need to be used every day to help suppress yeast ‘happiness’ and overgrowth.

Clogged pores and oily skin also seem to give the yeast cause for celebration, so I like to keep those ‘happy thoughts’ under wraps too.  The best choices depend on a person’s skin type and skin sensitivities because the treatment options can be irritating.  My ‘go to’ ingredients are benzoyl peroxide, salicylic acid or glycolic acid and physical exfoliation with a slightly rough shower sponge or scrub, and if money is no object, a Clarisonic Plus Sonic Brush.

So, what’s the bottom line….

What does pityrosporum folliculitis look like?

Itchy and tender, red pimples and little clogged white bumps

  • situated along the hairline and jawline of the face often covering the entire forehead too,
  • running down the sides and back of the neck
  • also on the upper chest and back, and sometimes going down the back to the waistline

The best home treatment remedies for pityrosporum folliculitis acne from my dermatology practice are:

For the face:

Wash w/ a Buf Puf Facial Sponge and alternate Calming Zinc Cleansing Bar in the morning with a pore unclogging cleanser at night such as Glytone Mild Gel Wash Cleanser (with glycolic acid), OTB Cleanser #1 (with 10% benzoyl peroxide) or OTB Oil Off Cleanser (with glycolic acid and salicylic acid).  Use a Clarisonic Plus instead of the Buf Puf if you can make the splurge (we sell them in my office).  Blue text is clickable!

For the neck, back and chest:

Wash as soon as possible after sweating.  If you can’t wash right away, then degrease the skin with rubbing alcohol.

Every day in the shower use a slightly rough shower sponge or cloth such as the Salux Cloth, a Buf Puf Body Sponge or the Clarisonic Plus Sonic Cleansing Brush and alternate using a foaming pyrithione zinc cleanser such as OTB Cleanser #2 with a pore unclogging cleanser such as the 3 I listed for the face.  I’ve created a ‘turn key’ kit with all 3 of these necessary steps called my Back Acne Kit.

Does diet help this kind of acne?

Maybe.  There is no scientific evidence for this – yet – but in my dermatology practice I see that when my pityrosporum folliculitis patients eat a mostly healthy diet with more fruit and veggies and less junk food and sugar, their skin rewards them with fewer yeasty pimples.  We know that yeast always love sugar and grease, so, taking away the feast seems to quiet the ‘yeasty party in the pores’.

Are there treatments that can help when the acne is severe and doesn’t respond to home treatment?

Yes, they require a doctor’s supervision and prescription.  Pulsed therapy with oral anti-fungals can be helpful, but there are side effects and so the decision is not to be considered lightly.  I always start with the skin care that I outlined above, and which becomes a long term skin care regimen for yeast suppression in pityrosporum folliculitis prone individuals.

Pityrosporum Folliculitis
Diagnosis and Management in 6 Female Adolescents With Acne Vulgaris
Katherine Ayers, BA; Susan M. Sweeney, MD; Karen Wiss, MD
Arch Pediatr Adolesc Med. 2005;159:64-67.

Photo: Thanks and Gratitude to The U.S. Army

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6 Responses to “Can sweat cause pimples and acne?”

  1. Cura Pelle August 6, 2011 at 9:42 am #

    Thanks for another great column. I’m alternating 2% pyrithione zinc with 2% ketaconazole shampoo for my scalp yeast (malassezia globosa), and I’ve been experiencing success. The zinc shampoo had been recommended to me only to stave off tachyphylaxis, so it’s great to read that pyrithione zinc exerts its own anti-yeast effect.

    I love this blog. Thank you for writing it.

  2. Cynthia Bailey MD August 7, 2011 at 11:20 am #

    Thank you for the encouraging and kind words, and for reading. It’s all very much appreciated :D and I love that you use the term tachyphylaxis!
    Cynthia Bailey MD

  3. Agatha Tefora August 10, 2011 at 7:56 am #

    Thanks for the post. Are there any preventive products you can recommend for us?

  4. Cynthia Bailey MD August 10, 2011 at 11:39 am #

    In the post I mention using my Back Acne kit in the shower, some dietary recommendations and showering or de-greasing with rubbing alcohol asap after sweating. Cheers, Cynthia Bailey MD

  5. Lillie August 13, 2011 at 5:39 pm #

    Dr. Bailey, I just discovered your wonderful blog. Thank you! I am currently using Tazorac and am wondering if you recommend the Clarisonic in combination with prescription retinoids. I am interested in investing, but I’ve had problems over-exfoliating in the past. Thanks so much, and keep up the great work!

  6. Cynthia Bailey MD August 15, 2011 at 6:28 am #

    Hello Lillie,
    Every person’s skin is different. Many of my patients, myself included love the combination of a prescription retinoid plus the Clarisonic. It takes our skin to a new level. That said, there are some that struggle with this combination too and have to figure out just how much of both they can handle without causing irritation. With any prescription medicine, the prescribing doctor should supervise decisions that affect any aspect of the prescription, including exfoliation products used with a retinoid. I help coach my patients to successfully use the two together, and I’m there to answer their question or examine their skin if they have a concern.
    Warm Regards,
    Cynthia Bailey MD