Itchy Bumps on Your Back and Chest That Aren't Acne
SkinArticleIf small, same-sized, itchy bumps on your upper back and chest haven't budged after months of acne washes, they may be a yeast infection of the hair follicles called Malassezia folliculitis, often nicknamed fungal acne. One review says it can last for years when it's treated as acne. Here is how it differs from acne, what makes it more likely, and how it's confirmed.
In this article
Months of benzoyl peroxide washes, and the bumps across your upper back and chest look the same. One possible reason: they were never acne.
What it is
Malassezia folliculitis, often called “fungal acne,” is an overgrowth of a yeast that normally lives on skin, inside the hair follicles.1 A 2014 review called it commonly misdiagnosed as acne and said it may persist for years when treated with acne medicines alone.1 It’s often missed because it looks so much like acne.2
How it differs from acne
| Acne | Malassezia folliculitis | |
|---|---|---|
| Bumps | Mixed sizes and stages | Small and all about the same size2 |
| Blackheads and whiteheads | Usually present | Not seen2 |
| Itch | Less prominent | Itchy23 |
| Where | Face, back, chest | Mostly upper back and chest; sometimes the hairline, chin, neck or upper arms2 |
A review says it most often affects young to middle-aged adults.3
What makes it more likely
Risk factors include:2
- Hot, humid weather and heavy sweating
- Oily skin
- Thick creams or sunscreens sitting on the skin
- A recent course of antibiotics, including one prescribed for what looked like acne
- A weakened immune system, including steroid creams or pills
How it’s confirmed and treated
A clinician can scrape or tape-strip the skin and look for the yeast under a microscope; confirming it can take a biopsy.3 Treatment is antifungal, as a cream, a shampoo used as a body wash, or pills.21 Selenium sulfide shampoo, econazole and ketoconazole work in most cases, though creams can take longer than pills.2 It tends to come back, so a weekly antifungal wash is often used to keep it away.2 Some people have acne and the yeast together, and need treatment for both.1
Since heat, sweat and heavy creams feed it, lighter products and changing out of sweaty clothes are sensible steps.2 See sweat under your breasts and why you’re breaking out as an adult.
Try: “The bumps on my chest and upper back itch, they’re all the same size, and two months of benzoyl peroxide didn’t help. Could this be Malassezia folliculitis, and can you take a skin scraping?”
Skin, Head to Toe covers this in Chapter 6, “Bumps, Backs and Bottoms,” in a section called “When It’s Yeast.” Its Skin Sort puts same-sized, itchy bumps that ignore an acne routine in the Clue box, the one that goes to a clinician. See the book.
This article is for general educational purposes only and is not medical advice. It isn't a substitute for diagnosis or treatment from a qualified healthcare professional who knows your health history. See a clinician for bumps that are deep and painful, skin that is hot, swollen or spreading red, or a rash with fever. Don't start oral antifungal pills without a prescription; some interact with other medicines. Girl Playbook does not endorse any specific product, test, or provider.
Girl Playbook sells this book. It provides education and worksheets, not individualized medical care.
Sources
The research behind this article, in the order it’s cited. How we source our articles.
- Journal of Clinical and Aesthetic Dermatology (via PubMed Central), 2014Malassezia (pityrosporum) folliculitis (opens in a new tab)abcd
- DermNet, 2026Malassezia folliculitis (opens in a new tab)abcdefghij
- Journal of the European Academy of Dermatology and Venereology (abstract via PubMed), 2020Critical synthesis of available data in Malassezia folliculitis and a systematic review of treatments (opens in a new tab)abc
Spotted something out of date? Tell us and we’ll check it.
