Updated: Apr 6, 2020
Lately, I have seen many patients who come in with a rash on their buttocks after wearing Lululemon leggings to workout in. The rash usually lasts about 24 to 36 hours after sweaty exercise. Because this same brand of leggings has been a common thread throughout all of these cases, my first thought was that it was a reaction to the fabric. However, after doing some research, I found that this common Lululemon rash is most likely a fungal infection called pityrosporum folliculitis.
If your patients ask you about how to treat and/or prevent this rash, here is what you can recommend.
What Is Pityrosporum Folliculitis?
Pityrosporum folliculitis is caused by an overgrowth of a particular kind of yeast – called pityrosporum – on the skin. It presents as small, raised bumps that often resemble acne. However, pityrosporum folliculitis is almost always itchy and uncomfortable, whereas acne is not. It is important to distinguish these two common skin concerns from one another, as acne treatments may make this fungal infection worse.
Pityrosporum folliculitis commonly occurs along the hairline and on the chest, back, and upper arms. Recently, I’ve seen it most commonly on the buttocks, where sweat tends to accumulate in tight clothing while exercising.
How to Treat Pityrosporum Folliculitis
This specific rash has been so widespread lately that it has been the topic of discussion in a private Facebook group of board-certified dermatologists. We found that the rash will temporarily clear up with topical steroids, but will come back. Oral doxycycline and topical benzoyl peroxide and retinoids do not improve it, so it can not be treated as acne, although it is possible for pityrosporum folliculitis and acne to occur simultaneously.
The most effective treatment method for this fungal infection is ketoconazole shampoo or cream, which are applied topically. In more severe cases, oral itraconazole may be used in combination with these topical treatments.
Rash Prevention Tips for Your Patients
With a proper diagnosis and treatment, this rash should go away without any complications. However, you should send your patients home with some guidelines to prevent the rash from occurring each time they work out. You can share these prevention tips:
Change out of wet workout clothes immediately after exercising.
If possible, take a shower directly after working out.
If it is not possible to shower immediately afterwards, use wet cleansing wipes on sweaty areas of the body after a workout and change into dry clothes.
Exercise in loose-fitting clothing or a different type of legging if the rash is still a problem.
Pityrosporum folliculitis can be challenging to identify because it often resembles acne lesions. However, it needs to be treated differently than acne in order to clear it up completely. In addition to prescribing the right topical and/or oral treatments for this fungal infection, suggest prevention tips to your patients to avoid repeats of this itchy, uncomfortable rash.
Have you noticed a surge of patients with this problem? If you have any insights or ideas as to why a particular brand of leggings seems to be the culprit, please share them with me (Dr. Leslie Baumann) via LinkedIn. I would love to hear your input!
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