Back Acne

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What is back acne?

Back acne, or “bacne,” is acne vulgaris on the back, usually the upper back. Acne vulgaris—or acne for short—is a skin condition that affects the pores. Pores have a hair follicle and sebaceous gland—or oil gland—at the bottom and an opening at the top. The oil—called sebum—flows up to the skin surface to moisturize the skin. As it travels upwards, it carries dead skin cells and debris with it out of the pore. Acne occurs when the oil, dead skin, and debris are trapped in the pore, forming a plug. The clogged pore can also trap bacteria, causing inflammation.

The upper back is an area with more oil glands than most other body sites. So, it’s a common place for acne to develop. Other commonly affected sites include the face, neck, chest and shoulders. Like these other sites, back acne comes in two forms.

The first type of back acne is non-inflammatory acne characterized by the following types of blemishes:

  • Blackheads, which are clogged pores that remain open at the skin surface. The medical name for them is open comedones.
  • Whiteheads, which are clogged pores that are closed at the skin surface. They are called closed comedones.

Back acne can also be inflammatory. This type of acne includes the following types of blemishes:

  • Pimples, which are raised, tender red or pink bumps. They are called papules when they don’t have pus and a white tip. When they are pus-filled with a white tip, they are pustules.
  • Nodules, which are large, solid, painful lumps deep under the skin
  • Cysts, which are pus-filled nodules that don’t feel solid or hard

Acne is the most common skin condition in the United States. Nearly everyone will deal with an acne breakout during their lifetime. For some people, it remains a mild problem. For others, it can be severe. You are more likely to have a severe problem with back acne if one or both parents had a similar problem themselves.

You can get acne at any age or stage of life. However, the most common time to experience acne, including back acne, is during adolescence and young adulthood. About 80% of people between ages 11 and 30 will have an acne breakout. Researchers aren’t entirely sure why this happens. It’s likely related to changing hormone levels. Other potential causes of back acne include excess oil production and over-sensitivity to skin bacteria.

Mild to moderate back acne usually responds to over-the-counter (OTC) treatments. This includes benzoyl peroxide and mild exfoliants. Severe cases, including nodular and cystic back acne, require the care of a dermatologist. Prescription medicines are usually necessary to control this type of acne.

Back acne can be more than a cosmetic problem. The breakouts and possible scarring can cause emotional problems and self-consciousness. Effectively treating back acne early can help prevent these complications.

What are the symptoms of back acne?

Back acne usually affects the upper back and shoulders. These areas have a high concentration of oil glands compared to other sites, such as the lower back.

The symptoms of back acne vary depending on the severity of the condition. Back acne blemishes may include:

  • Whiteheads, which are white domes over a pore
  • Pimples, which are raised, tender bumps that can be red or flesh-colored and may have a white tip
  • Nodules, which are large, hard, painful lumps under the skin
  • Cysts, which are softer, pus-filled nodules

Mild back acne is the presence of a few blackheads or whiteheads. Moderate back acne is a having a mix of blackheads, whiteheads and pimples. You can usually manage these forms of acne on your own. Deep or painful lumps are a sign of severe acne that requires a dermatologist’s care. Seeking care early can help prevent or minimize scarring.

What causes back acne?

Back acne is the result of clogged pores containing oil, dead skin cells, and bacteria. While the exact reasons pores become clogged in this manner are unclear, poor hygiene is not one of them. In fact, being overly zealous in washing your face can irritate your skin and make acne worse.

Instead, researchers believe acne is likely due to a combination of genetics and other factors. Hormonal changes are probably a main culprit. When androgen levels rise during the teenage years, oil production increases as does skin cell turnover. This may make pores more prone to becoming clogged.

In women, hormonal changes during menstruation, pregnancy and menopause are also linked to acne. Some people may be overly sensitive to normal skin bacteria, as well.

What are the risk factors for back acne?

Several factors increase the risk of developing back acne. However, not everyone with risk factors will have a problem with acne breakouts on their back. Risk factors include:

  • Age: Teenagers most commonly get acne, including back acne, but it can affect anyone.
  • Certain medications: Examples include corticosteroids, anabolic steroids, lithium and phenytoin.
  • Diet: High-carbohydrate or high-glycemic diets may contribute to acne breakouts, according to some study results.
  • Heredity: When a parent has had problems with back acne, you are more likely to have the same problem.
  • Skin environment: Contributors to back acne breakouts may include greasy or oily skin care products, tight or occlusive clothing, high humidity, heavy sweating, and friction or pressure from equipment, such as sports pads or straps.
  • Stress: Stress can increase breakouts in people who already have back acne.

Research also suggests smoking may be linked to acne breakouts in general.

Reducing your risk of back acne

You can’t prevent or avoid back acne breakouts altogether if you are prone to them. But you may be able to lower or reduce your breakout triggers by:

  • Cleaning your skin with gentle cleansers and lukewarm water. Hot water can irritate the skin and worsen acne. Avoid irritating skincare products, including antibacterial soaps, abrasive scrubs or scrubbing tools, and alcohol-based products, including astringents. Instead, use fragrance-free, oil-free, non-comedogenic products.
  • Leaving the blemishes alone and not picking at them. Popping or squeezing pimples increases the risk of scarring and further irritates the skin, which can worsen the problem.
  • Not wearing anything with straps that will rub your back. Instead of a backpack, choose a briefcase or wheeled bag. Carry purses on your arm or in your hand instead of on your shoulder.
  • Protecting your skin from the sun. The sun can irritate the skin and make acne worse
  • Stopping smoking
  • Washing sheets and pillowcases weekly with fragrance-free products and hot water to kill bacteria
  • Wearing loose-fitting clothes. When you work out or sweat, wear wicking clothes and shower right afterwards. Wash your workout clothes after each wear.

If you are concerned about your risk of back acne, talk with your dermatologist. Early intervention can help minimize scarring and other complications.

How is back acne treated?

For mild or moderate back acne, OTC products may effectively control breakouts. The American Academy of Dermatology (ADA) recommends a benzoyl peroxide foaming wash. It works by killing bacteria and is most effective when you use it every day. Because the skin on the back is thicker than the face, neck and chest, let the wash stay on the skin for up to five minutes. This will help the benzoyl peroxide penetrate better. Then, rinse it thoroughly to prevent the product from bleaching your towels, sheets or clothes.

The ADA recommends starting with a wash containing 5.3% benzoyl peroxide. This strength is least likely to cause irritation and dryness. If it doesn’t seem to be effective, try the higher 10% strength. The ADA also recommends using the OTC retinoid adapalene 0.1% (Differin and others) if you need additional acne control. It works as an exfoliant to unclog pores. Use it daily after you shower or before going to bed. Special lotion applicators for the back are available to help you get the medicine where you need it. If back acne hasn’t improved after eight weeks of OTC treatment, see a dermatologist.

When back acne is deep or painful, you should visit a dermatologist. Prescription medicines may be necessary to control severe acne. This may include oral antibiotics in combination with topical treatments, such as prescription-strength retinoids. For women, oral contraceptives can be effective back acne treatment. If other treatments fail, oral isotretinoin (Amnesteem, Clavaris, others) may be appropriate. In some cases, doctors recommend injecting nodules with a corticosteroid or draining cysts.

What are the potential complications of back acne?

Like other forms of acne, back acne can cause complications. Physical complications include scarring and skin color changes, such as darkening of the skin. With nodular or cystic back acne, scars can be pitted or raised and thick. The best approach to scars and skin discoloration is to prevent them by seeking effective acne treatment early. However, once scars form there are treatments available to improve the look of them. This includes chemical peels, dermabrasion, laser resurfacing, and skin grafting.

Back acne can also cause emotional scars and contribute to mood disorders, such as depression and anxiety. People with back acne may feel self-conscious or embarrassed by their condition, which can lead to low self-esteem. Controlling back acne breakouts and treating any physical scars often heals the emotional ones. If you’re struggling with back acne, don’t delay seeing a dermatologist. Effective treatment is available.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Oct 12
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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