What Is Back Acne?

Overview

Curious about those persistent breakouts on your back? Those small acne lesions not only cause discomfort but can also be incredibly itchy, making it difficult to find relief.

Acne is a common skin condition that affects millions of people worldwide. While most people associate acne with the face, it can also occur on other body parts, including the back. Back acne, also known as "bacne," can be equally distressing and may significantly impact one’s self-esteem and quality of life.

But don't worry, as you don't have to endure the discomfort of back acne in silence. In this article, we will explore the causes and treatment options for back acne, as well as how to prevent it.

What is back acne?

Back acne refers to pimples or cysts that develop on your back.¹ It can involve:

• Whiteheads: Bumps with a white center that form when plugged follicles stay underneath your skin
• Blackheads: Bumps with a black dot in the center that appear on your skin when plugged follicles open
• Cysts: Red and painful pus-filled lumps appear on your skin when a bacterium is trapped in a hair follicle
• Papules: Small pink bumps without a head appear on your skin when a clogged hair follicle becomes inflamed

Acne develops on your back when dirt, sweat, dead skin cells and bacteria get trapped in the pores of your skin.¹ Sweaty shirts, backpacks, and sports equipment can create friction on your back and worsen back acne. 

Causes of back acne

Back acne is primarily caused by the same factors that contribute to facial acne. The back has a high number of sebaceous glands. These glands produce sebum (oily substance) that forms a protective coating for the skin. When the sebaceous glands become overactive, they produce high amounts of sebum that accumulate in the follicle and create a plug (comedo) above the sebaceous gland duct. As the sebum and dead skin cells continue to pack into the follicle (clog the skin pore), the comedo expands behind a small follicular opening to the skin. As a result, a closed pimple will form on the skin's surface.²

Hormonal changes during puberty (adolescence), pregnancy, menstruation, or menopause, can stimulate the sebaceous glands to produce excess sebum, which leads to acne breakouts. ^2,3

In addition, friction due to backpacks, shirts, and sports equipment can irritate the skin, which leads to the development of back acne or worsen the present ones.

Signs and symptoms of back acne

Acne can appear along your shoulders and upper back or develop all over your back and down to your waist. The systemic symptoms are often absent, but you may experience local symptoms of pain, itchiness, redness of the skin, and tenderness.

You might have one type of pimple or a combination of non-inflammatory pimples (whiteheads and blackheads) and inflammatory pimples (papules and cysts).

In addition to the local symptoms, acne can have a psychological impact, regardless of its distribution and severity.⁴

Management and treatment for back acne

There are several over-the-counter (OTC) and prescription treatments you can use for your back acne.

Cleanser

Scrubbing your back with a harsh exfoliator or scrub irritates your skin and makes acne worse. It's best to wash your back with a mild, non-irritating, oil-free body cleanser after getting sweaty and before applying acne treatment. Avoid using harsh soap and scented products, as these increase inflammation.⁵

Topical Treatments

When acne flares up, you can use one of the following products:

• Salicylic acid: It is an active ingredient in many OTC acne products. It has anti-inflammatory (reduces inflammation) and comedolytic (inhibits the formation of pimples) properties. It is used to treat mild acne and as an adjuvant to regimens treating severe acne.⁶
• Benzoyl peroxide: It has antibacterial properties (kills bacteria) as well as mild anti-inflammatory and comedolytic properties.⁷ It is very effective in treating inflammatory acne like cysts and papules. Benzoyl peroxide works well when you leave it on your skin for a few minutes. This helps the medicine penetrate your skin since the skin on your back is thicker than on your face.⁸
• Azelaic acid: It has antibacterial, anti-inflammatory, and comedolytic properties similar to benzoyl peroxide, which make it effective against mild and inflammatory acne. Azelaic acid also helps in reducing skin redness and hyperpigmentation (a condition in which some areas of the skin become darker than others). The medicine is well-tolerated with mild tingling on initial application.⁹
• Topical retinoid: It is the first-line treatment for acne because it targets the microcomedo (precursor to all acne lesions). Retinoid is effective on all types of acne-a whitehead/blackhead pimple and an inflammatory cyst/papule. Topical retinoid is usually used in combination with other topical medications like benzoyl peroxide to increase the penetration of the product by unclogging the closed pores. ¹⁰ It is advisable to start with a lower-strength topical retinoid and less frequent applications (Sunday, Tuesday, and Thursday only) and then increase the strength and days of the application over time.
• Topical antibiotics: They are mostly used to treat inflammatory cysts and papules. Clindamycin and erythromycin are the most commonly prescribed topical antibiotics. However, the antibiotic resistance (the ability of bacteria to defeat the drugs designed to kill them) to both medications lead to the necessity of adding other topical formulations (retinoids or benzoyl peroxide) to achieve the optimum therapeutic response. ²

Oral Treatments

• Oral antibiotics: They might be prescribed if you have severe acne (10 or more inflammatory lesions). Oral antibiotics work by reducing the amount of acne-causing bacteria on the skin. Tetracycline class (doxycycline, minocycline, sarecycline) is the most commonly prescribed antibiotics due to their antibacterial and anti-inflammatory properties.¹¹ The doctor will likely prescribe the shortest possible dosage to avoid the development of antibiotic resistance. You should continue the antibiotic therapy until you are no longer developing lesions.
• Isotretinoin: It is an oral retinoid prescribed for severe cystic acne or other acne that does not respond to topical treatments. Isotretinoin reduces excessive secretion of sebum, clogged pores, inflammation, and bacterial number.¹² The doctor starts by prescribing the lowest dose of isotretinoin to avoid severe flares of acne, which can accompany the beginning of the treatment. Then, the doctor increases the dose based on your weight and treatment response. Most patients taking isotretinoin show significant improvement in reducing the severance of acne for years, if not indefinitely. However, isotretinoin has a teratogenic potential (increase the risk of birth defects and developmental disorders) thus, cannot be used during pregnancy.²

Diagnosis

A doctor or dermatologist (medical doctor specialised in treating skin conditions) can usually diagnose your back acne by a visual examination of your skin. He/she will assess the severity of the acne (mild, moderate, severe), contributing factors (medical condition, hormonal, or drug-related), and the psychological impact. Based on the collected information, the doctor will choose the appropriate treatment for your case. 

Risk factors

Several factors can increase the likelihood of developing back acne. These include:

• Family history: If one of your parents or both have a history of acne, you have a higher risk of developing back acne¹³
• Changes in the level of hormones: Hormonal fluctuations during puberty and menstruation or hormonal disorders can cause sebaceous glands to secrete excessive sebum¹⁴
• Medications: Some medications like corticosteroids or lithium can increase the potential of acne breakouts¹⁵
• Skin friction: Pressure or friction on your skin can increase the risk of developing back acne. Athletes who wear tight-fitting sports equipment are more susceptible to back acne
• Stress: It increases the level of cortisol, a hormone that causes your glands to produce excessive sebum¹⁶

FAQs

How can I prevent back acne?

• Maintain good hygiene by regularly washing your back with a gentle cleanser to remove sweat, sebum, and dead skin cells
• Avoid wearing tight-fitting clothes, and minimise friction and pressure on the back
• Shower after physical activity to prevent the buildup of sebum and sweat. 
• Avoid touching or picking at the acne to prevent worsening the acne and irritating the skin
• Avoid food that triggers your back acne

How common is back acne?

Anyone can get back acne. It affects people of all ages, gender, and skin types. But it is more common in teenagers. 

When should I see a doctor?

You should see a doctor or dermatologist if:

• Your acne does not go away with topical OTC treatments
• You have severe and inflamed back acne
• You have painful cysts or pimples deep under your skin
• You have signs of a bacterial infection, such as a fever

Summary

• Back acne is a common skin condition characterised by the presence of pimples on the back
• It ranges from mildly annoying to very painful pimples
• It is primarily caused by excess sebum production, bacterial infection, hormonal changes, and friction or pressure on the skin
• The management and treatment of back acne involve topical treatments and oral medications
• It's important to avoid touching or picking at acne and seek medical attention if self-care measures do not improve the condition
• By implementing preventive measures and seeking appropriate treatment, you can effectively manage and reduce back acne, thereby improving your overall skin health and well-being