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Back acne, acne on the back, bacne

Back acne is common and often harder to treat than facial acne. The back is made of tough skin with thousands of sebaceous glands that produce a lot of oil.

What is back acne?

Back acne is usually viewed as the same disease as facial acne since it develops in a similar manner and expresses itself in similar lesions. However, sebaceous glands on the back are larger and produce more oil than those on the face. These larger glands can produce more severe lesions such as nodules and cysts more frequently. The skin on the back is also much thicker than that on the face, sometimes making effective treatment more challenging.

Stats

  • About 2/3 of people with facial acne have some amount of back acne.
  • 20% of all healthy adult males have some amount of back acne.
  • Back acne tends to be more prevalent in men, but is evidenced in both sexes.
  • Other areas of the body, such as the chest, shoulders, arms, buttocks and legs also experience acne, but the back is more common than the other extremities.

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Causes of back acne

No one is certain of the cause of acne. We do know that maturation of the oil glands is required. This is why we see back acne only after puberty begins. Beyond this, what causes back acne is similar to what causes facial acne. For some reason, acne prone individuals tend to overproduce skin cells inside of their pores. This overproduction of skin cells creates pore blockage. The blockage traps skin oil which creates a perfect breeding ground for acne bacteria. The proliferation of bacteria along with a build up of oil and skin cells often breaks the pore wall, signaling the body to enact its immune response. The immune response brings redness and pus into the area, and a zit is born.

When speaking about back acne in particular, there is a particular form of acne called “acne mechanica”—a fancy name for acne which is caused by irritation of the skin. Anything that repeatedly rubs against the skin, such as backpacks, rough massages, tight fitting clothing, weight lifting machines which press on the shoulder area, or anything else that rubs the back area and irritates the skin can aggravate acne in that area. Acne mechanica tends to be aggravated by moisture, so if you’re sweaty and combine that with the repeated rubbing that comes with your backpack, clothing, etc., that could make the problem worse. By simply existing as a human being, your back is going to be in contact with chairs, clothing, beds, and other people’s touch so no one will be able to remove all irritation of the skin of the back. Still, there are some simple ways you can help the situation.

Avoiding irritation

  • Try wearing breathable cotton clothing more often.
  • Try carrying your belongings in something other than your backpack while treating your back acne. Once you're clear, you can try using your backpack again. If you stay clear, great. If not, perhaps a backpack isn't the best option for you.
  • Generally try to be aware of anything that irritates the skin of your back and make accomodations if you can.
  • Try to time your daily treatment (as referenced directly below) so that you can shower and treat your skin after a sweaty workout.

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Treatments

The good news is that we have effective acne treatments to handle just about any case of back acne.

Light to moderate cases

  • I personally have a very light case of back acne. Gentle cleansing plus a 10% alpha hydroxy acid keeps me completely clear. This light to moderate regimen is an easy way to keep everything under control.

Moderate to severe cases

  • When applied correctly and generously, a moderate to severe regimen combining benzoyl peroxide and alpha hydroxy acid works very well. I’ve found this regimen to be highly effective against moderate to severe back acne.
  • The other thing that worked well for me was Accutane. Accutane is a vitamin A derivative administered in pill form for 15-20 weeks. It has been shown to dramatically and often permanently shrink oil glands, leading to reduction and at times remission of acne symptoms. For me, it cleared my severe back acne, and the acne never came back as bad as it was before I went on Accutane. From the sound of it, it sounds like a miracle pill, and for many people it is, especially in the short term. However, it often comes with severe side effects. For instance, my joints ached terribly while on Accutane and have never been the same. I still have chronic dry eyes and lips as well, and my hair has thinned faster than any of the other men in my family. If I had it all to do over again, I would use the back regimen first and see if that could keep me clear, but I would keep Accutane as an option just in case. All about Accutane.

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References

Kligman, Albert M., and Gerd Plewig. Acne and Rosacea. Berlin: Springer, 2000. pp. 27, 361.

Tan JK., et al. "Prevalence and severity of facial and truncal acne in a referral cohort." Journal of Drugs in Dermatology. 2008 Jun;7(6):551-6.

"Acne." University of Wisconsin. 8 Oct. 2008 link