Acne is a common condition that typically develops in areas of skin with a lot of oil-producing glands, such as the face, chest, and back.
The treatment for back acne depends on its severity and may involve over-the-counter (OTC) products, prescription medications, or treatments such as light therapy.
In this article, we look at what back acne is, what causes it, and how to treat it.
Back acne refers to pimples or cysts on the back. It can involve:
- Blackheads: Each bump has a dark dot in its center.
- Whiteheads: Each bump has a white center.
- Papules: Each small bump has no distinct “head.”
- Cysts: These painful or tender lumps look similar to boils and are a severe form of acne.
Back acne is not a distinct medical condition, but it has some unique challenges, compared to acne on the face. For example, it can be more difficult to see and reach back acne in order to apply treatments.
Why does acne occur on the back?
Like the chest and face, the back has a high density of sebaceous glands. These produce sebum, a waxy substance that keeps the skin healthy.
Sebaceous glands are attached to hair follicles, or pores. If sebum or dead skin cells clog a pore, it can cause a blockage. This blockage may lead to inflammation or trap bacteria in the pore. This is how acne lesions develop.
A type of yeast, Malassezia, can also cause lesions that look similar to acne. The yeast tends to overgrow in humid, sweaty environments. Because the back is often covered by clothing, backpacks, slings, and other thing, it can be an ideal environment for this microbe.
If the yeast gets into the hair follicles, it can cause a condition known as pityrosporum folliculitis. And if antibacterial treatments have not worked for back acne, the person may have pityrosporum folliculitis instead.
There are several ways to approach back acne, including:
According to the American Academy of Dermatology Association (AAD), people with mild-to-moderate back acne may benefit from combining acne-friendly skin care with OTC products that target the lesions.
A basic skin care routine for acne typically includes:
Wash the skin with a mild, nonirritating cleanser every day and after getting sweaty. Avoid harsh soaps and astringents, and do not scrub the acne — this increases the inflammation.
When acne flares up, people can use a benzoyl peroxide wash. This ingredient kills bacteria and helps reduce lesions. It works best when a person leaves the wash on their skin for a few minutes before rinsing it away. Look for a concentration of around 5.3%, as higher amounts can cause irritation.
A person may also need to reconsider shampoos and other hair products. If any of these are harsh, they may irritate the skin as they run down the back in the shower.
Medicated nonprescription creams and gels
To reduce acne, a person might also try a skin care product that contains 0.1% retinoid, in addition to using a benzoyl peroxide face wash. Many OTC creams contain retinoids.
Another option is adapalene gel. Doctors recommend using this after showering and before going to sleep.
An applicator can help a person apply treatments to difficult-to-reach parts of the back.
If the skin on the back feels dry or tight, particularly after showering or bathing, a person might use an oil-free moisturizer. Look for products that are labeled “noncomedogenic.” This means that they do not clog pores.
Sun exposure can make acne lesions darker and more noticeable. It can also cause them to last longer. Use a noncomedogenic sunscreen with an SPF of 30 or above whenever the back is exposed.
Prescription drug-based treatment
If home care strategies and OTC treatments do not help, and especially if acne is severe, speak with a dermatologist, who might recommend:
- Prescription-strength topical products: The doctor may prescribe stronger versions of retinoid or benzoyl peroxide products, or antibiotic creams, for example.
- Oral contraceptives: When acne seems linked to the menstrual cycle, these may reduce the amount of oil that the skin produces.
- Oral antibiotics: Drugs such as doxycycline and erythromycin can reduce the amount of acne-causing bacteria on the skin. A dermatologist recommends the shortest possible dosage because overuse can lead to antibiotic resistance, and antibiotics can kill healthy bacteria in the gut.
- Isotretinoin: This potent medication treats all four causes of acne: excessive oil, inflammation, clogged pores, and bacteria. It is extremely effective — around 85% of people who take it experience permanent clearing of acne after one course. However, it can cause severe side effects, such as suicidal thoughts, aggression, difficulty moving the limbs, and a serious skin rash.
- Antiandrogen therapy: This involves taking medications that suppress testosterone, such as cyproterone acetate and ethinylestradiol or spironolactone. Dermatologists may consider it for females who do not respond to oral contraceptives or have polycystic ovary syndrome (PCOS).
Light and laser therapy
A dermatologist may recommend and perform laser or light therapy for acne. This involves exposing the skin to a special type of light during regular sessions for a set period.
There are different types of light therapy:
- Red, blue, or infrared light therapy can treat pimples but not whiteheads, blackheads, cysts, or nodules.
- Photopneumatic therapy can help unclog pores — treating whiteheads and blackheads but not cysts.
- Photodynamic therapy can treat severe acne very successfully, but it is more expensive.
- At-home light therapy devices can treat pimples, but the light is less intense than the one a dermatologist uses.
For lesions that leave noticeable scars, a dermatologist can use procedures such as laser treatments, microneedling, and chemical peels to reduce the appearance.
The acne-friendly skin care routine outlined by the AAD and summarized above can help prevent back acne, as well as treat it. A gentle cleanser, noncomedogenic moisturizer, and adequate sun protection may be all a person needs.
Other skin care strategies that can prevent or reduce acne and skin irritation include:
- regularly washing bed linens, towels, and pillowcases
- regularly washing clothes, particularly tight-fitting ones, such as bras
- avoiding things that rub against the back, such as backpacks
- exercising in loose-fitting clothes made from natural fibers, such as cotton
- showering and changing clothes immediately after exercise or using cleansing wipes
- washing workout clothes and equipment after each use
Acne affects many people. Certain factors that can contribute to or raise the risk of its development include:
Teenagers often have acne, possibly due to the increase in testosterone that occurs during puberty. Testosterone plays a key role in stimulating the growth and development of the testicles and penis in males and maintaining bone and muscle strength in females.
Experts believe that testosterone causes the sebaceous glands to overproduce sebum, increasing the likelihood of blocked pores. Acne may improve when the person enters adulthood.
A person is more likely to develop acne if one or both parents have or had it.
If both parents had acne, a person may be more likely to develop it at an early age. And if a person’s parents had acne as adults, the person may also be more likely to have it during adulthood.
Females are more likely than males to have acne, possibly due to the influence of female sex hormones, which fluctuate during the menstrual cycle, pregnancy, and menopause.
In addition, PCOS, which affects females and causes high levels of testosterone, can lead to oily skin and acne, among other symptoms.
Other factors that may cause acne or trigger outbreaks include:
- certain medications, such as steroids and some forms of hormonal birth control
- cosmetic products that are not noncomedogenic
- regularly wearing items, such as backpacks, that rub or irritate affected areas of the skin
There is also some evidence that dietary factors can worsen or improve acne. According to the AAD, some studies have shown that a low glycemic index diet reduces acne. This involves eating “slow burning” carbohydrates, which do not cause blood sugar to spike.
Also, some studies have found an association between cow’s milk and higher rates of acne. However, the link is unclear, and there is no evidence that other dairy products, such as yogurt or cheese, cause acne.
Back acne, or backne, occurs when dead skin cells and oil from the sebaceous glands block pores, causing inflammation. It can be harder to see and reach acne on the back in order to treat it. However, a range of effective OTC and prescription treatments are available, and using an applicator can help.
To prevent acne and help reduce it, a person should adopt a regular, gentle skin care routine. It is also a good idea to change out of sweaty clothing, change bedsheets regularly, and avoid harsh soaps and other harsh products that touch the skin.
In addition, back acne can worsen if a person regularly wears things that rub against it, such as a backpack.
Speak with a dermatologist about severe or persistent acne. Some acne-like lesions result from different health issues, which require different treatments.