What Causes Back Acne and How to Prevent It

Back acne, often referred to as ‘bacne’, is a condition that is similar to facial acne both in appearance and underlying causes. It typically presents as a mix of pimples, blackheads, whiteheads, and cysts that form on the skin of the back. The most common location for the acne is across the shoulders and the back of the neck, but in severe cases it can reach down to below the shoulder blades and across the lower back. The skin condition can impact all ages and skin types. 

Whether you’re a long-time sufferer or new to the challenges of bacne, this article can help you better understand the causes of the skin condition and take steps to prevent it.  Back acne is more than simple blemishes on your back skin. It also impacts your self-esteem. Many sufferers avoid going to the beach or playing in the pool They will not wear tank tops or spaghetti strap outfits for fear of showing unsightly splotches. Also, left untreated, back acne can lead to scarring. 

What Causes Back Acne? 

The causes of back acne can vary, but the condition occurs from an overproduction of sebum which clogs hair follicles and pores leading to inflammation and infection. 

Many things can cause back acne such as: 

• Overproduction of Oil: The sebaceous glands in the skin produce an oily substance called sebum. Sebaceous glands can overproduce produce excess oil, which can clog pores. Genetics, puberty, and hormones often cause the body to produce an excess of sebum which can quickly cause blockages which leads to back breakouts. 
• Accumulation of Dead Skin Cells: Regular shedding of dead skin cells is a normal process. However, these cells can accumulate and mix with excess oil, leading to clogged pores – especially if you do not shower or bath regularly to wash away the shedding skin cells. Exfoliation of the area can also help by scrubbing away the buildup of dead cells. 
• Bacteria: The bacterium Propionibacterium acnes, which is commonly found on the skin, can infect and inflame the blocked follicles, resulting in acne. In severe back acne, painful cysts form which lead to scarring. 
• Hormonal Fluctuations: Hormonal changes, especially during puberty, menstrual cycles, pregnancy, or due to certain medications can cause an increase in oil production which causes back acne. 
• Sweat and Friction: Sweat, especially when trapped against the skin by tight clothing, workout gear, or backpacks, can irritate the skin and cause clogged pores. 
• Genetics: Some people may be genetically predisposed to acne, meaning if your family members have had facial or back acne, you may be more likely to develop it too.
• Diet and Lifestyle: While the connection between diet and acne is still a subject of research and much debate, certain foods, particularly those high in sugars and dairy, may trigger a back acne breakout. Stress and lifestyle habits can also influence skin health.
• Lack of Personal Hygiene: If you fail to shower or bath regularly, you may end up suffering from back acne. Also, if you have long hair and do not regularly wash it but let it hang loose on your back it can cause clogged pores and breakouts on the neck and shoulders. 

Understanding what causes back acne can help in managing and preventing breakouts. It’s important to remember that acne can vary greatly among individuals, and what causes an outbreak in one person may not have the same effect in another.

Symptoms of Back Acne

The symptoms of back acne can vary in severity and appearance, but typically include:

• Whiteheads (Closed Comedones): Whiteheads appear as small, flesh-colored, or white bumps on the skin, which result from pores clogged with oil and covered by a thin layer of skin.
• Blackheads (Open Comedones): Blackheads are similar to whiteheads but appear as small, dark spots on the skin’s surface. The dark color is not dirt but oxidized sebum and dead skin cells that have clogged the pore.
• Papules: These are small, red, raised bumps caused by infected hair follicles. They can feel tender to the touch.
• Pustules: Similar to papules, these are red and tender bumps, but they have white pus at their tips. Pustules are more inflammatory than papules.
• Nodules: Nodules are large, solid, painful lumps beneath the surface of the skin. They are formed by the buildup of secretions deep within hair follicles.
• Cysts: Cysts present themselves as large, pus-filled lesions that look similar to boils. Cysts are the most severe form of acne lesion and are more likely to cause scarring.
• Scarring: In severe cases of back acne, the inflammation can result in scarring of the skin, which may be permanent.

These symptoms can be exacerbated by factors like tight clothing, excessive sweating, and not showering after a workout. The severity of back acne can range from mild (a few occasional pimples) to severe (large, painful cystic lesions).

Diagnosing Back Acne 

Back acne is typically diagnosed through a physical examination. A dermatologist or healthcare provider will examine the skin on your back to determine the presence and severity of acne. The healthcare provider will look for various types of acne lesions, such as blackheads, whiteheads, papules, pustules, nodules, and cysts.

On occasion, they may ask about any symptoms experienced, such as pain, itching, or tenderness in the affected area to rule out the irritation being hives, rash, or some other skin disorder. Questions about your medical history, family history of acne, lifestyle, diet, and any medications or supplements you’re taking can provide insight into what could be triggering the acne breakout. 

In most cases, back acne can be diagnosed without the need for specialized tests. However, if the healthcare provider suspects a more complex underlying condition, further tests may be conducted. For example, hormonal imbalances can sometimes contribute to acne, so blood tests might be ordered to check hormone levels if that is suspected as a contributing factor.

Based on the examination and findings, the dermatologist or healthcare provider will recommend a treatment plan tailored to the individual’s needs.

Preventing Back Acne 

Preventing back acne involves a combination of good hygiene practices and lifestyle changes. 

• Shower and exfoliate after a workout. 
• Using a gentle, non-comedogenic body wash with a long-handled brush can aid in exfoliating hard-to-reach areas of the back. 
• Wear breathable, loose-fitting clothing, especially during exercise, to prevent sweat and oil from being trapped against the skin.
• Frequently wash your bedding. Many people believe that using satin sheets and pillowcases can also help prevent back acne. 
• Maintain a balanced diet, rich in fruits, vegetables, and whole grains, and low in refined sugars and dairy. 
• Stay hydrated and reduce stress through activities like yoga, meditation, or regular exercise.
• Avoid excessive sun exposure which can worsen back acne and cause dark spots to develop. 

Over-the-counter Acne Preventatives and Treatments 

When it comes to treating back acne, there are various over-the-counter (OTC) and prescription medications available. OTC topical treatments typically contain benzoyl peroxide, salicylic acid, or alpha hydroxy acids, which can help to unclog pores and reduce skin bacteria. 

Benzoyl peroxide and salicylic acid are two widely used over-the-counter topical treatments for managing and preventing back acne. 

• Benzoyl peroxide is known for its effectiveness in killing acne-causing bacteria and reducing inflammation. It helps in breaking down blackheads and whiteheads, making it particularly useful for treating inflammatory types of acne. 
• Salicylic acid effectively unclogs pores via exfoliation. It’s a beta hydroxy acid that helps to dissolve the type of skin debris that clogs pores and causes acne, making it ideal for non-inflammatory acne like blackheads and whiteheads. 

Both ingredients can be found in various concentrations in cleansers, lotions, and spot treatments. They can be used separately or together, depending on the skin’s tolerance and the severity of the acne. However, it’s important to start with lower concentrations to gauge skin sensitivity and to use sunscreen, as these ingredients can make the skin more sensitive to the sun.

The American Academy of Dermatology suggests also using Adapalene 0.1% Gel (a retinoid) in conjunction with benzoyl peroxide. The over-the-counter retinoid assists in unclogging pores, thereby boosting the efficacy of benzoyl peroxide. Dermatologists typically advise applying adapalene post-shower or just before bedtime. Consistent, daily application is imperative to clear up the breakouts and prevent new ones from forming. 

5 Top Over-the-counter Acne Treatments 

• Differin Acne Body Wash – The gentle body wash contains 2% salicylic acid, hyaluronic acid, and blue tansy extra. 

• Differin Acne Body Spray – The body spray lets you reach those hard-to-reach areas of your back to treat the breakouts. The formula is made up of 2% salicylic acid to treat acne, 3% glycolic acid, and 2.5% witch hazel to help reduce oil and prevent acne while drying out existing pimples, blackheads, and whiteheads. 

• Cetaphil Body Wash – A body wash that contains  2% Salicylic Acid treats acne to exfoliate the back skin. 

• Proactiv 3-Step Acne Treatment  – This is a popular three-step treatment for facial and back acne. It comes with a cleanser, toner, and spot treatment to focus on the problem areas. 

• PanOxyl Acne Foaming Wash: The cleanser contains maximum strength Benzoyl Peroxide 10% which is an effective antimicrobial for prevention and to dry up existing pimples. 

Prescription Medications and Treatments

For treating back acne, especially in moderate to severe cases, dermatologists often prescribe medication that targets the underlying causes of acne, such as excess oil production, bacterial growth, and inflammation. 

Common prescription medications include:

• Topical Retinoids: Medications like tretinoin, adapalene, and tazarotene help to unclog pores and renew skin cells. They are effective in treating blackheads and whiteheads.
• Topical Antibiotics: Clindamycin and erythromycin are commonly used to reduce bacteria and inflammation on the skin.
• Oral Antibiotics: For more severe cases, oral antibiotics like doxycycline, minocycline, or tetracycline may be prescribed to reduce bacteria and inflammation.
• Oral Contraceptives: For women whose acne is influenced by hormonal fluctuations, certain birth control pills can be effective in controlling acne.
• Anti-Androgen Agents: Drugs like spironolactone can be effective for women with acne by reducing the effect of androgens (male hormones) that can contribute to acne breakouts.
• Isotretinoin: For severe, cystic, or treatment-resistant acne, isotretinoin (formerly known as Accutane) can be prescribed. This powerful medication offers long-term remission of acne symptoms in many people, but it carries significant potential side effects and is not suitable for everyone, especially pregnant women.
• Chemical Peels and Laser Therapy: In some cases, dermatologists might recommend procedures like chemical peels or laser therapy to reduce acne and improve the appearance of the skin.

It’s crucial to follow the dermatologist’s instructions regarding the use of these medications, as some can have side effects and may not be suitable for everyone. 

Treatments for back acne do not work overnight. It often takes several weeks or even months to see significant improvement in acne, so patience and consistency with the treatment regimen are important.

Acne Back Skin Care 

It is essential that you properly care for your skin to prevent the development of back acne and help eliminate existing breakouts. 

• Wear only loose, breathable workout attire made of cotton or moisture-wicking materials.
• Always launder your gym wear after each session.
• Shower and switch to fresh clothes as soon as possible post-exercise (or any sweat-inducing activities).
• If showering immediately isn’t an option, gently cleanse your skin with an oil-free wipe and change out of damp clothing.
• When cleansing your back or applying treatment, use a gentle touch. Aggressive scrubbing can exacerbate acne

• Avoid harsh skincare items like antibacterial soaps, astringents, and rough scrubs, as these can aggravate acne. This also applies to loofahs, back brushes, and buff puffs. Instead, use only mild, fragrance-free skincare options.
• Choose skincare products and makeup labeled as “non-comedogenic,” “non-acnegenic,” “won’t clog pores,” or “oil-free.”

• Avoid wearing backpacks that rub against your back, as friction can irritate your skin and aggravate acne. Use a handheld bag instead, and if you wear a shoulder bag, rest the strap on your arm.
• Resist the urge to pick or squeeze acne, even on your back, as this can worsen the condition.
• Select a non-comedogenic sunscreen, oil-free offers SPF 30 or higher, provides broad-spectrum coverage, and is water-resistant.

When to Seek Back Acne Treatment 

While back acne can be a stubborn and hard-to-prevent condition, understanding its causes, adopting preventive hygiene habits, making certain lifestyle adjustments, and seeking appropriate medical treatments can greatly help manage and reduce its occurrence. Remember, each person’s skin is unique, so what works for one individual might not work for another. It’s always advisable to consult with a dermatologist for personalized advice and treatment plans.