Updated: Jun 25
Body or back acne (bacne) can be triggered by various causes- not all of which are true acne. Not every pimple is acne, especially when it comes to the body. Infected hair follicles called folliculitis can share similar features but be triggered by yeast or bacteria in the pores. Read more...
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Is there a difference between acne on the back versus on the face?
Body or back acne (bacne) can be triggered by various causes- not all of which are true acne. Not every pimple is acne, especially when it comes to the body. Infected hair follicles called folliculitis can share similar features but be triggered by yeast or bacteria in the pores.
What makes bacne different to treat than regular acne?
"Bacne" can be really frustrating to manage. The most important first step is accurate diagnosis. Many patients referred to me for persistent body acne have often been misdiagnosed. This is concerning due to the high risk of scarring from body acne.
To be truly acne, you should be able to find a background of clogged pores or comedones, also known as whiteheads and blackheads. Acne will start with clogged pores that then become inflamed.
On the body, the common triggers for true acne-related breakouts are physical blockage of the pores.
Body gear for sports such as football and lacrosse can physically block the pores.
Thicker products such as oil-based moisturizers or hair gels can also directly clog pores.
Believe it or not, most cases of persistent body acne sent to me are actually a form of folliculitis or infected hair follicles. Hair follicles can become infected by bacteria or yeast or other causes.
When people talk about “sweat acne” they are usually mislabeling their breakouts as acne when they actually have folliculitis.
The key ways to tell the difference between folliculitis and acne:
Folliculitis tends to be more extensive- extends down the length of the back and potentially involves the buttocks. Acne on the contrary limits itself to the shoulders and upper back.
Folliculitis tends to have pus bumps based around hair follicles as opposed to clogged pores or comedones. Both acne and folliculitis can have pustules- the difference is where they are based. If you can see a hair follicle coming through every pustule, there is a good chance this is folliculitis. If the pustules have clogged pores, sebum, oil, or keratin debris, then this may be true acne.
Sweating can allow bacteria to dive into pores and trigger this type of folliculitis. Many people harbor staphylococcus on their skin- in their noses, under their arms, or in the fold between the hip and the groin. When they sweat a lot, the bacteria spread from these areas and triggers flares. It's important to know this because antibiotics by mouth for an extended period of time may be more helpful.
Another persistent cause is a yeast that gets into our pores- pityrosporum folliculitis. On social media, I have seen this referred to as 'fungal acne'. I have seen people flare with this after sunburns or sweating as well. This is treated with a different antibiotic or anti-yeast agent by your dermatologist.
What techniques do you suggest using to spot-treat back acne?
Spot treating bacne is not always practical for obvious reasons. It is fairly challenging to even detect the earlier stages of acne because we rely on the feel of the skin as opposed to being able to get a good look at it. It is also harder for topical spot remedies to penetrate the thick skin of the back for the sake of effectiveness given the different overall thickness of the skin. Routine acne spot treatments containing salicylic acid or benzoyl peroxide may help. Avoid traumatizing the back with attempts at manual extraction. The risk of scarring in this area is higher.
Which products would you recommend for back acne or "bacne" and why?
For true acne based on comedones, also known as clogged pores, consider adding an acne cleanser to your shower routine. Benzoyl peroxide cleansers in 10% concentration can reduce oil buildup and treat acne-causing bacteria on the surface. Use a white towel or towel you are not worried about since benzoyl peroxide cleansers can bleach towels or bath mats. If persistent, given the high risk of scarring, consider a visit to your dermatologist for early intervention with prescription topical or oral medications if needed.
Should people shower right after working out?
For body acne related to sweat, try to consider preventative measures such as looking at your clothing. Cotton fabrics tend to absorb and hold onto sweat. Moisture-wicking fabrics tend to pull sweat away from your skin, through the fabric, and evaporate off the surface. This can help create an environment where yeast and bacteria trigger body breakouts and are under better control.
Although there are no specific studies evaluating the effectiveness of dandruff shampoos on body acne, zinc pyrithione or selenium sulfide shampoos have been shown to be effective for Pityrosporum in the scalp related to dandruff. It is not unreasonable to consider the use of these shampoos as body washes in the shower after sweating to control the yeast and bacteria that contribute to these breakouts.
Can a "back facial" help treat acne?
A “back facial” generally entails a combination of microdermabrasion to mechanically exfoliate, unclog the pores, and potentially supplement with chemical exfoliation with alpha and/or beta hydroxyacids. The method is based on recognizing that the pores on the back are fairly deep with back skin being thick relative to other areas on the body. If these pores are clogged they can be difficult to ‘unclog’.
What are some ways to manage back acne?
Microdermabrasion combines suction with exfoliation to accelerate the unclogging of pores. This can be done in the office however there are also at-home devices that can be considered for use. Benzoyl peroxide, retinoids, salicylic acid, and even anti-yeast agents can be effective to address back acne. Acne on the back can have a tendency to scar so early intervention is key. Consideration to oral antibiotics or potentially Accutane may be worthwhile if persistent or severe.