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Are you frequently getting breakouts on your back and shoulders and wondering what could have caused it?
Multiple factors can lead to back breakouts, but the most common causes are acne vulgaris, bacterial folliculitis, pityrosporum folliculitis, and dermatitis. Of these causes, acne vulgaris is the most common. The term “vulgaris” is Latin for “common,” which suggests the high prevalence of this condition.
Everyone gets acne from time to time, but it is particularly common among adolescents, especially boys. This type of teen acne is the result of underlying hormonal changes triggered by puberty and often subsides as they enter their twenties.
However, in plenty of cases, the condition may continue or worsen during adulthood. Plus, some people get their first breakout when they are already adults. Adult acne is generally considered to be more stubborn and severe than teenage acne.
This article will take you through the causes of back acne and its risk factors and treatment. It will also discuss cases that may warrant prompt medical attention.
How Common Is Acne?
Acne is a widespread condition and affects nearly 9.4% of the global population. In fact, it is the 8th most commonly reported disease across the globe. (1)
Causes of Acne
Your skin is covered with tiny pores that lead to a tunnel-shaped structure called a follicle. This follicle has hair growing inside it and is connected to a sebaceous gland that lies under the skin.
Negligent skin hygiene can lead to the accumulation of dirt, dead cells, oil, and other impurities within the follicle. This is further compounded by the overactivity of the aforementioned sebaceous glands that produce excess oil, which builds up inside the follicle, causing congestion.
The combination of dead skin and sebum is then devoured by the bacteria that naturally reside on your skin, which then multiply rapidly to give rise to an infection.
Once the bacteria start multiplying inside the pore, the immune system generates an inflammatory response against the infection by directing an army of white blood cells to the affected site, ultimately leading to the formation of acne lesions, such as papules and pustules.
Like facial acne, back acne forms when the hair follicles or sebaceous glands get clogged by a buildup of excess oil, sweat, bacteria, and dirt. (2) This can lead to the formation of non-inflammatory lesions or comedones.
Signs and Symptoms of Back Acne
There are no particular signs and symptoms of back acne or any acne aside from the inflammatory lesions that develop as a result of this skin infection. However, these lesions can be of different types.
Comedones are basically plugged pores that collect dirt, skin debris, and sebum over time and appear as small bumps on the surface of the skin.
There are two types of comedones: whiteheads and blackheads. If the opening of the pore remains covered with skin, the gunk inside it appears white from the top, which is why the closed comedone is referred to as a whitehead. If the comedone remains open, the gunk inside it gets exposed to air and oxidizes, turning black and thereby forming a blackhead.
Then there are the more severe forms of acne that are characterized by pus-filled papules or deep-seated nodules, both of which can hurt a lot. The skin surrounding these may turn red and tender, signifying underlying inflammation.
Given that acne is usually triggered by excessive sebum secretion, people who have this condition often have oily skin. But acne can just as well be triggered by increased skin dryness, which prompts the sebaceous glands to produce more oil to compensate for the lack of moisture. This excess sebum then collects inside your skin pores to give rise to acne.
Treatment Modalities for Back Acne
The doctor will recommend the appropriate medical treatment for your back acne depending upon the severity of your condition and other relevant factors such as your age and gender. These treatments may aim at improving the acne, managing the underlying causative factor, relieving the symptoms, or fading acne marks. (3)
Here are the treatment options for back acne:
1. Combination therapy
Combination therapy involves the use of different medical interventions to address acne instead of relying on just one. Two of the most sought-after and effective acne treatments are usually used, namely, topical retinoids and topical or oral antibiotics.
Retinoids are vitamin A derivatives scientifically proven to increase skin renewal. This star compound not only helps clear out clogged pores but also diminishes acne scars by accelerating the shedding of the top skin layer, which is then replaced by fresh new skin. Plus, retinoids also improve the absorption and efficacy of other topical anti-acne products or treatments.
Adapalene gel is one of the most commonly prescribed retinoids for acne. The doctor will also prescribe antibiotics such as erythromycin, clindamycin, and tetracycline to address the underlying bacterial infection. However, using topical antibacterials can cause resistance in the long run; hence, benzoyl peroxide gel is added to lower the risk and combat bacterial resistance.
2. Hormonal therapy
Hormonal therapy is specifically used for treating acne in women who have polycystic ovarian disease (PCOD) and hormonal variations.
A high concentration of androgens in the body makes the sebaceous glands expand and secrete more oil, which ultimately contributes to acne. Thus, hormonal therapy basically aims to correct the deficit in female hormones so that they can balance out the male hormones.
3. Isotretinoin
Isotretinoin is an oral medication that is only prescribed and monitored by a dermatologist and is highly useful in the treatment of severe acne.
However, it can make your skin extremely dry, especially around the lips. So, it is very important that you moisturize your skin properly, apply a hydrating lip balm, and drink lots of water to minimize its side effects.
Note: Isotretinoin, anti-androgens, and tetracyclines are not recommended for pregnant women. (4)
4. Corticosteroid injections
Corticosteroid injections help curb skin inflammation. Since pain and swelling are both signs of underlying inflammation, (5) getting corticosteroid injections can make back acne shrink and hurt less.
5. Comedone extraction
Comedone extraction helps remove blackheads and whiteheads. (6)
6. Laser or light therapy
Laser or light therapy is generally used in combination with other acne treatments. (7) Different lasers or lights, such as infrared, blue, and red light, can help fade acne blemishes in multiple sessions.
7. Microdermabrasion
Microdermabrasion involves the use of a diamond- or crystal-tipped device to gently exfoliate the superficial layers of the skin for skin rejuvenation. (8) It also helps medicated products penetrate deeper into the skin and facilitates healing from within.
8. Chemical peeling
Chemical peeling uses alpha and beta hydroxy acids to exfoliate the outer layer of the skin that contains the clogged pores. The procedure also promotes the growth of new skin cells.
As you shed the topmost layer, it is gradually replaced by fresh new skin from underneath. This type of skin resurfacing helps fade acne marks over time. (8)
9. Benzoyl peroxide
Benzoyl peroxide foam cleansers are recommended to wash your back to kill the bacteria infecting your skin and reduce acne flare-ups. The concentration can vary from 5.3% to 10% and will be decided according to the severity of your acne.
10. Medicated body washes or shower gels
Medicated body washes or shower gels that contain salicylic acid, resorcinol, sulfur, tea tree oil, licorice root extracts, alpha hydroxy acids, and glycolic acid can help manage existing flare-ups and prevent future ones. Plus, they may also be useful in fading acne marks.
Most acne treatments can take up to 6–8 weeks to show results, and the acne may clear up only after 3–4 months.
Diagnosing Back Acne
In most cases, the doctor can diagnose back acne simply by looking at the lesions. Aside from the visual examination, other relevant factors such as your age, lifestyle, and medical history will also be taken into account.
The expert will also determine the severity of your infection by evaluating the grade of the acne.
Complications of Unresolved Back Acne
Treating back acne in its initial stages when the lesions are still mild can promote faster and better skin healing. Plus, it also restricts the spread of the infection to other parts.
If left untreated though, the infection may become chronic and result in the formation of cystic acne lesions or nodules. These are large and painful lumps that form by the union of several smaller pustules as the inflammation spreads underneath the skin. Other areas of the skin might also get affected. Severe, deep-seated acne may also lead to skin scarring.
Back acne can also rub against your clothes to cause a lot of pain, which can put a damper on your daily life. You can forget about carrying a backpack as it will put pressure on the lesions and worsen the irritation. In fact, any activity that involves exerting or leaning on your back can be quite a painful ordeal.
Plus, the inconvenient location of these lesions can make it difficult for you to rest your back against a chair or lie on your back. You may experience restless nights trying to figure out a suitable sleeping position that doesn’t aggravate the acne on your back.
When to See a Doctor
The following conditions warrant medical attention:
- New lesions despite treatment
- Worsening or unbearable pain
- Severe skin redness (erythema)
- Acne scars
- Emotional distress
- Irregular periods or amenorrhea
Final Word
Acne is a bacterial skin infection characterized by recurrent or persistent pimples or “zits.” These most often occur on the face, neck, upper trunk, and upper arm but can also occur on your back.
Back acne can be quite a nuisance due to its location, but the good thing is that it can easily be managed through a variety of treatments. It’s best to treat back acne in the early stages when the lesions are just starting out and the infection is still mild and limited. Delaying treatment can lead to painful and widespread acne and an increased risk of permanent scarring.
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