Acne can occur wherever we have a concentration of sebaceous glands. So whilst it’s common on the face, breakouts on the chest and back are ultra-common.
What is the cause of back acne or ‘bacne’?
In women, this tendency can be exacerbated by hormones eg premenstrually or by progesterone-predominant forms of contraception, like the mini-pill, the period-delay pill and the Mirena coil.
It can also occur in those who aren’t acne-prone as a consequence of certain modern lifestyle habits. I think that the combination of high-intensity workouts and tight-fitting clothing, which effectively grind the mix of surface bacteria, sweat, oil and dead skin cells into the skin plays a big factor in triggering bacne in the women I see.
I also think that certain beauty habits can contribute - using products that contain comedogenic ingredients like cocoa butter and coconut oil will also exacerbate any natural tendency to break out. That’s especially common if you have long hair and forget to cleanse your skin after doing your haircare routine.
Another common culprit is fake tan, especially if you sleep in it – I’ve seen this trigger huge blackheads and whiteheads, often leading to blemishes as a consequence.
Finally, poorly-chosen body sunscreen can also really clog skin, especially in the context of significant sun exposure.
Is bacne normal?
It typically affects around 15% of people with acne. But it’s entirely possible to have it on the body and have the face unaffected and vice versa.
What are the main difficulties in treating it?
It’s a large area of skin to treat and access isn’t easy. Bacne can also go unnoticed - it’s not uncommon when I see a bride for a consultation near her wedding day to witness last-minute panic as she discovers that her low back-ed gown reveals pesky pimples. I make a point of asking every bride-to-be that I see at their first appointment - ideally 12 months ahead of their big day! - what the cut of the dress is as they’ve often not given this much consideration.
What’s the best way to treat bacne?
Firstly, do no harm. Try to avoid making poor cosmetic choices including use of hair conditioners that contain clogging ingredients like coconut oil. Pin hair up off your shoulders before doing your body cleanse and again avoid leaving hair in contact with your back and shoulders to air-dry if using a leave-in hair product.
Use brands like Bioderma and La Roche Posay for sun protection as they are formulated not to clog pores. And use a general purpose non-comedogenic moisturiser like Cetaphil Moisturising Lotion to keep skin supple – stay away from oil-based products.
Eat a diet rich in omega 3 fatty acids, zinc and antioxidants and avoid high GI index carbs and excessive dairy, particularly skimmed milk.
If you’re prone to bacne, make sure you exercise in silky, moisture-wicking fabric. Lululemon’s line of clothing is woven with antibacterial silver yarns to help keep skin bacteria and sweat-free.
Avoid using a backpack - sweating, irritation and friction creates a perfect storm to drive bacne. Switch to a hand-held bag or shoulder strap.
When it comes to your body skincare routine, shower immediately after working out; I recommend bacne sufferers try using a salicylic acid-based cleanser (look for products with 1-2% salicylic acid). I like Cerave Salicylic Acid Smoothing Cleanser for this issue. If trouble persists, then my first line would be to use a leave-on product and I like Flawless Neutralising Gel, a combination of azelaic acid, bakuchiol and salicylic acid, which also help improve the appearance of the dark marks blemishes leave behind. Remember to dose correctly - the back is typically very tolerant of actives and can handle a twice daily regime. If it’s a persistent issue, combine a daily anti-inflammatory active with a night-time serum like Flawless Nightly Serum.
Give this plan 6 weeks. If you’re still not winning, see your doctor or consult a dermatologist. Back breakouts do often require oral medication as it can be hard to treat large areas, so if your blemishes are extensive and leaving pigmentation marks or scars behind, it would be worth seeking medical advice promptly.