AskID: Back & chest acne

We asked Prof Niki Ralph:
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‘Back/Truncal acne, or “Bacne” as it is now more commonly referred to, is acne affecting the back. Acne affects up to 85% of teenagers and for those who suffer with it, it not only affects the face but many also report spots on the back and sometimes chest, especially in teenage boys and men.
It is caused by increased oil/sebum production which occurs at the onset of puberty combined with the build up of dead skin cells in and around the pores. Bacteria on the skin’s surface such as Cutibacterium acnes in combination with the blocked pores leads to the inflammatory skin lesions such as whiteheads (pustules), red spots (papules) or the deeper nodulocystic lesions. Unfortunately, if there is significant inflammation it may result in scarring of the affected area.
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For some people it is confined only to the upper back/shoulders however it may affect the entire length of the back and for some individuals even extend onto the buttocks.

Tips to treat Back acne:
1) Shower washes
Switch your regular shower wash for one which contains a combination of AHAs (lactic and glycolic acid) and BHA (salicylic acid). Acids such as these exfoliate the skin preventing the build up of dead skin cells, ultimately unblocking pores/clearing blackheads and smoothening the skin.
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2) Shower daily and immediately post workout. Bacteria responsible for acne thrive on sweaty skin, therefore it is important to remove gym clothing and shower as soon as a workout is done. Ideally cotton clothing should be worn as cotton absorbs the oil/sweat away from the skin’s surface. Always use clean gym clothes rather than previously worn clothes which may contain oil, bacteria and dead skin cells.

3) Choose a suitable body moisturiser
Moisturiser can soothe the skin but it is vital as it contains the correct ingredients to prevent further breakouts. Ensure they are labelled non-comedogenic or oil-free. Ameliorate is a great product which contains lactic acid, which smoothens the skin while hydrating it. It is also available as a shower scrub and works not only for acne prone skin but also those with keratosis pilaris.

4) Avoid picking at the skin.
Discuss treatment options with your doctor/dermatologist if all of the above has not improved the skin or especially if one feels their acne is scarring. Addition of prescription topical therapies (which contain retinoids +/- antibiotics) for mild acne may be used, however the skin on the back and chest is thicker therefore they may not be sufficient enough to penetrate the skin in those with more severe acne compared with mild more superficial acne/folliculitis. Picking at the skin may not only lead to scarring but also prolonged pigmentary changes.
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5) Visit your GP or dermatologist to discuss further options such as oral antibiotics, hormonal therapies such as the combined Oral contraceptive pill, Spironolactone or for those who failed such treatments or have a scarring type of acne consider oral isotretinoin (vitamin A derived).