How to help back acne

What makes back acne worse?

Acne develops when pores become plugged, commonly by natural skin oil and dead skin cells. Sweat trapped under clothing and rubbing from shirts, backpacks or sports equipment can worsen back breakouts. Hormonal changes, oily skin or hair products and certain medicines can also contribute. Back acne can include blackheads, whiteheads, red bumps and deeper lumps. Anyone can get it, although it is more common in teenagers and young men.13

How to start treating mild back acne

1. 1Wash gently. Use a mild cleanser once or twice daily and after exercise. Avoid scrubbing and repeated washing throughout the day.
2. 2Test benzoyl peroxide first. Apply a small amount to one or two small areas for three days. If there is no reaction or discomfort, follow the product directions.
3. 3Start benzoyl peroxide once daily. Choose a shower or washing time that fits your routine, and follow the package rather than increasing the amount or frequency.
4. 4Use a wash or a product that stays on the skin as directed. A benzoyl peroxide cleanser can remain on pimples for up to five minutes before rinsing, but follow your product's instructions. For a cream or gel, wash, gently pat dry and apply a small amount.
5. 5Get help reaching your back. A back lotion applicator can help you reach awkward spots, giving the bottle's 'apply' instruction some much needed logistical support.

Benzoyl peroxide treats mild to moderate acne and comes in washes, lotions, creams and gels. There is no single concentration to recommend for every back acne routine here: use the directions for the product you choose, and ask a pharmacist or doctor if you are unsure how to use it.4

What to change after exercise

Shower and change into clean clothes after exercise instead of staying in a sweaty shirt. Choose loose, breathable tops and consider a shoulder or handheld bag instead of a backpack, giving wardrobe decisions a job beyond looking intentional. Reduce rubbing from equipment where possible. Wash sheets and towels at least weekly, and avoid squeezing or picking pimples: that can cause infection, scars and slower healing.135

What else can treat back acne?

Other treatments applied directly to the back include salicylic acid, azelaic acid and retinoids such as adapalene or tretinoin. Retinoids are medicines used to help clear acne. A salicylic acid wash is another option for oily, acne prone skin. Mild back acne with relatively few pimples can sometimes clear with treatments applied to the skin alone. Some treatments require a prescription and a safety discussion with a doctor.35

Avoid harsh cleansers, rubbing alcohol and very drying toners alongside acne treatment. Acne medicines can dry or peel the skin; a water based or noncomedogenic moisturizer can help. Noncomedogenic means intended not to clog pores, but stop using a product that makes your breakouts worse. For benzoyl peroxide, ask your doctor before adding lotions or other skin medicines to the treated area.34

What if your skin gets irritated?

For mild irritation from acne medicines, use smaller amounts and reduce use to every other or third day until your skin adjusts. Follow any specific prescription instructions. Benzoyl peroxide can cause dryness, peeling, warmth, tingling or slight stinging. Tell your doctor if these symptoms are severe or persistent. Keep benzoyl peroxide away from hair and colored fabrics because it can bleach them.34

Get immediate medical advice for burning, blistering, redness, swelling or a rash during benzoyl peroxide use. Stop using it and get immediate medical help for hives, itching, throat tightness, breathing difficulty, faintness or swelling of the eyes, face, lips or tongue.4

Before using benzoyl peroxide, tell your doctor about pregnancy, plans to become pregnant, breastfeeding and other medicines. Children under 12 need a doctor's advice before using it. Some acne medicines increase sun sensitivity, so use sunscreen on exposed skin and avoid tanning.34

How long does back acne take to improve?

Benzoyl peroxide can take four to six weeks to show effects; contact your doctor if it has not helped by then. Clearing back acne can take several months, and severe acne treatments can take two to three months to show improvement. Those are different milestones: an early response is not the same as complete clearing. Do not wait through that period if your acne is worsening, painful or leaving scars.1234

When should you see a doctor?

Book an appointment for hard or painful lumps, pimples deep under the skin, severe inflammation, recurring breakouts or scars. Seek care for signs of infection, including fever. Acne that causes emotional distress also deserves treatment. If you have many pimples across your back or treatment is not helping, a clinician can examine the skin and discuss prescription options. Ask whether medicines you take, including corticosteroids, could be contributing; do not change a prescription yourself.13

Widespread or persistent back acne sometimes needs tablets or capsules. Options include antibiotics, an appropriate combined contraceptive pill or isotretinoin. For severe acne, an antibiotic is often paired with medicine applied to the skin. Isotretinoin treats several causes of acne and requires monitoring because of possible side effects. A dermatologist can also treat a large painful cyst or nodule; do not try to drain one at home.25

Women with stubborn chest or back acne can discuss hormonal treatment, particularly when other treatments have failed. Birth control pills and spironolactone are prescription options requiring a health review. Spironolactone is not used for acne in men because of side effects. Anyone who can become pregnant must use birth control while taking spironolactone because it can cause serious birth defects. Tell the prescriber about medical conditions, medicines and supplements.6

Do you stop treatment once your back clears?

After severe acne clears or nearly clears, maintenance treatment is usually still needed, although the treatment can change. Skin care and medicine applied to the skin can help prevent its return. Ask your dermatologist which parts of your treatment plan to continue rather than stopping everything at once.2