How to treat back acne

What causes back acne?

Acne develops when hair follicles, the openings where hair grows, become blocked with excess oil and dead skin cells. Bacteria grow inside those blocked follicles and cause inflammation and pus. Hormonal changes, certain medicines and skin or hair products that make skin greasy can contribute. Back acne can include whiteheads, blackheads, raised pimples and deeper lumps; the type of spot helps determine the treatment.2

How to build your back acne routine

1. 1Wash gently twice a day. Use a gentle cleanser rather than scrubbing your back to remove spots.
2. 2Choose a treatment for the spots you have. Benzoyl peroxide and salicylic acid are options for mild acne; a pharmacist can help you choose.
3. 3If a treatment leaves skin dry or tight, layer a moisturizer over it. Choose one without fragrance and labelled noncomedogenic, meaning less likely to clog pores.
4. 4Wear loose, breathable clothing, especially during exercise or sweating. Do not pick or squeeze spots, because that can cause scars.

General acne care favours a gentle, nonabrasive cleanser applied with your fingertips. Washcloths, sponges and other scrubbing tools can irritate skin. Avoid harsh toners and exfoliants, which can dry skin and make acne look worse. More friction is not a substitute for treatment.4

Which treatment fits your spots?

Whiteheads form when a clogged pore closes; blackheads form when it stays open. The dark colour of a blackhead is not dirt, and scrubbing makes acne worse. Papules are firm, inflamed bumps, while pustules contain pus and often have a white or yellow centre. Treating every bump as something to squeeze increases the risk of making acne worse.5

Benzoyl peroxide kills acne bacteria and helps clear pores. A cleanser you rinse off can limit dryness and peeling compared with a product left on the skin. For very dry skin, a 4% or 5% benzoyl peroxide cleanser is a starting option. Salicylic acid unclogs pores but does not kill bacteria; it is best suited to mild acne, including small bumps that are not inflamed. Products left on the skin can be more powerful, but also more drying.3

Noncomedogenic means less likely to clog pores, which is a more useful label claim than a bottle's enthusiasm. Fragrances and essential oils can irritate skin, so choose products without them. Testing products one at a time makes the culprit easier to identify, even if the bathroom shelf would prefer an ensemble cast.3

How long does back acne take to improve?

Acne treatment takes several weeks to a few months to show a difference. Switching treatments too often can irritate skin and cause further breakouts. For blackheads, whiteheads and pus filled pimples, six to eight weeks is a useful point to assess progress and seek help if treatment is not working. Do not wait through that trial period if you already have deep, painful or scarring spots.45

Protect your back when it is exposed

Tanning damages skin and can worsen acne. Some acne medicines also increase sensitivity to ultraviolet rays. Outdoors, cover your back with protective clothing or apply a broad spectrum, water resistant sunscreen with SPF 30 or higher wherever clothing leaves skin exposed. Choose sunscreen labelled noncomedogenic or "won't clog pores", seek shade and avoid tanning beds.4

Can apple cider vinegar treat back acne?

Apple cider vinegar is not a proven acne treatment. It can cause burning or irritation, and its acidity can strip skin oils and damage the protective barrier. Skip vinegar and use an acne treatment instead.3

When should you see a doctor?

See a doctor if self treatment is not helping, you have many spots, deep painful lumps or scars, or acne affects your mental health. Hot, swollen, red skin can indicate infection; redness can be harder to see on brown or black skin. Prescription options include topical retinoids to reduce inflammation and prevent spots, antibiotics, and oral medicines for more severe acne. A doctor can assess which treatment fits the severity of your back acne.2