Back acne is the same basic process as acne elsewhere, despite having acquired its own nickname. Oil and skin cells plug hair follicles, the small openings containing a hair and an oil gland. Bacteria that normally live on skin can multiply inside those blocked follicles and cause inflammation, meaning swelling, redness and pain. Acne can run in families and occur at any age.134

Does back acne mean your hormones are out of balance?

Not necessarily. Oil glands can be especially sensitive to hormones even when hormone levels are normal. Changes during puberty, periods and pregnancy can also trigger acne. Stress can worsen existing acne without being its original cause.125

Acne alongside irregular periods, unusual hair growth or hair thinning is worth discussing with a doctor. These can occur with polycystic ovary syndrome, or PCOS, a condition involving hormonal imbalance. A clinician can assess the combination of symptoms rather than treating the location of your spots as a diagnosis.2

What else could be contributing?

  • Sweat and friction: Sweaty shirts, tight clothing, backpacks and sports equipment can worsen back acne.
  • Skin and hair products: Oily products can contribute to blocked pores.
  • Medicines: Corticosteroids, testosterone, lithium and some hormonal contraceptives can trigger or worsen acne. Discuss new or suddenly worsening acne with your prescriber.
  • Food: Back acne does not identify a dietary problem. There is not enough evidence to recommend a specific diet for treating acne.
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Do you need blood tests?

Most acne is diagnosed by examining the skin, without diagnostic tests. Not all back spots are acne, though. An unusual rash, a sudden change or additional symptoms deserves an examination rather than more acne products.24

What can you do about mild back acne?

Home treatment is reasonable for a few spots or a mixture of blackheads, whiteheads and pimples without deep pain. Products labelled noncomedogenic are intended not to clog pores, which is a useful job description beneath a very long word.56

  1. 1After sweating, shower and change into clean clothes. If you cannot shower immediately, gently use an oil free cleansing wipe and change your shirt.
  2. 2Wash gently. Avoid abrasive scrubs, loofahs and back brushes, which can worsen acne. Do not pick or squeeze spots.
  3. 3Try a benzoyl peroxide wash daily, following the product directions. Leave it on your back for two to five minutes before rinsing. A 5.3% foaming wash is less likely to cause irritation, dryness or peeling than stronger options.
  4. 4Use a back lotion applicator or ask someone to help if you cannot reach areas needing treatment.
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Benzoyl peroxide can bleach fabric. If treatment keeps irritating your skin despite less frequent use, get medical advice. If you are pregnant or planning pregnancy, discuss treatment choices with your clinician; some acne antibiotics are unsuitable during pregnancy, and isotretinoin must not be taken during pregnancy.24

When should you see a doctor?

Seek medical help for deep painful lumps, scarring, widespread acne, severe inflammation or repeated flare ups. Fever or hot, swollen skin can indicate infection. Acne affecting your mental health also deserves treatment and support.35

Treatment can start showing results in six to eight weeks; complete clearing can take three to four months. If there is no improvement after six to eight weeks, see a dermatologist. Widespread acne or acne that resists skin treatments can need prescription tablets.67

Where this answer comes from

  1. 1Acne Types, Causes, & Risk Factorsniams.nih.gov
  2. 2Acnebad.org.uk
  3. 3Back Acne (“Bacne”): Symptoms, Causes & Treatmentmy.clevelandclinic.org
  4. 4Acne: MedlinePlus Medical Encyclopediamedlineplus.gov
  5. 5Acnenhs.uk
  6. 6Back acne: How to see clearer skinaad.org
  7. 7How to get rid of back acnedermnetnz.org