In this line of work, it’s all about making subtle yet impactful changes to our appearance to present the best version of ourselves. But sometimes it’s more than just how we look and how we feel, literally — I’m talking about back acne (“bacne”), a condition that is for the most part out of sight but never out of mind for patients. 

Studies¹ show that almost 50% of adults with facial acne experience back acne. The insecurities stemming from back acne prevent many from wearing open-back dresses or engaging in activities such as swimming. A select few also choose not to treat it because if it’s not visible, why bother? This may be true, except that back acne can be a very painful condition and can lead to a high chance of complications like scarring and skin colour changes if left untreated. 

Below, my take on how to manage back acne at home, the types of in-clinic treatments available in Singapore, and what you can do if you have unsightly scars left by untreated bacne. 

What is back acne or bacne?

Back acne is simply the presence of acne on your back; it’s caused by the same thing that causes facial acne — oil-secreting glands or hair follicles. However, our backs are more likely to accumulate dead skin cells and a common skin bacteria known as Cutibacterium acnes, as that area is more prone to excess sweat and friction. 

Back acne can manifest as different types of acne lesions, including; 

Whiteheads

Also referred to as closed comedones, whiteheads develop when a plugged follicle under your skin stays closed, forming a white bump. 

Blackheads

When that plugged follicle or whitehead as described above opens, it develops into a blackhead or open comedone. Please note that this black appearance is due to a reaction between sebum and air, and not from dirt. 

Papules

These are small, pink and tender bumps that form when a clogged hair follicle becomes inflamed.

Pustules

These are pus-filled papules, also known as pimples. Pustules usually have a reddened base. 

Nodules

Nodules are bacteria-filled hair follicles that are often hard, large and painful. 

Cysts

Also known as cystic acne, cysts are the most serious type of acne where the infection extends deeper into the skin. 

Unlike facial acne, a proper diagnosis for bacne is important because it is commonly confused with the Steatocystoma multiplex, a benign skin disorder. This inherited condition is completely untreatable with medication or creams and needs surgery or other innovative treatments. 

Bacne can also be due to a condition called pityrosporum folliculitis, otherwise known as fungal acne, that results from an overgrowth of yeast found on our skin. The rulebook for treating fungal acne is also drastically different from conventional bacterial acne treatments. Therefore, consulting a medical professional familiar with these different conditions is essential in preventing your bacne from worsening.

What triggers back acne?

There are many reasons for back acne; knowing why and how they form will go a long way in managing your discomfort better. 

Some common triggers include

Genetics

While there is no gene for acne, genetics can determine how prone you are to developing acne. About 50-90% of acne is due to genetic variation. 

Medication

Acne can develop as a side effect from certain medications, such as antidepressants. 

Hormones

In adults, acne can occur due to hormonal fluctuations. For women, these fluctuations tend to occur during menstruation and pregnancy.

Sweat

Sweat is known to make back acne worse, especially if you often wear tight clothing that prevents air circulation. 

Stress

While stress doesn’t directly cause acne, it can worsen existing acne. Researchers³ have also found that all types of wounds —including acne— recover more slowly under stress. 

How is back acne treated in Singapore?

Although back acne and facial acne are similar in appearance and both stem from  hyperactive sebaceous glands, treatment for back acne requires a more aggressive approach. This is because the skin on our back is thicker and usually more resistant to topicals that can only penetrate so deep.

At home, you can manage back acne by;

Using acne-friendly skincare 

Ditch harsh foaming soaps, abrasive scrubs and astringents. Instead, opt for oil-free and water-based skincare products. 

Using OTC acne products

These include benzoyl peroxide, remember to let it sit on the skin for a few minutes since the back on the skin is thicker. However, OTC acne products only work for mild acne. 

Developing good hygiene habits

• Always remember to shower after sweating (or at the very least, wipe yourself off and change your clothes ASAP)
• Wear loose-fitting workout apparel with sweat-wicking fabric and avoid compression clothing
• If you have long hair, avoid letting conditioner-coated strands sit on your back
• Wash your bedsheets and towels regularly
• Avoid sun exposure

Keep in mind that at-home measures alone produce slow results and are less effective. There might also be a higher chance of scarring that requires more time and cost to treat. Personally, I recommend seeing a medical professional if you really want to treat your back acne, and these at-home tips should be done to COMPLEMENT your in-clinic treatment. 

At the clinic, I usually treat back acne with: 

• AGNES RF, a radiofrequency microneedling treatment that removes acne once and for all by targeting hyperactive sebaceous glands. This is especially suitable for those with stubborn spots that always reoccur at the same areas as AGNES RF can precisely target and treat these compromised follicles without damaging the skin’s epidermis. 
• Combination peels that are more effective than conventional medical peels as they are more aggressive 
• Laser treatment, combination treatment including the use of  long-pulsed Nd:YAG laser and a variety of fractional  lasers. Both are used not just to treat acne but also rejuvenate skin. 
• Topical treatment
• Oral medication 

How to tackle unsightly scars left by untreated bacne?

If left untreated or treated wrongly, bacne can lead to complications like scarring and darkening of the skin. In some cases, the scars can even be pitted or thick. Physical complications aside, I’ve seen the emotional distress that bacne can cause in my patients, especially for ladies who like to bare their backs in sunny Singapore — so don’t wait to seek treatment. 

Thankfully, there are ways to salvage unsightly scars left by bacne. I use a combination of lasers, including the pico laser, pro yellow laser,  and fractional  lasers to holistically treat bacne scars. To find out more on how to treat the different types of acne scars, check out my guide here: Acne Scar Treatment (Singapore) CAN Be 100% Effective. 

Conclusion

To sum up, back acne is a very treatable condition that’s not only overlooked but should be given the same level of care as facial acne. If you’re unsure whether to seek clinical treatment for your back acne, feel free to reach out. 

References

1. Tanghetti, E. A., Kawata, A. K., Daniels, S. R., Yeomans, K., Burk, C. T., & Callender, V. D. (2014). Understanding the burden of adult female acne. The Journal of clinical and aesthetic dermatology, 7(2), 22–30.
2. Dr. Liji Thomas, M. (2021). Genetics of Acne. News-Medical.net. Retrieved 28 October 2021, from https://www.news-medical.net/health/Genetics-of-Acne.aspx.
3. Kiecolt-Glaser, J. K., Marucha, P. T., Malarkey, W. B., Mercado, A. M., & Glaser, R. (1995). Slowing of wound healing by psychological stress. Lancet (London, England), 346(8984), 1194–1196. https://doi.org/10.1016/s0140-6736(95)92899-5