Dealing with zits on your face is one thing—but back acne (aka bacne) is another level of annoying. At least when you're wrestling with an angry blemish in your T-zone you can see what you're doing. Not so when pimples pop up on your back. It's hard enough just getting soap back there—applying zit cream between your shoulder blades is like a pulled muscle waiting to happen. And it might not work anyway, because the skin on your back doesn't respond as well to many of the acne treatments you use on your face.
Here, dermatologists explain the difference between acne and bacne, and how to get acne off your back for good.
Though acne and bacne are caused by the same things, you need to treat them differently.
"Acne is caused by increased oil production, bacteria, pore blockage, and irregular skin cell turnover," board-certified dermatologist Eric Meinhardt, M.D., tells SELF, and that goes for your face and your back. Sebaceous glands in the skin produce oil, which can collect along with dead skin cells in the pores, plugging them up and giving bacteria a perfect breeding ground, all of which can lead to redness, whiteheads, blackheads, and sometimes infection. Hormones can play a large role, which is why you might break out more around your period, for instance. And if you've noticed that your breakouts pop up in similar places as other family members, that could be acne's genetic components at work, Meinhardt says.
More From SELF
While the root causes of zits are basically the same in both places, the skin on your face is very different from the skin on your back, which has its upsides and downsides. The skin on the face has more blood supply, Meinhardt says, which helps acne heal faster and reduces scarring. But the skin on the back is much thicker than the skin on the face (specifically the second layer, called the dermis). That means that the back is more resilient, and can handle stronger treatments, scrubs, and exfoliants that would be considered too harsh for the face.
The ingredients doctors most commonly recommend for body acne are generally the same as what you'd use on your face, but the products themselves are usually stronger.
"Salicylic acid is attracted to the oil in the sebaceous glands; and once there, it helps to loosen the sticky cells and oil to clear clogged hair follicles," Heidi Waldorf, M.D., the director of laser and cosmetic dermatology at the Mount Sinai Hospital, tells SELF. Benzoyl peroxide is a topical antibiotic that will work to kill bacteria and clean pores. Salicylic acid and benzoyl peroxide products with concentrations over 2 percent can dry out the skin on the face. But since the skin on the back is a bit thicker and less sensitive, you can reach for formulas with higher percentages. (Meinhardt points out that any benzoyl peroxide above 5 percent is unnecessary; it's no more effective but causes more side effects.)
Because bacne tends to cover a large swath of skin—and because it's harder to reach your back to apply spot treatments—many products will come in the form of body washes and face scrubs that you can put on in the shower. Meinhardt is a fan of the Neutrogena Clear Pore line to treat back acne. The cleanser has 3.5 percent benzoyl peroxide and the scrub has 3.7 percent. If you prefer a salicylic acid cleanser for your back, try Dial Acne Control Deep Cleansing Body Wash ($7; Walmart.com). Meinhardt recommends leaving these cleansers on for a few minutes before washing them off to give the products time to truly treat the acne.
In addition to the usual suspects, board-certified dermatologist Debbie Palmer, D.O., recommends trying products with retinol, which helps loosen up dead skin cells and regulate cell turnover. “Retinoids not only treat the acne you have today, they also change the way the cells turn over, reducing your development of acne tomorrow,” Waldorf says. She likes Differin gel ($13; target.com), which used to require a prescription. (Retin-A, a form of vitamin A, still does.) "Differin can also be applied at the same time as a benzoyl peroxide, so you can get the anti-blockage and antibiotic effects," she adds. To make sure you don't miss a spot when applying topical creams and gels, Waldorf recommends using an applicator like the L'applique ($7; lapplique.com) to help you reach those hard-to-get-to areas.
Sulfur is another lesser known ingredient that works by killing acne-causing bacteria. Reach for a cleanser with the active ingredient—like the Dermissa Sulfur Facial Bar ($3; walgreens.com)—rather than creams, many of which can have a rotten egg smell.
Bacne scars can be worse than acne scars on the face.
Pimples on the back are more likely to scar than those on the face. “The face will theoretically heal better because it has better skin cell turnover, more healing potential, and better blood supply,” Meinhardt says. What's more, she says, the back is more prone to getting keloids, which are raised, overgrown scars. Antioxidant-rich formulas are key to getting the redness left behind to fade quickly—and it's important to start treatment right away. "When scars have healed but are still red or pink, I recommend using topical antioxidants twice daily," Palmer says. That goes for the face and back. Her favorite antioxidant for bacne is vitamin C, and she recommends Replere Protect & Rejuvenate Day Lotion ($90; replere.com) to her patients. Remember to apply morning and night, and you'll be ready to rock that backless dress in no time.
When it comes to prevention, here are some pro tips—and rookie mistakes to avoid.
Just like on your face, there are bad habits that can lead to breakouts on your back. You wash your face when it gets dirty and sweaty, right? For the same reason, you'll want to change out of your sports bra soon after a workout, so that the sweaty clothing against your back doesn’t become a breeding ground for bacteria. In general wearing tight clothing with body-hugging fabrics can trap natural oils and shedding skin in pores, which can lead to breakouts. If you're prone to bacne, you might want to avoid tight fitting fabrics, and instead opt for breathable materials that wick moisture and keep your skin as dry as possible.
Perhaps surprisingly, the way you wash your hair can have an impact on bacne. While the oils in hair treatments might be good for nourishing your strands, they can be bad news for the skin on your back. That's why Palmer says that you should rinse conditioner off to the side instead of letting it run down your back. Also, try waiting until you've completed all of your hair treatments before washing your body. That way you can wash off any oily residue, clearing the way for your acne treatments to do their thing.