An estimated 80 percent of all people ages 11 to 30 have acne outbreaks at some point, and about two-thirds of people suffering from acne will also have it on their backs, the National Institutes of Health (NIH) reports. Back acne is the same disease as facial acne, but because the sebaceous glands on the back are bigger and produce more oil than on the face, lesions and cysts can be larger and more severe. The condition is more common in men than in women.
When male sex hormones called androgens cause excess oil production in the pores of men and women, the oil doesn't flow evenly and backs up. The oil then combines with dead skin cells in the pore lining to clog the pores, paving the way for a bacteria called "propionibacterium acnes" that causes inflammation and pimples. Areas of the back suffer from another form of acne called "acne mechanica," which is caused by irritation of the skin when something repeatedly rubs it, such as backpacks, tight clothing or sports gear.
Chocolate and greasy foods have been blamed as causes of acne, but there is little evidence to support this. The same applies to dirty skin and stress; they don't cause acne, but they may make it worse, the NIH says.
Prescription treatments for back acne include retinoid topical creams such as tretinoin, adapalene and tazarotene, all of which are well-studied and have proved effective. Oral antibiotics are sometimes prescribed, but studies reported in a 2003 edition of "Dermatology" found that acne-causing bacteria can become immune to the antibiotic after a short period of time, causing the acne to return. Lasers and light therapy have been tested as treatments but thus far have proved only mildly to moderately effective. The Derma Network reports that newer treatments such as radiofrequency energy, chemical peels and microdermabrasion show promise. If all else fails, it may be necessary to try hormone blockers or birth control pills designed to reduce acne.
Avoid using cleansers such as soaps that contain pore-clogging ingredients and make the situation worse. Instead, use a gentle, water-soluble cleanser and a loofah sponge or back brush, followed by a topical disinfectant with a 5 percent solution of either benzoyl peroxide or tea tree oil. Another option is to use an exfoliating product containing a 1 percent to 2 percent beta hydroxy acid (BHA) product or one with 8 percent alpha hydroxy acid (AHA). BHA is usually preferred over AHA because it cuts through the oil better, according to a study in the October 2001 issue of "Cosmetic Dermatology."
Wear clean clothing made from natural fibers such as cotton or those designed to wick moisture away from the skin, which is especially important when you exercise. Use powder to keep your back dry, or try using an antiperspirant on your back (although to avoid overheating, avoid this if you'll be sweating). Shower immediately after a workout or perspiring to get rid of dirt and bacteria, and stop carrying a backpack until the acne clears. If you have oily hair, shampoo it every day.