What is ‘bacne’ and how do I get rid of it?

‘Bacne’, as the name suggests, is a type of acne that occurs on your back.

Acne affects almost 10% of the global population. Truncal acne, or ‘bacne’, is estimated to affect around 50% of acne sufferers.

It is more common in men than in women. One study compared back acne prevalence and found that 54% of men had it compared to 43% of women. You’re more likely to have back acne if you have severe facial acne.

Back acne affects 54% of men.

Acne mainly occurs in teenagers and adolescents due to hormonal changes during puberty. For most, symptoms fade in your mid to late 20s. However, some people continue to have bacne symptoms into their 30s.

Acne forms when the pores in your skin become clogged. Excess oil (sebum), dead skin cells, and bacteria clog the pores which lead to inflammation.

Bacne can also be caused by fungus. Certain factors can lead to an overgrowth of yeast in the skin’s microbiome. This can cause an infection in the hair follicles, which leads to a specific type of fungal acne.

Other factors can trigger acne breakouts or mean you are more likely to get bacne.

Hormonal changes

Hormones are one of the main causes of acne. Male hormones (androgens) like testosterone influence sebum production which can trigger acne breakouts.

Several factors can cause hormonal changes.

	Puberty is the process where children’s bodies change as they become an adult. These physical changes are caused by your body starting to release sex hormones like oestrogen and testosterone. This sudden increase in testosterone can cause acne to develop.
	During pregnancy, you have higher levels of androgens. They are responsible for the baby’s organ development. Higher levels may cause acne, especially during the first trimester.
	Some women experience breakouts 2 weeks before their period starts. Your testosterone levels stay stable throughout your menstrual cycle. However, your oestrogen and progesterone levels dip which causes an imbalance. This can lead to period acne.

Conditions that cause hormone imbalances like polycystic ovary syndrome (PCOS) can cause acne. Studies show that women with PCOS who have other symptoms (e.g. irregular periods or hirsutism) are more likely to have truncal acne.

Genetics

Your genetics can also play a role in truncal acne. No one gene says you will have acne. However, if one or both of your parents had severe acne, likely, you will too.

One study found that there are multiple genes responsible for acne triggers. These include sebum production and inflammation. However, there is no specific gene that dictates where the acne will occur.

Like facial acne, back acne is characterised by spots and oily skin. Back acne can cause all the same types of spots as facial acne.

The image slideshow below shows different cases of truncal acne and acne scarring.

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Spots usually occur on the upper back and shoulders because that is where the most sebum-producing glands are. However, symptoms can occur lower down or across the back.

Scarring is more common with truncal acne, especially if you have nodules or cysts. When these lesions heal, they burst and damage the surrounding skin. This can cause holes, dark red scar tissue and uneven skin.

While the cause of back acne is the same as facial acne, there are additional factors that can worsen and trigger back acne breakouts.

Sweating

Excessive sweating can cause breakouts. If sweat sits on the skin too long, it can clog your pores. This is particularly true for ‘bacne’.

In hot climates or during exercise, tight clothes can trap sweat and cause friction. This traps heat and sweat, which is a risk factor for back acne. It can also encourage bacterial growth.

Diet

There is some evidence that your diet can trigger back acne.

Some research has shown that sugary foods can trigger breakouts. This includes white bread, potatoes, pastries and white rice. As well as sugary foods, later research shows that fatty foods and animal products can also cause ‘bacne’ symptoms.

It is believed that they cause a blood sugar spike, which affects certain hormone levels. These hormones can trigger androgen production and result in back acne.

Stress

Another factor in ‘bacne’ breakouts is stress. Stress causes the release of certain hormones. Studies have found that several hormones, including a critical stress hormone called CRH, are linked to acne lesions.

Lifestyle changes can help prevent and manage your back acne. It will also help prevent acne scarring if your acne is severe.

• keep your skin clean and dry - this prevents sweat from staying on your body and bacteria from growing
• wear loose and breathable workout clothes - it will prevent sweat from accumulating on your skin and causing breakouts
• wash your bedding and towels frequently - oil and residue from hair and skincare can eventually transfer back to your skin
• avoid popping pimples - it can cause inflammation, increase the risk of infection and result in scarring
• wash your hair first when showering - oil from haircare products can trigger breakouts, so washing your hair first means you reduce the risk of any products sitting on your skin
• use a gentle body wash - some body washes have chemicals or irritants that can cause breakouts
• keep a food diary - you can track the severity of your symptoms over a few weeks and see if there are any patterns with your diet

You should also have a good skincare regime.

1. Cleanser - use a gentle, oil-free cleanser to remove any bacteria and sweat.
2. Exfoliator - helps to unclog your pores and push new, healthy skin cells to the surface. It is available as chemical exfoliators (e.g. salicylic acid or glycolic acid) or physical scrubbers. Excessive exfoliation, however, overly strips oil from the skin.
3. Moisturiser - acne products can dry out your skin, so moisturising will help keep your skin healthy.
4. Sun cream - if your back is exposed to the sun, it can cause skin damage and darken your blemishes. Wear sun cream with an SPF of at least 30.

While these factors won’t cure your acne, they will improve and help to prevent breakouts.

If you have any symptoms of truncal acne, you should go to your GP. It’s usually a sign of more severe acne.

There are many acne treatments available over the counter and on prescription for ‘bacne’. What treatment you need will depend on the severity of your symptoms.

Mild to moderate back acne

If you have a few whiteheads, blackheads or spots on your back, you may only need over-the-counter acne medications.

Benzoyl peroxide is available as a cream or gel in most pharmacies. It works by killing and preventing the growth of acne bacteria. It also helps to unclog pores.

You should see your GP for your back acne. They can prescribe stronger treatments, such as:

• Antibiotic tablets or gels/creams (e.g. lymecycline, doxycycline or oxytetracycline) - antibiotics will help to fight the acne bacteria, reducing symptoms.
• Azelaic acid - reduces inflammation and bacterial growth.
• Retinoids (e.g. Differin) - speed up the skin’s natural exfoliation process, which helps to unclog pores and promote healthy skin growth.
• Combined contraceptive pill (e.g. Dianette) - treats hormonal imbalances in those with hormonal acne.

Some treatments will have a combination of acne medicines. For instance, Duac contains both an antibiotic (clindamycin) and benzoyl peroxide. Similarly, Epiduo contains benzoyl peroxide and adapalene.

First-line treatment for acne is an oral antibiotic and a topical cream.

Most treatments should start to work after 2-3 months. If you are not noticing a difference in your symptoms, you may need more specialist treatment.

Severe back acne

You may have to be referred to a dermatologist if you have:

• a large number of papules and pustules on your back, chest and face
• painful nodules
• scarring or risk of scarring

One common treatment for severe body acne is isotretinoin (Roaccutane). It works in several ways. It reduces bacteria, normalises sebum production and prevents hair follicles from becoming clogged.

People take it for 4-6 months. It causes a lot of side effects and has a high risk of birth defects if a woman falls pregnant on it. So, it is reserved for severe acne cases.

There are specific treatment options available for treating acne scarring.

• Dermabrasion - involves removing the top layer of skin with a specially-made brush or laser.
• Laser treatment - depending on the type, lasers are used to remove affected areas of skin or promote collagen growth.
• Punch techniques - where acne patches are surgically removed and the skin is evened out.
• Subcision - involves removing the top layer of skin and allowing blood to pool and even out the skin.

These treatments are not usually available on the NHS or health insurance as they are classified as cosmetic surgeries.