Back acne

Despite acne being widely considered as one of the main skin conditions that affects the face, it’s also an extremely common problem for other parts of the body too. The back in particular is often a problem area which can become heavily populated with pimples and spots; however odds are it doesn’t get the same level of attention due to the fact it can easily be concealed with a jumper or a T-shirt instead.

However, the more it is ignored, the worse it gets, so we asked Dr Stefanie Williams, dermatologist, Get The Gloss Expert, founder and Medical Director at European Dermatology London about its causes and how to get rid of back acne - for good.

“Anyone suffering with breakouts needs to be fully assessed and treated by a dermatologist,” recommends Dr Williams. “Not only because acne usually needs some sort of prescription treatment, but also because it might not even be acne you’re suffering with. There are a number of other, very similar looking skin problems including rosacea and perioral dermatitis (POD), which even GPs often mistake for acne,” she cautions.

From the ingredients you should look for in your anti-acne beauty products, to the ones that you should avoid, plus the specialist treatments that you can book in for, here’s what we found out...

GTG: What causes back acne?

SW: Back acne is caused in principal by the same combination of factors as facial acne:

1) Overproduction of keratin (a dead skin material) in the hair follicle (‘pore’), which causes blockage of the hair follicle. Overproduction of sebum (skin oil) in the hair follicle, which can’t reach the skin surface as the follicle is blocked leads to development of comedones (blackheads and whiteheads).

Certain acne bacteria can then grow around that blockage and cause inflammation (i.e. papules and pustules).

2) Hormonal dis-balances (too many male hormones)

3) Certain people simply have a stronger disposition to develop inflammation and acne in certain areas (some people get it more in the face, others on the back).

4) In addition to these, sweating and friction from clothing can also aggravate acne on the back.

5) As with any skin inflammatory skin condition, stress and the wrong type of diet (i.e. high in sugar and processed carbohydrates) can aggravate acne also.

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GTG: What over-the-counter products for acne treatment would you recommend?

SW: Washes and oil-free moisturisers containing salicylic acid and glycolic acid can be helpful. Benzoyl peroxide is also available over-the-counter in certain countries and is very helpful (but in the UK sadly not any longer). Avoid oily and creamy washes and rich moisturisers and emollients.

GTG: What are the prescription products that are available to treat it?

SW: There is a variety of different prescription approaches to treating acne, both topical and oral (systemic).

1) Topical antibacterials: These can be divided into antibiotics such as clindamycin and erythromycin; and non-antibiotic antimicrobials/antibacterials including benzoyl peroxide and azelaic acid. A mixture of both is sometimes used, such as a cream containing clindamycin and benzoyl peroxide. Topical antibacterials are most effective in treating inflammatory acne lesions (red papules and pustules) but don’t work well in comedonal acne. Antibacterials help reduce P. acne bacteria and calm inflammation. They are also great as ‘emergency spot cream,’ helping individual pimples to calm down faster.

To avoid acne bacteria becoming resistant to antibiotics – and many are now resistant to antibiotics such as erythromycin – non-antibiotic antimicrobials such as benzoyl peroxide or azelaic acid can be very useful.

It is also important to know that every single inflammatory spot starts with a blackhead or whitehead. Some may be so small – microcomedones – as to be invisible to the naked eye, yet they were always there before the spot developed. That’s why it’s so very important never to treat spots with antibiotics alone, but to combine them with so-called keratolytic (anti-comedonal) agents that dissolve the keratin plug, which clogs the pore and triggers spot formation.

2) Retinoids and keratolytics: These topical derivatives of vitamin A encourage skin cells to shed, dissolve keratin plugs and so prevent comedones clogging pores.

3) Oral antibiotics: These tablets or capsules work by reducing the number of bacteria in and around the follicle, while reducing the inflammatory response. Oral antibiotics work stronger than topical antibiotics, but like topical antibiotics they are primarily effective in inflammatory acne and not in non-inflammatory blackheads and whiteheads.

4) Isotretinoin: Commonly known by one of its brand names, Roaccutane, isotretinoin is a powerful systemic drug, which targets all of the contributing factors that cause acne. It is also classed as a retinoid and it is a synthetic form of vitamin A.

In order to minimise side-effects such as dry skin and lips, we favour a low-dose approach with isotretinoin in our clinic. Most patients tolerate isotretinoin very well. However, anyone taking it must be reviewed by one of our dermatologists once per month in order to check your progress and make sure your tolerance remains good.

GTG: What are the specialist procedures for back acne that are available at your clinic?

SW: Performed regularly by a specially trained Medical Aesthetician, acne facials are an indispensable tool that work alongside your prescription treatment to help you reach your goal of clear skin, faster.

Every single inflamed spot starts with a comedone. So if we manage to remove this first step in the genesis of a spot, we are effectively starving the acne of its fuel and hastening faster results overall. This is exactly what a good acne facial does – removes comedones, deep-cleanses pores and provides an anti-bacterial action.

Our facials can be performed not only on the face, but also in other problem areas such as the back, shoulders and chest.

Our acne facials begin with deep pore cleansing and gentle exfoliation followed by thorough extraction of comedones, either manually or with a Hydrafacial device. A clarifying and soothing mask is then applied, followed by a lymphatic drainage massage, which detoxifies and de-puffs your skin. High-intensity blue LED light is then used to reduce bacteria and oiliness and calm inflammation. A sunscreen or light moisturiser is then applied.

European Dermatology London, Chelsea Bridge Clinic, Chelsea Bridge Wharf, Riverfront, Ground-Floor, 368 Queenstown Road, London SW8 4NN. Book an appointment by calling 020 7467 8500. www.eudelo.com.

Source: ‘Acne...not just a teenage problem’ by Kate Kerr and Dr Stefanie Williams for European Dermatology London.

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