Debunking Acne Myths: Does Back Acne Need to Be Treated?



Myth: Back acne will clear on its own

Patients with back acne may not seek treatment options because they assume it will clear on its own; however, deep painful lesions typically require treatment by a dermatologist. Mild to moderate cases may respond to less aggressive over-the-counter treatments but also may benefit from a combination of topical and systemic antibiotic therapies. According to James Q. Del Rosso, MD, a dermatologist in Las Vegas, Nevada, “Many dermatologists believe that truncal acne vulgaris warrants use of systemic antibiotic therapy, which may not necessarily be the case, especially in patients presenting with mild to moderate acne severity.” Cases of deep inflammatory acne on the back often warrant using systemic therapies such as oral isotretinoin. These severe cases may be less responsive to standard therapies and may require repeated treatment.

Although back acne is not as cosmetically visible as facial acne, it has been associated with sexual and bodily self-consciousness in both males and females. Preliminary data from one study showed that 78% of patients with truncal acne (n=141) on the back and/or chest indicated they were definitely interested in treatment, but truncal acne was not mentioned by these patients without direct inquiry from a physician. As a result, it may be beneficial for dermatologists to ask acne patients about lesions presenting on the back and inform them that treatment options are available.

Treatment application also is a consideration for back acne. Benzoyl peroxide cleanser/wash formulations are convenient, and the foam formulation of clindamycin phosphate allows for easy use due to its spreadability, rapid penetration, and lack of residue and fabric bleaching.

It is important to inform patients that back acne can flare even during active treatment. Patients should be instructed to wear loose-fitting clothes made of cotton or other sweat-wicking fabrics when working out and to shower and change clothes immediately after. Sheets and pillowcases should be changed regularly to avoid exposure to dead skin cells and bacteria, which can exacerbate acne on the back. Backpacks and handbags also can rub against the skin on the back, causing acne to flare. As an alternative, patients should be encouraged to carry handheld bags or bags with shoulder straps to avoid irritation of the skin on the back.

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