Skincare with Friends Ep 79. How to Get Rid of Back, Butt or Chest Acne

Body skincare is something we have sort of neglected . I have such a hard time with the acne on my face, the rest of me has to wait it’s turn, which never comes. My podcast co-host Natalie has struggled with Keratosis pilaris in the past and is presently dealing with chest acne. In this post we are going to go through the best treatments for body acne, whether it’s on your chest, back or butt.

We have had a call for help from a listener who is suffering with back acne and she’s getting married in 10 weeks, this is my recommendation so she can get sorted and healed for the big day. I personally went to the doctor a few weeks before my wedding and got a long course of antibiotics so acne wouldn’t be a problem. My advice for acne sufferers is always go and see a doctor, even for body acne, even if you don’t feel like you deserve medical advice. A doctor can diagnose your skin condition correctly and provide treatment that you won’t be able to get over the counter that is way more likely to work. Don’t f**k about, get help.

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What is Body Acne?

There are a few factors that cause spots- excess oil, skin cells not shedding properly and blocking pores, bacteria and the skin’s own inflammatory process. The Pilosebaceous unit is the structure in the skin that becomes the spot, acne can occur anywhere that pilosebaceous units exist and there are a lot of them on the face, back and chest (that’s why we don’t get spots on our feet). Pilosebaceous unit is the sciencey name for the pore. Each pore has a sebum gland and a hair coming out of it. In acne sufferers the skin cells within the pore are not shed properly and the pore becomes blocked. A bacteria called Cutibacteria Acnes feeds on the hot sebum, multiplies and can create a localised infection in the Pilosebaceous unit aka pore.

There are different types of spots-

• Closed Comedones- these are little under the skin bumps, they have no head or opening
• Open Comedones- blackheads, visible pores filled with a firm dark plug, not inflamed
• Pustules- whiteheads, inflamed with pus just under the skins top layer
• Papules- deeper red spots
• Cysts- very deep, hard, painful bumps

You might have one or many of these types of spots on our body. It will be unsightly and sore. If you are not sure if what you have is actually body acne , it’s worth getting an opinion from a doctor.

Why Do We Get Spots on our Back/Bum/Chest?

You can get acne anywhere you have sebum glands and most of our sebum glands are on our face, chest, back and sometimes the buttocks (you have to say that word using Forrest Gump’s voice).

“A change in the microbiome of the skin may play an important role in the development of inflammatory lesions. Nutrition, protein supplements, clothing, climatic conditions, sweat, hormonal treatments, particularly of testosterone, and mechanical factors have been reported as triggering body acne.”

(Poli et al, 2020)

Androgen hormones have a part to play in acne formation, high testosterone lead to increased sebum production. Trans men often get an issue with back and chest acne as a side effect of their hormone replacement with Testosterone. Supplementing with Whey protein increases something called Insulin Like Growth Factor or IGF-1, which can increase androgen and sebum production and hence acne. Lots of people report their acne improving when they cut out dairy from their diets.

How to Get Rid of Body Acne

I searched for studies about body acne treatment specifically and people aren’t researching body acne as a separate thing. According to the research body acne sufferers aren’t reporting this issues to doctors as regularly as facial acne , even though 50% of acne sufferers also have spots in other parts of their bodies as well as their face (Poli et al, 2020). Studies are few and far between but this is what one review study I found had to say-

“Despite efforts made, successful treatment of truncal acne, especially on the back , remains problematic due to the involvement of a more extensive body surface area, potential difficulties for the patient to apply his/her treatment him/herself, the bleaching of clothing such as Benzoyl Peroxide, as well as treatment costs….As a result, treatment adherence may be a major issue in the management of truncal acne, especially on the back, and oral therapy with antibiotics, zinc gluconate, isotretinoin or spironolactone (in women) currently remains the preferred treatment option. Specific care must be given to prescribe isotretinoin only in severe cases, according to current guidelines.”

Poli et al, 2020

What works for the face should work for the rest of the bod in terms of ingredients. The treatments with great evidence include- Benzoyl Peroxide, Retinoids like Adapalene and Antibiotics like Clindamycin. These are listed in the NICE guidelines which demands the highest evidence before it makes a recommendation. 

Oral Medicines for Body Acne

Systemic drugs (medicines that you swallow) are a good way to target large areas of body acne. Oral treatments include 

• Roaccutane– can only be prescribed under dermatologist supervision, carries risk of liver damage, damage to unborn babies and depression
• Antibiotics like erythromycin, tetracycline and doxycycline- prescription only, usually only work while you are taking them, put you at risk of fungal infection
• Zinc salts like Zinc Gluconate and Zinc Sulphate have some effectiveness against acne, though probably not as much as antibiotics, particularly in women and in older sufferers (Dreno et al, 2001). You need 30mg of elemental Zinc a day, which equates to 200mg Zinc Gluconate.

Most of these things require a visit to the doctor, which I thoroughly recommend doing if you’re worried about anything skin related.

Ingredients to Look Out for

The biggest issues I can see for treating body acne is practicality. You are having to cover a larger area, which is harder to reach and then put clothes on top of it. You’re going to need shit loads more of whatever it is so that teeny 30mls meant for your face is going to last you about 10 minutes. Most prescription acne treatments come in 30ml sizes and this is not great if you need to cover their entire butts or back. So we have to think about what is over the counter. 

We also have to think about how we’re going to get the good skincare onto those hard to reach areas. Dabbing a gel onto your chin is easy enough but to reach the middle of your back, you’re going to want a spray or a body wash.

Here is amazing table which explains the effects that each anti acne ingredient has on acne. Basically different anti acne ingredients do different things, Benzoyl Peroxide kills the bacteria that causes acne, Salicylic and Alpha hydroxy acids unclog the pores, Niacinamide reduces inflammation, Azelaic helps with inflammation, kills bacteria and unclogs pores (check out our post on Azelaic Acid and how great it is). It is a good idea to include ingredients which kill bacteria and unclog with calming anti inflammatory ingredients. 

(Araviiskaia & Dréno, 2016) 

Over the counter ingredients which really work for body acne include Benzoyl Peroxide, Salicylic Acid, Alpha Hydroxy Acids, Niacinamide and Hypochlorous Acid.

I’m very interested in Hypochlorous acid at the moment. I was sent some from Clinisoothe and it literally cured some eczema I was getting on my arms. I had an itchy rash for weeks, actually bleeding and red and awful. I sprayed the stuff on and it was nearly gone the next day after weeks of suffering and moisturising with no improvement.

“a variety of anti-inflammatory and other biologic properties of HOCl have led to applications for wound healing, pruritus (itching), and diabetic ulcers, as well as applications for the management of other inflammatory skin disorders”

(Del Rosso et al, 2018)

You can get Hypochlorous Acid in larger volumes than other ingredients and there is evidence it helps acne and wound healing.

Products That Work for Body Acne

• Sesderma Azelac Lotion E14 for 100ml has Azelaic and Salicylic Acid, they don’t disclose the percentage is the
• Cerave do a Blemish Control Cleanser with 2% Salicylic (which is the highest allowable percentage in an OTC formula) and Niacinamide £10 for 236ml, also an SA Smoothing moisturiser £15.20 for 340g
• Revolution do a Salicylic Wash 1% and Moisturising gel 0.5% £6 for 200ml
• La Roche Posay Effaclar Micro-Peeling Face and Body Cleansing Gel £14.50 for 200ml it has Salicylic Acid (2%), Lipohydroxy Acid (0.05%), Zinc (0.2%) 
• Me+ Salicylic acid Body Gel £7.99 for 250ml 2% Salicylic Acid and Bisabolol
• Clinisoothe Skin Purifier £14.50 for 100ml May help with eczema, psoriasis, dermatitis, rosacea, acne and spots.
• Acnecide Daily Cleanser with Zinc Gluconate £7.50 for 235ml
• Humane and Panoxyl have Benzoyl Peroxide Body Washes and is available in the US. There does seem to be any BP body washes on the UK market. You can get Panoxyl from iHerb £20 for 10% BP 156g or Vitamin.co.uk, but I wouldn’t be able to vouch for those sites.

There are also practical hygiene measures which you might want to think about. There could be something you’re doing or not doing which could be causing or exacerbating the issue.

• You should shower and change clothes soon after exercising
• Try and wear cotton clothing
• Change bed sheets regularly
• Use a non soap cleanser with a pH of 5.5 or less .

I would be tempted to try a Salicylic Acid body wash first to try and treat body acne, mainly because it’s easy get hold of and there is some evidence it could work. A 12-week, double-blind, randomized study by Shalita et al evaluated the response of mild-to-moderate acne with use of Stridex® pads (0.5% salicylic acid, Blistex, Oak Brook, Illinois) twice daily as compared to patients using vehicle pads twice daily, both applied twice a day for 12 weeks. The actively treated group demonstrated greater reduction of both inflammatory lesions and open comedones. (Shalita, 1981)

References

Araviiskaia, E., & Dréno, B. (2016). The role of topical dermocosmetics in acne vulgaris. Journal of the European Academy of Dermatology and Venereology, 30(6), 926-935.

Del Rosso JQ, Stein-Gold L, Lynde C, Tanghetti E, Alexis AF. Truncal Acne: A Neglected Entity. J Drugs Dermatol. 2019 Dec 1;18(12):205-1208. PMID: 31859617.

Del Rosso JQ, Bhatia N. Status Report on Topical Hypochlorous Acid: Clinical Relevance of Specific Formulations, Potential Modes of Action, and Study Outcomes. J Clin Aesthet Dermatol. 2018 Nov;11(11):36-39. 

Dreno B, Moyse D, Alirezai M, Amblard P, Auffret N, Beylot C, Bodokh I, Chivot M, Daniel F, Humbert P, Meynadier J, Poli F; Acne Research and Study Group. Multicenter randomized comparative double-blind controlled clinical trial of the safety and efficacy of zinc gluconate versus minocycline hydrochloride in the treatment of inflammatory acne vulgaris. Dermatology. 2001;203(2):135-40. doi: 10.1159/000051728. PMID: 11586012.

Poli F, Auffret N, Leccia MT, Claudel JP, Dréno B. Truncal acne, what do we know? J Eur Acad Dermatol Venereol. 2020 Oct;34(10):2241-2246. doi: 10.1111/jdv.16634. Epub 2020 Jun 8. PMID: 32421879.

Shalita AR. Treatment of mild and moderate acne vulgaris with salicylic acid in an alcohol-detergent vehicle. Cutis. 1981;28:556–561