''Backne'' (Acne on my back)

Originally Published: March 12, 2004
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Dear Alice,

I have very smooth, soft skin on my face, but my back is the total opposite. First of all, it is very uneven in its color and I get large pimples on it that can't be burst, and they sometimes hurt without any interference from me. I also have large pores on my back. What is wrong with my back's skin and what can I do to bring it back to its original state?

Dear Reader,

To start with, hands off. Popping pimples is never the way to go — especially pimples as painful as yours seem — since it can lead to infection or long-term scarring. And despite what the photo retouchers at Men's Health, Cosmo, and the like might have you believe, "backne" (acne on one's back) is a common affliction. Acne results from an overproduction of sebum (oil) from the sebaceous glands. Just as the face, chest, arms, and back are particular hot spots for sebaceous glands, so, too, are they particular hot spots for acne. Within acne, there are two different genres: non-inflammatory and inflammatory. Non-inflammatory acne includes blackheads and whiteheads and is often the less visible type of acne. Inflammatory acne, on the other hand, includes pimples, red pustules, and larger lesions that are formed when sebaceous glands flare up.

You describe large painful pimples that cannot be burst and that hurt even when they are not touched. It is possible that what you are experiencing could be cystic acne, a more serious type of inflammatory acne. It is important that you meet with a dermatologist, who will better be able to diagnose whether or not what you describe is indeed cystic acne, or another condition. If it is the case that you are experiencing cystic acne, you can discuss treatment options with him/her, as well.

Treatment for cystic acne differs from other acne treatments since it is often more severe than a scrub of a little white pad can manage. Cystic acne is usually caused in much the same way as regular acne: an overproduction of sebum leads to a rupture, which begins to house bacteria, causing an inflammatory reaction. However, while regular acne treatments might combat only one of these causes, treatment of cystic acne will often attack from multiple angles. Your provider might suggest antibiotics to tackle the bacteria causing the inflammation. Also, if the bumps are enlarged and swollen, s/he might consider using cortisone shots that work to remove the swelling. Oral or topical retinoids, vitamin A derivatives that help to open clogged pores might also be suggested, though their side effects can sometimes be more problematic than the acne itself.

As you are clearly concerned about the state of your back and its accompanying discomfort, it makes sense that your next step is to get a referral from your primary care provider to have your "backne" examined by a dermatologist.

Alice