Acne below the belt

Dear Alice,

For a number of years I have had acne from waist down. I can't find any information on it except for acne of the face and back. I'm embarrassed to wear shorts in the summer. Any suggestions?

Dear Reader,

If pimples on the back are "backne," might this be dubbed… "legne?" Acne on the body is actually triggered by the same factors that cause acne on the face, which, contrary to popular belief, aren't chocolate or greasy foods. Acne is largely the result of an interaction between hormones, oil glands, hair follicles, and pores. 

Outbreaks occur most commonly on the face and neck but can also appear on the back, chest, shoulders, or below the waist. People can develop acne for a variety of reasons. Fluctuation in hormone levels is a common culprit, especially during puberty or before a person's menstrual period. Acne can also develop due to genetics, cosmetic products, allergies or sensitivities, environmental pollutants, harsh scrubbing of the skin, tight clothing, and stress.

While the bumps on your legs may appear similar to acne, they could also be due to another condition, but only a health care provider can tell for sure. Other common types of marks that may appear on the legs include keratosis pilaris, a harmless build up of keratin that blocks hair follicles, causing dry skin and small bumps. Keratosis pilaris can be treated by a dermatologist, usually with medicated creams, and while it can't be cured, it usually goes away on its own. Folliculitis, which is an inflammation of hair follicles, is also common on the legs. Folliculitis creates groups of red or white-headed bumps on the skin, which usually resolves naturally after a few days. More severe folliculitis can even cause the skin to burn or produce blisters and may require medical treatment. Another skin condition that can affect the legs is atopic dermatitis (commonly called eczema), a genetic skin condition that can cause outbreaks of very dry, itchy, and red skin. Symptoms can sometimes include raised bumps or skin with a scaly or cracked appearance. Eczema can be treated with medicated creams or ointments, and treatment is recommended to be paired with mild, non-irritating skin products. Finally, allergies can cause hives, raised oval bumps on the skin that result from a reaction to anything from foods or medications to environmental factors or products. A health care provider can help diagnose allergy triggers, so they can be avoided and also provide treatment. 

If the outbreak is indeed acne, it may be comforting to hear that acne isn't usually high-risk. That being said, it can be a real source of discomfort, both physically and emotionally. Some things you can do to reduce body-acne outbreaks are:

  • Cleanse gently. Body cleansers, creams, lotions, and laundry detergents with strong soaps, dyes, "anti-acne" agents such as alcohol or acids, or perfumes may irritate skin and make acne worse. Use mild soap and warm water (not too hot). Scrubbing rigorously with a washcloth or loofah can also irritate skin and make acne worse.
  • Use clean hot tubs and pools. This will prevent bacteria from infecting the skin, which can cause acne or other skin conditions. 
  • Use mild skin-care products and makeup. Look for the word hypoallergenic (won't cause allergies) and non-comedogenic (won't clog pores) in the products you buy.
  • Determine if shaving is causing irritation. Shaving itself, or shaving cream, could be causing acne. Showering and shaving gently may help prevent irritation.  
  • Consider acne medication. Anti-acne medications, both over-the-counter and prescription, may work wonders for your skin. However, some people find acne relief simply from treating their sensitive skin gently (such as using mild cleansers, mild lotions, and wearing clothing with natural fibers).
  • Loose, natural fabrics may be less irritating to your skin, since tight clothes can trap sweat and cause keratin to build up.
  • Epsom salt baths may help slough off dead skin and soothe acne sores.
  • Check in with your stress level. Are you coping effectively with both day-to-day and out-of-the-ordinary stressors? Is your acne worse during certain times?
  • Protect your skin from the sun. Sun exposure can damage the skin and exacerbate acne and scarring.

In some cases, a health care provider may prescribe medications such as antibiotics to impede growth of bacteria and reduce inflammation, vitamin A derivatives or retinoids to clear out follicles, or prescription-strength benzoyl peroxide. You may consider talking to your health care provider to formally diagnose your condition and discuss treatment options. 

Even though the skin on your legs may not be blemish-free, it might help to remember that many people's skin isn't either. It might also be freeing to wear shorts even if you have some hang-ups about the state for your skin. Airing out those legs in summer may improve the condition, and you may find that some sunshine and the feel of warm breezes on your legs make whatever blemishes you have fade into the background. 

Last updated Feb 25, 2022
Originally published Oct 30, 2009

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