How to get rid of back and chest acne (body acne): a step-by-step routine

How common is body acne?

Very. The NHS says acne affects the back in more than half of people with acne, and the chest in about 15%. Back skin is thicker than facial skin, which is one reason the American Academy of Dermatology’s advice for the back differs slightly from the face.

Is it acne or fungal acne?

Check this first, because the treatments are different.

	Body acne	Fungal acne (Malassezia folliculitis)
Look	Blackheads, whiteheads and pimples of different sizes	Small (1–2 mm) bumps and pustules, all alike
Feel	Usually not itchy	Often reported itchier than ordinary pimples
Where	Back, chest, shoulders	Upper back, chest, shoulders, also forehead and hairline
Triggers	Friction, sweat, products, hormones	Heat, humidity, sweating, occlusion, antibiotics
Treatment	Benzoyl peroxide, adapalene	Antifungals

Sources: DermNet, Rubenstein & Malerich 2014, AAD.

You can have both at once. If antibiotics made your body acne worse, or the bumps itch, read fungal acne explained.

How do you use benzoyl peroxide wash for back acne?

The American Academy of Dermatology (AAD) recommends a benzoyl peroxide foam or wash:

• Strength: a 5.3% foam is less likely to cause irritation, dryness or peeling. If you need more, 10% is the strongest you can buy without a prescription.
• Contact time: it works best if left on the back for 2 to 5 minutes, which helps it get into thicker back skin. Then rinse.
• How often: daily.

A practical way to fit in the contact time: apply it at the start of your shower, wash your hair and the rest of your body, then rinse it off at the end.

Skin Realist check: a benzoyl peroxide wash that’s rinsed off after five seconds barely has a chance to work. The few minutes of contact time is what makes a body wash worth using.

It bleaches fabric. Rinse well, and switch to white towels, sheets and workout tops while you use it.

Should you add adapalene?

Yes, if benzoyl peroxide alone isn’t enough. The AAD says adapalene 0.1% gel works better alongside benzoyl peroxide by helping unclog pores. Apply it once a day, after showering or before bed.

From the Differin Drug Facts label:

• use it once a day, as a thin layer over the whole affected area
• acne may seem to worsen in the early weeks before it improves, and irritation usually lessens with continued use
• limit sun exposure and use sunscreen outdoors
• it’s for ages 12 and older

Reaching your back is awkward; a clean applicator or a partner helps. Don’t apply it to broken or sunburned skin.

What habits make body acne worse?

Sweat and workout clothes

From the AAD’s back-acne and workout advice:

• Shower and change as soon as possible after sweating.
• Can’t shower? Change out of sweaty clothes and wipe your skin with an oil-free cleansing wipe or salicylic acid pads.
• Wear loose cotton or sweat-wicking clothes, and wash workout clothes after every use.
• Pat, don’t rub, sweat off with a clean towel.
• Wipe down shared gym equipment before use.

Friction from bags and gear

The AAD says anything that rubs your back can make acne flare. It suggests switching from a backpack to a handheld bag, or moving a shoulder strap onto your arm. For sports gear, the AAD’s sports-equipment advice is to put clean, soft padding between equipment and skin. More in maskne and acne mechanica.

Products and scrubbing

• Use oil-free, non-comedogenic sunscreen and body lotions. The AAD recommends a broad-spectrum, water-resistant SPF 30+ sunscreen on uncovered skin, because sun can darken acne marks and make them last longer.
• Skip antibacterial soaps, astringents, abrasive scrubs, loofahs, back brushes and buff puffs (AAD).
• Use gentle, fragrance-free products, and don’t pick or pop spots.

From the labels we’ve checked: CeraVe Renewing SA Cleanser is a fragrance-free salicylic acid wash for face and body if benzoyl peroxide is too drying. CeraVe Daily Moisturizing Lotion is an oil-free, fragrance-free body lotion, and Jack Black Oil-Free Sun Guard is an oil-free SPF 45 described as water and sweat resistant.

• Rinse off conditioner and hair products before washing your back. This is a practical step, not one we found studied, but hair products are a known cause of breakouts where they touch skin.

How long does body acne take to clear?

The AAD says that with effective treatment you may see results in 6 to 8 weeks, and complete clearing can take 3 to 4 months. Keep going even after it improves, or it’s likely to come back.

When should you see a dermatologist?

• Right away for deep, painful acne (nodules or cysts), which can scar
• No difference after 6 to 8 weeks of treatment
• The bumps itch or you think they may be fungal
• Body acne is leaving dark marks or scars

For women whose chest or back acne won’t clear, the AAD notes hormonal therapy may be an option; see hormonal and jawline acne.