Meanwhile, fluctuating hormone levels can be a contributing factor to bacne flareups. “The most common pattern is for a flare to happen seven to 10 days before the onset of [menstrual] bleeding and subside once bleeding starts,” Hadley King, M.D.9, clinical instructor of dermatology at the Weill Medical College of Cornell University in New York, tells SELF. This is because there’s a mid-cycle rise in progesterone that stimulates the production of sebum. Androgens (typically referred to as “male” hormones) like testosterone also stimulate sebum production during this time. The potential result? Oily skin, clogged pores and a new round of bacne10.
You might notice bacne flareups during other hormonal changes too (think: during or after pregnancy or during perimenopause and menopause). Hormone-related conditions, such as polycystic ovary syndrome, can also spur bacne thanks to the intense hormonal shifts it can cause.
How your particular genetic makeup and hormones interact with other aspects of your lifestyle adds an additional layer of potential back acne causes. If stress is an ongoing problem for you, for instance, this could be one of the reasons why bacne is too—the body produces more androgens in response to stress, which peer pressures oil glands to kick into high gear7.
Excessive sweating is another common bacne precursor—say, from work. King out or living in a warm climate. “When sweat sits on the skin for an extended period of time, it can lead to clogged pores,” Dr. Garshick says. Add to the mix tight athletic clothing causing friction as you exercise (and trapping heat and sweat against your skin in the process), and you’ve got a perfect storm for bacne breakouts4.
An uptick in back acne can also be a side effect of certain medications, including drugs that contain corticosteroids, testosterone, or lithium, according to the Mayo Clinic.
Though research is still shaky on the subject, there’s a chance your bacne breakouts could be linked to certain aspects of your diet as well. Studies suggest that foods with a high glycemic index (white bread, white potatoes, pastries, white rice, milkshakes) may be prominent acne triggers. “This is probably because of the blood sugar spike that results and how this affects our insulin levels and other hormones,” Dr. King says. Ditto dairy, she adds: “Milk and dairy products may promote insulin secretion and the production of hormones, such as IGF-111, which is known to be a major contributor to acne development12.”
How many types of acne are there?
There are several types of acne that can become a series regular on your back. And it’s helpful to understand what type you have so you can better treat your acne. Read on to learn how to recognize each type of bacne you might experience.
Also known as closed comedones, whitehead pimples strike when pores become clogged with excess oil, bacteria, and dead skin cells. “Just as they do on other areas of the body, whiteheads present on the back as a closed pore with a raised white or skin-colored tip on them13,” Deanne Robinson, M.D.14, assistant clinical professor of dermatology at Yale University of Medicine in New Haven, Connecticut, tells SELF.
Like whiteheads, blackheads (or open comedones) are a result of clogged pores. But unlike whiteheads, “there’s an opening that exposes the oil and dead skin cells trapped within the pore to the air, causing the buildup to oxidize and turn a dark color13,” Dr. Garshick says. (Both whiteheads and blackheads are non-inflammatory forms of acne, Dr. Robinson says, which means you may not know they’re even on your back unless someone else sees them.)
This type of acne is what most people refer to as pimples. “Papules occur when excess oil, dead skin cells, and bacteria become trapped deeper into the skin and lead to inflammation (redness and swelling),” Jacquelyn Sink, M.D.15, board-certified dermatologist at Northwestern Medicine Central DuPage Hospital in Winfield, Illinois, tells SELF. “They manifest as small, firm bumps13.” Depending on your skin color, papules can be red, brown, or other hues.
These zits present much in the same way as papules, but are larger in size and contain a yellow- or white-ish fluid. “Pustules typically appear as a bump that may have a central pus bump,” Dr. Garshick says. “Not only can these be present in acne, but in various types of folliculitis (inflammation of the hair follicle)13.”
A highly inflamed form of acne, nodular acne are deeper, firmer bumps located underneath the skin. “Nodules may appear skin-colored or red, depending on how inflamed they are, and may be associated with tenderness to the touch,” Dr. Garshick says. They tend to be larger than papules and pustules and require treatment by a dermatologist to prevent longterm scarring13.
Cystic acne involves larger, more painful lumps underneath the skin caused by deep-seated inflammation. Because they’re filled with pus, cysts tend to be softer than nodules and may be associated with redness or inflammation, Dr. Garshick says. They may drain or have an overlying crust and can cause scars when they heal.