Bacne Scars Were Ruining My Life & Wardrobe — Until I Tried This Treatment
I’m a 32-year-old with 18-year-old skin issues.
For as long as I can remember, I have suffered from acne. I use the word “suffer” pointedly, because it truly has felt like an impediment on my life at times. My period arrived early — at nine-years-old, the morning before a trip to a waterpark with my summer camp group. I remember feeling like things couldn’t get any worse as I cried in the bathroom, totally gutted over the fact that my swimsuit would be staying home. Little did I know what was waiting for me — hormonal acne that spread across my chin and cheeks on a 25-day cycle. It wasn’t until I was older that the back acne (and subsequent scars) started cropping up.
Acne dotted across my back and shoulders, creating hard, painful cysts that were sometimes tender when I bumped them. In the summer, I’d do my best to hide my bacne, refusing to wear skimpy tanks and scorching my skin in the sun to try to clear up the bumps. And whenever I’d get naked with a new partner, I’d reach for the lamp on the nightstand, afraid that they’d spot my pimple-littered back and run for the hills.
Frankly, this whole act was exhausting. And it seemed like nothing I did would clear up the bumps. I tried a round of Doxycyline to clear up my facial acne, which worked, but it did nothing to fix the zits on my back. The charcoal masks, the salicylic acid washes, the tea tree oil spritzes — nothing seemed to do anything to help. In short, I have been in hell. Puss-laden, scar-filled, cystic hell. Just around my 32nd birthday, though, I decided to finally do something about it.
“Any body part that has oil-secreting glands or hair follicles, including your back, chest, and shoulders, may suffer from acne.” - Dr. Macrene Alexiades
How Is Back Acne Different Than Face Acne?
Although the acne on my back has started to wane as I’ve gotten older, I still get regular breakouts on my shoulders and down my back. And although they aren’t in the quantity that they have been in the past, they’ve left behind scars that can sometimes look worse than the zits themselves.
So I made an appointment with triple board-certified dermatologist Dr. Macrene Alexiades, MD, PhD, and founder of Macrene Actives, to finally get things under control. Turns out, my struggles weren’t all that unique. “While the face is the most common site for acne, it is common on the chest and back,” she says. “Any body part that has oil-secreting glands or hair follicles, including your back, chest, and shoulders, may suffer from acne.”
She notes that studies have shown that the prevalence of acne on the back among acne sufferers is 60%. What’s more? “Back acne tends to be more severe,” Dr. Alexiades says, which explains why I sometimes get cysts on my back but have never dealt with them on my face.
Back acne is, however, different from the breakouts you get on your face. “Back skin is twice as thick than the skin on the face, necessitating stronger treatments,” Dr. Alexiades says. “The cysts are larger and deeper, causing intractable scars, which can be deeper, wider, and more discolored than scars on your face. They can be firm and difficult to treat.”
What Causes Back Acne?
When she first took a look at my chart, Dr. Alexiades immediately noted the birth control pill I was on. Because I suffer from migraines with aura (meaning sensory disturbances), my doctors have encouraged me to avoid combination pills or any birth control that uses estrogen. So I take the mini pill, or the progesterone-only pill, which keeps me from having children but is no friend to my acne woes.
“Progesterone-only pills can actually make acne worse,” she told me. But because of my health issues, and the fact that my boyfriend and I don’t want children quite yet, getting off the pill was a non-starter. But Dr. Alexiades told me that this wouldn’t be an impediment to my healing, as my breakouts started long before I was on the pill, and were likely attributed to many factors.
“Back acne is the result of an accumulation of oil within the pores of the skin, combined with an overgrowth of bacteria,” Dr. Alexiades says. Different types of bacteria can cause the acne, including Cutibacerium acnes, which is what triggered the inflammatory response. Some back acne, however, can be the result of folliculitis caused by other bacterias — and these flares can be harder to treat. But for the most part, “the main cause of acne, including back acne, is hormones,” she adds.
How Can You Treat Back Acne & Scarring?
Before we could even discuss how to deal with the scarring, Dr. Alexiades needed to clear my acne first. So she put me on a regiment of spironolactone (a blood pressure medication that, off-label, can be used as an androgen blocker to minimize breakouts). I was tasked with taking one 25mg pill twice a day for a month.
Spironolactone works to block androgen hormones, specifically testosterone, which cause the skin to produce too much oil. That, in turn, clogs the pores and causes acne. So I was, in effect, balancing out the hormones that my progesterone-only pill has helped throw out of whack. Dr. Alexiades also put me on a topical prescription retin-A that I had to apply a few times a week.
In addition to the pills and prescriptions, I also started using a few topical treatments from body care brand Soft Services. I used the Clearing Clay Multi-Use Breakout Treatment twice a week in the shower, massaging it into my skin for a minute before rinsing it off. The solution uses 10% sulfur, which helps to heal zits already-in-progress and fade scarring. On the days when my breakouts were truly heinous, I reached for the brand’s Clearing Mist, which uses 1% salicylic acid.
After a week of treatment, I started to see results. I no longer had intense cysts, and the smaller zits on my back and shoulders began to clear up. But the craziest thing was the scarring. I didn’t expect it to clear from this regimen alone, but little by little, the shiny, purple marks that used to dot my back began to disappear.
When I went to Dr. Alexiades for my follow-up appointment she was shocked. “We hit a home run!” she told me. While we’d discussed lasers as part of my treatment, she decided, in the end, that I didn’t need them. But they can be effective in treating more stubborn scarring, specifically a new laser called Aviclear. [Ed note: Dr. Alexiades is the lead author on the upcoming publication regarding Aviclear’s FDA approval.]
“Aviclear is a 1726 nm device that actually destroys sebaceous glands with an Accutane-like effect, with the added benefit of scarless wound healing,” she says. “What is most impressive is that the cysts heal without scarring, and the device appears to remove acne scars while it treats.” Other treatments for scars include fillers for indented scars and fractional laser resurfacing.
These treatments may be in my future, but for the moment, I’m enjoying the slow and steady route of my acne-clearing journey. For the first time in my life, I’m looking forward to my skimpy tank tops this summer. And I’m no longer reaching for the nightstand light — and that, in and of itself, feels like a blessing.
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