In the DermTV episode entitled “Acne Treatment in Three Easy Steps”, I discussed what I’ll call “regular” or “facial” acne. But what happens if your blemishes are mostly on your back? We call that “bacne”, and its treatment requires slightly different measures because of where it is and what it is. It doesn’t matter where your acne is, it’s caused by the same thing wherever it occurs. But, the skin of the back is a little bit different. First of all, because of where it is, you can’t see the blemishes and it’s very different for you to put the topical medications on them because you just can’t reach them…unless of course you have a significant other or a very good friend. For that reason, when we treat acne, we are more inclined to use internal medications earlier on to help get the medication to all of those blemishes that are hard to get to, so especially we tend to use antibiotics. Also, topical medications can be prescribed in pad form, and with a pad, it’s just a little bit easier to reach all of those difficult to get to places. Second, the skin of the back is much thicker, it’s also a little tougher and because it’s thicker that means that the blemishes are a little bit deeper so it’s harder to get topical medications to them. As a result, we use higher strength medicines, so salicylic may be 2% instead of 1%, and glycolics may be 10% instead of 5%, but we want to use stronger medications so we can try to penetrate deeper. Again, for deeper penetration, earlier on, again, we go to internal medications to try to reach those hard to get to blemishes. The flip side of thicker and tougher though is that the skin is better able to withstand stronger medications without getting irritated. And third, rubbing is involved much more on the back than it is on the face and anytime you rub acne prone skin you’re going to push debris and dirt into the pores and you’re going to thicken the skin, both of which contribute to acne breakouts. So with “bacne”, make sure you’re wearing lighter fabrics and looser fitting fabrics. And one more thing about “bacne”: try at all costs to avoid wearing a backpack because the additional pressure and rubbing from your backpack has to make your back even worse.