Back-acne.  The why and the how to fix.

Let’s face it, any type of acne or skin eruptions is super frustrating.  Back-acne, especially as an adult, is a challenge, mostly because it’s one of those things you look forward to saying goodbye to as you move into your 20’s, let alone having to deal with it on your back and be a grown up.  What’s more, why is it that not everybody has it?  You’d be forgiven for thinking you’re being punished for something you did in a past life!  Back-acne isn’t fun for anybody.

There are many studies that have looked into adult acne. I’ve shared my favourite fix its here before. It’s considered a given that during our teenage years, acne will make it’s debut and hopefully nearing the end of our teens, make it’s very welcomed exit. But acne during the adult years is becoming increasingly more common.  One study found that androgen precursor hormones like Sex Hormone Binding Globulin (SHBG) and DHEA-S were absolutely at play for those experiencing acne (1).  This makes perfect sense to me when we are looking at acne in all shapes and sizes, but I specifically wanted to understand back-acne (or bacne) better.  Everywhere I searched didn’t give me specifics, so pulling out my trusty book of Chinese Medicine tricks to look for answers naturally made sense.

Your back is considered the most ‘yang’ part of your body when we look at the body from a TCM viewpoint. Being the most yang, it naturally needs the yang energy.  We can categorise our hormones into ‘yang’ type and ‘yin’ type – don’t try and be too scientific about it, you’ll only do your head in, but if you can look at it this way it may make a little more sense.  Yang being warming and most active, we associate this with progesterone and yin being more cooling and internal, we would put oestrogen into this yin category.  With this in mind, any back-acne the tells me specifically that these factors are what I need to use as clues.

I remember during the pregnancy of my first child the skin on my back improved dramatically – in fact, it was close to perfect.  Not too long after I began menstruating again, it went back to it’s old tricks – bumpy, lumpy and in patches, congested.  What was it, that made my skin so amazing whilst I was pregnant?  I’m holding all that good progesterone responsible for my glowing skin – for me and my back!

Progesterone is the hormone that steps into full throttle during the second phase of our menstrual cycle – known as the luteal phase.  Progesterone is also present in higher levels during pregnancy which helped explain why my skin was super smooth during this time (alongside a few other key players).

It may not be as cut and dry as low progesterone leading to back-acne though.  Typically, progesterone becomes low when oestrogen levels are high given that the body craves balance.  Think of your sex hormones oestrogen and progesterone filling up a jar – the jar always wants to be full, but the ratio of what’s inside changes.  So when oestrogen is high – the break on progesterone is naturally pulled.  The issue then isn’t actually about low progesterone specifically, but excess oestrogen leading to low progesterone.

As I researched this topic a little further, I read options of what certain doctors and health care professionals thought lead to acne on the back.  Many suggest that it is a mostly external issue – i.e. sweating, not changing clothes regularly or wearing unclean clothes, topical issues like washing powders or shampoos.  Another causative factor may be our spinal segments, specifically those that are related to upper thoracic region when compromised or impinged may affect the skin.  Again in TCM theory this makes sense.  T3 specifically is that which relates to the lung and in TCM the lung governs skin so it’s worth exploring.  There’s also the connection between our gut health and our skin.  When our digestive health is under stress, it certainly can show up in many ways.  The way I see it, we need to address it from the inside out and the outside in. I’ve got a few tried and tested tips to share.

Lowering Oestrogen
We’ve talked about that here.  You might find looking into the root causes of what’s driving your oestrogen wild, useful.

Love your gut

Since our digestive system is the centre of our health and our skin and gut are like one big loop, skin conditions can certainly be helped along by some good gut loving.  Introducing broths to support a healthy gut wall and probiotics to constantly nourish good gut flora may be extremely helpful.

Cleansing correctly
Stripping your skin of it’s own oils can actually, for some, make the condition worse because our body goes into overdrive to make more oil.  Hands down my best winning combo is a good but gentle body scrub followed by a body oil I apply in the shower.  I am a MAD fan of coco.body.  When we use oil to cleanse and nourish, amazing results begin for two reasons.  Firstly – oil dissolves oil.  That means if you’re experiencing congestion, oil cleansing may very well be your best friend to keep your pores clean.  Secondly – oil is nourishing.  It also helps to act in moisturising and prevent your skin from going into overdrive to continue to make more oil.  Check out coco.body’s products here.

Move through impurities
Sweating is a darn good way to cool down, but when we sweat we release toxins.  This comes back to internal issues where by if we are overloaded (with toxins), our skin will very often be one of the first places to show us. A Cleanse can be extremely useful to get the body back on track.  Check out my cleanse programmes here.

Drink it up baby!
Something like 70% of us are dehydrated according to a study conducted by Sodastream (2).  Water is one way our body can safely move through toxins and help keep our skin happy.  9 glasses per day is the recommendation.  I generally try and apply the 2L rule for patients.

Know your triggers 
Don’t dismiss your hormones when it comes to more ‘spot prone’ times of the month. Nearing the period or at the end of your period may be common times when we see acne creep up on us.  This too tells us clues.  In the lead up to the period, energy builds in anticipation.  Acne towards the end of the period would mostly likely (from a TCM viewpoint) be seen from depletion where the body is exhausted after the process.  In clinic, this helps us treat and diagnose hormonal related skin issues.  Sometimes enlisting a health care professional can make the world of difference.  At my clinic, The Pagoda Tree, we’re always there to help!

Photo Credit – Steph Brown.

(1) Assessment of androgens in women with adult-onset acne – Hassan Seirafi MD, Farshad Farnaghi MD, Amir Vasheghani-Farahani MD, Najmeh-Sadaat Alirezaie MD, Fatemeh Esfahanian MD, Alireza Firooz MD and Seyedeh Zahra Ghodsi MD, 2007




  • April 19, 2016 By Lauretta 9:54 am

    Hi Nat,

    Thank you for more great info:) I always had a few pimples around my chin and jawline but since becoming pregnant it has gotten out of control! So many little spots on my neck, jawline, chin and back! I’ve had hyperemesis from weeks 6-14 now 17 weeks and have been back eating well again, taking my probiotic and fermented foods but it’s just not getting any better? Any other suggestions?

    Thank you,

    • April 19, 2016 By Elle 2:24 pm

      You may be having a girl! Excess estrogen can make you break out along the jaw line.

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