Back lumps, benzoyl peroxide, keloids and gym habits

Cystic acne on back

Cystic acne on back is the same disease as deep acne on the face: large, tender lumps (nodules and cysts) that form deep under the skin when plugged hair follicles become inflamed. Store products can calm the milder spots around them, but deep, painful lumps on the back need a dermatologist's help, the AAD says.

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What cystic acne on back looks like

NIAMS describes nodules as large, painful, solid lumps lodged deep in the skin, and severe nodular acne (sometimes called cystic acne) as deep, painful, pus-filled lesions. DermNet describes nodulocystic acne on the face, neck and trunk, with firm or tender lumps that often heal with scars. The AAD adds that severe acne tends to bring many breakouts that can cover the face, chest and back. On the back, the lumps are usually felt as much as seen: sore when you lie down or when a strap presses on them.

Why cystic acne on back is harder to treat

Skin on the back is thicker than skin on the face. That is why a benzoyl peroxide wash works best when you leave it on for two to five minutes before you rinse (AAD). A lotion applicator helps you reach the middle of the back.

Anything that rubs can make breakouts flare. A backpack is a common culprit, so the AAD suggests carrying a handheld bag instead, and NIAMS also lists pressure from tight clothes and backpacks. Heavy sweating and humidity are triggers too (MedlinePlus). Shower and change out of sweaty clothes as soon as you can after a workout (AAD).

Gym habits and supplements

Anabolic steroids and whey supplements are listed as risk factors for nodulocystic acne (DermNet), and MedlinePlus lists steroids and testosterone among the medicines that can trigger acne. If deep lumps started after you began a supplement or a steroid cycle, tell your doctor. For workouts, the AAD suggests loose clothes made of cotton or a fabric that wicks sweat away, washed after each use.

What helps the milder spots around the lumps

These steps calm the smaller pimples; they do not shrink deep lumps.

  1. A benzoyl peroxide foaming wash. A 5.3% wash is less likely to irritate or dry your skin, and a 10% wash is the strongest you can buy without a prescription (AAD).
  2. Adapalene 0.1% gel, a retinoid sold without a prescription since 2016 (FDA), put on after the shower or at bedtime (AAD).
  3. Old towels and sheets, because benzoyl peroxide bleaches fabric (AAD).
  4. No loofahs, back brushes or scrubs (AAD).
  5. Sunscreen made without oils on skin your clothes leave bare when you are outdoors, which the AAD says helps clear acne.

If treatment works, you may see results in six to eight weeks, and complete clearing can take three or four months (AAD).

When deep lumps need a dermatologist

Anyone with deep, painful acne on the back needs a dermatologist's help, the AAD says, because cystic acne on back rarely responds to store products alone, and so does anyone who sees no change after six to eight weeks of home care. The usual first plan for severe acne is an antibiotic paired with a medicine you apply, which can reduce the redness and swelling; if that fails, a dermatologist may talk with you about isotretinoin (AAD). For one large, painful lump, a dermatologist can inject a corticosteroid or drain it. Don't try to drain a cyst at home.

Deep, sore lumps on the back call for the same plan as on the face, and the guide on how to treat cystic acne lays out the steps in order.

Scars from cystic acne on back and chest

Raised scars favor the trunk. A hypertrophic scar is firm and raised, usually forms on the jawline, chest or back, and tends to appear 1 to 2 months after a breakout clears (AAD). A keloid grows larger than the breakout that caused it, and keloids are more common in skin of color, especially along the jawline, chest and upper back (DermNet).

The first sign of a keloid is thickening skin, usually 3 to 12 months after the acne clears. If you notice it, a pressure garment can prevent a keloid or reduce its size (AAD). Treating cystic acne on back early means fewer scars.

When it might not be acne

Acne conglobata is a rare, severe form of nodulocystic acne with many lumps, pimples and joined abscesses on the trunk, limbs and buttocks (DermNet). Lumps found only where skin touches skin, such as the armpits, groin or under the breasts, point to hidradenitis suppurativa (AAD). Small, itchy bumps that are all the same size on the upper back and chest can be Malassezia (pityrosporum) folliculitis, a yeast problem rather than acne (DermNet).

Sources

  1. Back acne: how to get rid of it. American Academy of Dermatology (AAD).
  2. What can clear severe acne? AAD.
  3. Acne scars: signs and symptoms. AAD.
  4. Stubborn acne? Hidden causes. AAD.
  5. Nodulocystic acne; Acne scarring; Malassezia folliculitis; Steroid acne. DermNet.
  6. Acne. MedlinePlus, US National Library of Medicine.
  7. Acne. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
  8. Prescription to nonprescription (Rx to OTC) switch list. US Food and Drug Administration (FDA).

This page is general information, not a diagnosis. See a dermatologist for deep, painful lumps on the back or chest.