Biological characteristics of the back skin
The back skin, has certain biological characteristics that have many implications upon the causation, course, presentation and treatment of acne on back.With the large surface area of the back having thousands of sebaceous glands with their pores producing an oily substance called sebum; there is a higher risk of blockage of these pores.
Such a predisposition, is augmented when coupled with the same quantitative factor of the anatomically associated increased sweat glands and the fact that increased perspiration is important in the causation of acne on back.
The skin of the back is thicker than anywhere else in the body; accordingly ducts of sebaceous glands need to penetrate it for a longer distance to reach the pores located at the skin surface.
This feature promotes relative stagnation and clogging of the sebum inside the ducts. It also favors the development of nodules and deeply seated cysts commonly encountered in acne on back.
The bacterial element (p.acnes), a normal inhabitant of the skin surface and known to contribute to the disease process is also enhanced; simply due to the large surface area, the humidity resulting from sweating and the difficulties associated with the personal hygienic approaches to the back.
Another factor is that blood supply of the back region is relatively diminished in comparison to the face, consequently acne lesions on the face heal better than those on the back.
It is well known that stress does not worsen acne on back, again this feature would be linked to the differences in blood supply of back in comparison to the face; as the chemical mediators of stress mainly corticosteroid hormones which aggravate acne reach their receptors in sebaceous glands via circulation and that means more steroids will be delivered to the face which has a much better blood supply. The back is also unseen and judgment by the back acne sufferer upon any response to stress is not practical.
This rule applies also to changes of back acne in relation to certain diets.
It has been suggested that hereditary contribution in the development of acne operates through the genetically determined size of pores in different individuals; some having relatively smaller pores would have the problem just as their parents did. Since the pores on the human back are larger than the face, such a hereditary role is not played in the causation of acne on back.
The large pores of sebaceous glands on the human back are also responsible for the more severe-looking appearance of some back acne lesions.
Since the back has much tougher skin than the face, topical treatment used for facial acne may not be sufficient, it can therefore tolerate stronger solutions of up to10 percent benzoyl peroxide.
At times it is more resistant to treatment and some dermatologists may recommend using benzoyl peroxide 2.5% in conjunction with another form of back acne treatment, such as glycolic acid or salicylic acid.