Watch this video to understand the basics of acne. Then read
below to learn more about the important differences between
“face/neck” acne and “chest/back/shoulder” acne.

Education

Acne breakouts don’t just appear anywhere.

This is because acne begins in a special type of follicle called the ‘sebaceous follicle’. The face, neck, chest and upper back are the most acne-prone areas because they have the highest concentrations of sebaceous follicles.

Pimples usually start as what’s known as a comedo. This occurs when oil has difficulty getting through the pore opening and the follicle starts to swell like a balloon. At this point, you may be able to feel tiny bumps under the skin which are not red or inflamed. These swollen follicles can ‘pop’, resulting in lots of inflammation (red bumps and pimples).

So acne could essentially be considered a ‘plumbing problem’, with the ‘pipes’ simply needing to be kept free from blockage.

People who produce more oil are more likely to get acne because the follicle swells up and ‘pops’ much faster whenever there is a blockage. Unfortunately, some people have the hereditary problem of producing oil 5-10 times faster than others and can end up with severe acne.

At puberty, hormones change which results in increased oil production. This is why acne tends to first develop around puberty and can then keep worsening.

It is important to avoid blockage of the pore openings so oil can keep flowing out onto the skin rather than cause a ‘blow-up’ of the follicles. There can be a number of different reasons for the blockages. Facial pores most commonly are clogged by touching or rubbing, which can push dead skin cells and oil back into them. Pores elsewhere, such as on the chest and back, tend to be quite small. They are so small you usually can’t even see them like you can see the pores on your face. This small pore size can make it difficult for oil to flow properly out of the follicle. Also, if you feel a lot of tiny, firm bumps on your back or chest in addition to the acne, you may have a hereditary condition called Keratosis Pilaris, in which tiny, hard plugs are directly on top of the pore and can cause a blockage. If you have a problem with these, you may use lactic acid lotion to help get rid of them, which can be found in most drugstores.

So there are two main reasons for getting acne.

One is that more oil is being produced than can get through the pore opening. The second is that the pore opening is blocked or too small to allow the oil to get through. In actuality, it tends to be a combination of these two things. There are plenty of things we can do to avoid, prevent or remove blockages of the pore openings (see Dr. K’s Top Ten Tips for prevention of acne). The reason that our focus needs to be on removing and avoiding blockages is because the amount of oil we produce is mainly hereditary and unfortunately we are pretty much stuck with it. Decreasing oil production would obviously help with acne but the problem is that the only medicine that seems to do this to a meaningful degree is isotretinoin (also known as Accutane), which has many potential side effects and complications.