My husband, Max, came home to find me cooking at the stove. “Hi,” he said simply, a twinkle in his eye. I blushed. He had noticed. Dropping his briefcase, he sidled up behind me. “Hold still,” he said in my ear. Then he stuck his fingernail deep into what must have been an angry red blemish on my upper back. It was hardly the reaction I was hoping for. (Plus, ouch!)
I put the gas burner on low, abandoning dinner, and went to change my shirt in the bedroom.
A week later, Max, who at 40 looks younger than his age and has the same glowing, blemish-free skin he had when we met more than a decade ago, returned from a shopping expedition with one of those long-handled brushes, a back scrubber, from Ricky’s. “This could help,” he said, handing it over. It was a sweet gesture, but I was mortified, and, as if that wasn’t enough, it didn’t help. (“Are you using it regularly?” Max asked.) In fact, the acne on my chest and back seemed to be getting worse.
“You could be irritating the skin, causing inflammation, and possibly exacerbating your condition," said Dr. Dendy Engelman, director of dermatologic surgery at Metropolitan Hospital in New York, of this attempt to address the sprinkling of pimples on my back and chest. “Don’t even use a loofah,” she wrote later in an e-mail, suggesting that I rely instead on a body wash with salicylic acid, which would help exfoliate my skin without irritation.
Exfoliation helps keep pores from getting clogged with dead skin cells, which can trap naturally occurring Propionibacterium acnes ( or P. acnes) bacteria with oil or sebum in an anaerobic environment. The bacteria uses the oil as a nutrient for growth, producing fatty acids and triggering an inflammatory response as the body sends white blood cells to the area to combat the infection. (Blackheads and white heads, by contrast, are clogged pores that haven’t triggered the inflammatory response.)
Aside from salicylic acid, Dr. Engelman also suggested I try swiping pads with benzoyl peroxide (an antibacterial agent) or more salicylic acid. I can use products with higher concentrations of active ingredients because, as Dr. Dennis Gross, a dermatologist in New York with an eponymous line of skin care products, explained, the skin on my back, shoulders and upper arms tends to be thicker and less delicate than the skin on my face, and the pores in those areas reside deeper in the skin.
Among the latest body acne treatments to come on the market are Clearasil Ultra On-the-Go Rapid Action wipes ($4.49) with 2 percent salicylic acid (the highest concentration allowed over the counter) and Proactiv+ Cleansing Body Bar ($29.95 for members; $40 for others) with one percent salicylic acid and exfoliating beads. In May, glo therapeutics introduced Back Acne Treatment ($32), a spray that uses salicylic acid, sodium chlorite and spearmint oil to fight breakouts, and can be used upside down. Rx Skin Therapy introduced Clarifying Wash Plus, which contains high concentrations of tea tree oil as well as , salicylic, glycolic and lactic acids, in June. The product, said Kristen Riddle, the founder and a co-owner of the company as well as a compounding pharmacist, was formulated for a teenage girl who was hoping to clear up the acne on her back in time to wear a strapless prom dress.
If you’d prefer to have someone else attack the problem, Bliss’s popular No Zit Sherlock treatment ($175 for 75 minutes) includes extractions and a bacteria-fighting hydrogen peroxide milk mask and can be performed anywhere on the body. And Dr. Gross’s in-office chest and back facial ($500) includes an alpha and beta hydroxy acids peel to help unclog pores, extractions, and a session under a blue-light LED, which he said penetrates the skin to destroy bacteria and reduce inflammation. In August, Dr. Gross plans to introduce One Step Acne Eliminating Pads ($38), which use L-carnitine and pantothenic acid, ingredients that he said help calm overactive oil glands and help disperse oil from the pore. “Oil in skin should flow like a liquid,” Dr. Gross said. “Like olive oil versus butter.”
But what is clogging up the works in my case? Maybe my hair conditioner. According to Megan McGhee, a medical aesthetician with Bliss, dimethicone, a silicone based polymer that is used in many hair care products to impart smoothness and shine, can act like shrink wrap on the skin, congesting pores. “Rinse your hair and then put it up in a clip while you wash your back,” said Ms. McGhee, who also flagged sunscreens, which may contain mineral oils, as a potential pore blockers.
And then there’s my workout routine. Tight fitting clothes physically block pores and trap sweat, creating the moist, humid environment in which the pernicious P.bacteria thrive. Dr. Nicholas Perricone, a dermatologist in New York and the author of “The Clear Skin Prescription,” also argues that lifting weights (what I’ve been doing more of lately) causes the body to release more testosterone, which can also contribute to breakouts. He advocates yoga and other forms of moderate exercise to help reduce stress, which is linked to acne, and an anti-inflammatory diet heavy on cold-water fish, beans and low-glycemic fruits and vegetables.
Unlike many other doctors, Dr. Perricone believes acne is caused when stress, poor diet and other factors spur the release of hormonelike pro-inflammatory chemicals called cytokines, which can make the cells inside a pore “sticky” and more prone to getting clogged. “Acne is a chronic, systemic inflammatory disease,” Dr. Perricone said.
I’m not willing to give up my favorite fitness classes or morning coffee, but I will add an hour of yoga, forgo bananas (deemed pro-inflammatory) in favor of apples, and add another step or two to my post-shower routine. And in the meantime, I’ll be skipping the racerback. I hear midriff cutouts are in, anyway.