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Truncal Acne: A Practical Guide to Treatment

Sporty & Rich Wellness - Truncal Acne: A Practical Guide to Treatment

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By: @dermahealthnutritionย 

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Truncal acne, acne involving the chest, back, or shoulders, is frequently overlooked, although present in more than half of patients with facial acne. According to previous studies, males are more prone to this disease compared to females.

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Although the pathophysiology is considered to be the same as facial acne, the clinical presentation and treatment response may differ. Truncal, as well as facial acne, are associated with an imbalanced skin microbiome and a strong predominance of Cutibacterium acnes. Furthermore, increased proliferation and reduced shedding of skin cells (keratinocytes) block sebum outflow of skin follicles. As a result, sebum accumulates and may lead to visible black heads (open comedones) and inflammatory lesions. Additionally, tight-fitting clothing, sweat, warm climate and mechanical factors can trigger and aggravate the disease. It is worth noting that deep, inflammatory truncal lesions can be very painful and far worse than those of facial acne.

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Truncal acne may persist for years and heavily impact the quality of life of affected individuals. Disfuring skin formations can also occur. Early treatment is therefore recommended. Although several treatment guidelines for acne are available, none specifically provide guidance for the treatment of truncal acne and treatment remains challenging. In Western medicine, topical treatments with salicylic acid, benzolyperoxide wash, or retinoid are recommended for milder forms. However, for patients with more severe forms, Western medicine recommends systemic treatment with antibiotics or vitamin A derivatives.

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Lately the impact of nutrition on truncal acne has been investigated in clinical trials. Notably, whey protein and over supplementation with vitamin B12 may worsen the disease and should be considered to be potential triggers in therapy-refractory cases.


See below for the best approach for truncal acne.


- Cleanse your back with a mild cleanser at least once a day to lower sebum production and consecutively, the occurrence of comedonesย 

- Avoidย physicalย trauma. Contrary to common believe, exfoliating, back scrubs and dry brushing may worsen the appearance if inflammatory lesions

-ย  Avoid over supplementation with vitamin B12

- Avoid whey protein supplementation

- Shower after sports activities as sweat may cause irritations

- Consult with a dermatologist to initiate topical and/or systemic treatment (especially to avoid scarย formation). Or consult with a functional or naturopathic doctor to explore alternative, individualizedย treatment options

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ย References:

Tan, J.K., et al. Prevalence and severity of facial and truncal acne in a referral cohort. J Drugs Dermatol 7, 551-556 (2008).

Del Rosso, J.Q., et al. A closer look at truncal acne vulgaris: prevalence, severity, and clinical significance. J Drugs Dermatol 6, 597-600 (2007).

Poli, F., Auffret, N., Leccia, M.T., Claudel, J.P. & Dreno, B. Truncal acne, what do we know? J Eur Acad Dermatol Venereol 34, 2241-2246 (2020).

Del Rosso, J.Q., Stein-Gold, L., Lynde, C., Tanghetti, E. & Alexis, A.F. Truncal Acne: A Neglected Entity. J Drugs Dermatol 18, 205-1208 (2019).

Tan, J., et al. Impact of facial and truncal acne on quality of life: A multi-country population-based survey. JAAD Int 3, 102-110 (2021).

Tan, J., et al. Randomized phase 3 evaluation of trifarotene 50 mug/g cream treatment of moderate facial and truncal acne. J Am Acad Dermatol 80, 1691-1699 (2019).

Tan, J.K.L. & Dirschka, T. A New Era for Truncal Acne: Emerging from a Legacy of Neglect. Dermatol Ther (Heidelb) 11, 665-668 (2021).

Veraldi, S., Benardon, S., Diani, M. & Barbareschi, M. Acneiform eruptions caused by vitamin B12: A report of five cases and review of the literature. J Cosmet Dermatol 17, 112-115 (2018).

Malgotra, V. & Singh, H. Malassezia (Pityrosporum) Folliculitis Masquerading As Recalcitrant Acne. Cureus 13, e13534 (2021).

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