Last Updated on September 19th, 2019
Hundreds of millions of children have been admonished by their mothers always to wash the backs of their necks. Preventing and treating acne on the neck, however, is not as simple as keeping the neck clean, because almost any form of acne can occur on the neck.
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Mild to moderate common acne, a condition also known as acne vulgaris, usually occurs on the face, but about 15% of people who have common acne get blemishes on the neck1. Whiteheads and blackheads on the neck are caused by2 the accumulation of dead skin cells, acne bacteria, and excess oil in pores on the skin of the neck, and reducing any three of these components of a clogged pore can reduce the number of blemishes on the neck.
Mom’s advice to wash your neck and to wash behind your ears is sometimes all you really need to do. Since the skin on the back of your neck is a little tougher than the skin on your face, it also responds well to benzoyl peroxide3—but don’t use benzoyl peroxide on the back of your neck if you spend lots of time in the sun, or if you have Asian or light brown skin. Benzoyl peroxide is great for neck and back acne, but it can leave permanent spots on the skin of the neck after acne has healed if you have Asian or light brown skin. Use sunscreen if you use any kind of antibacterial gel on your neck.
Another target for acne in men is under the chin, especially on areas of the neck that are shaved every morning. Many man develop a form of acne called acne keloidalis nuchae where they shave their necks every day4. This kind of acne is not triggered by clogged pores. It forms around ingrown hairs, which are attacked by the immune system. The immune system tries to destroy the hair5 with inflammation, and the skin seals the hair into the skin under raised, pink scar tissue.
Cleansing the skin won’t get rid of this kind of neck acne. It usually takes tretinoin topical to open up the hair follicle so the hair can come out, and careful treatment with antibiotics if the pore gets infected. The antibiotics used to treat common acne won’t usually work in hair follicles, because they are more likely to be infected with staph or strep than with acne bacteria. Neosporin, however, will usually cause the bacteria in pimples under the chin.
It is important not to try opening up pimples that form over ingrown hairs on your own. They can cause serious infections that affect larger areas of skin than common acne, and the bacteria inside the pimple can even get into the bloodstream. If self-treatment doesn’t work in 4 or 5 days, see a doctor.
The way to prevent this kind of neck acne is always to use a fresh safety razor. Dull edges trap hairs beneath the skin. Men of African or Latino descent tend to get this kind of neck acne on the back of the neck, but men of Asian or European descent get it under the chin.
Another kind of acne that appears on the neck is chloracne, acne that is caused by exposure to chemicals containing chlorine6. Chloracne is a common problem in China.
Chloracne was first observed in Germany when it was developing its chemical industry in the 1880’s. Now that Chinese companies make the majority of the world’s chlorinated phenols, polychlorinated biphenyls (PCBs), chloronaphthalenes, and other polychlorinated compounds, such as polychlorinated dibenzo-p-dioxins, polyhalogenated dibenzofurans, and chlorinated azo- and azoxybenzenes, the greatest number of cases of chloracne occur in China. Acne caused by exposure to dioxin is also reported in Vietnam, most of Eastern Europe, and Texas. There are people who develop chloracne after swimming in over-chlorinated swimming pools.
This form of acne can occur anywhere on the body7, but it is most common on the neck. People with light hair color are especially susceptible to chloracne.
This form of neck acne usually starts at the sides of the face between the eyes and the ears and spreads down the neck. The skin in pores fails to mature properly, so they grow large but fill up with sebum and dead skin cells. From the neck, acne may spread to chest, back, buttocks, and genitals.
There is no cure for chloracne, but two to three years without further toxin exposure will give the skin time to heal. Blemishes are reduced by the use of a treatment that does not work for any other kind of acne—Olestra. This fat substitute binds to the toxins that cause chloracne of the neck. Eating products that contain Olestra sends the toxins out with fecal matter8 and accelerates recovery from chloracne.
Cystic acne of the neck is largely a problem of young Hispanic adults. Many people with dark brown skin tones escape acne as adolescents, but develop this particularly severe form of acne as young adults. The problem is that the skin of the neck is in some ways too healthy. It grows over pores before they get a chance to drain, and the immune system attacks the trapped acne bacteria with inflammation that causes the formation of a cyst9.
Picking, probing, needling, lancing, cold treatments, and heat treatments all make this kind of neck acne worse. The only practical treatment that you can get over-the-counter is tretinoin topical, also known as Renova. This lotion stimulates the maturation of skin cells over the cyst so that they are easy to rinse off the skin. Over a period of 3 to 4 weeks enough skin matures and dies that the cyst opens on its own, and the ordinary skin care helps keep cysts from coming back. It is important to use sunscreen on the back of the neck during tretinoin treatment to prevent the formation of brown spots on the skin. Using a sunscreen that contains vitamin E in the morning, such as Banana Boat Ultra Defense Sunscreen Faces SPF 30 Lotion (which works on the neck, too), and topical tretinoin in the morning, opens the skin while preventing lasting discoloration.
Another kind of acne that can form on the neck is sports acne, also known as acne mechanica. This condition is caused when the back of the neck is irritated10 by a strap that also collects sweat. The solution is simple: Loosen the strap. It also is important to shower immediately after any sporting event to minimize irritation to the neck.
If you have acne keloidalis nuchae, chloracne, cystic acne, or sports acne on the neck, you need specialized skin treatment. If you just have mild to moderate common blemishes on the neck, however, you can benefit from a complete skin care treatment system such as Exposed Skin Care.
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