Acne on Shoulders: Shoulder Acne Causes and Interventions

A Formulate user who prefers to remain anonymous sent us the following question:

I have a lot of issues with shoulder acne. I've tried a bunch of different creams and acne treatments but nothing seems to work. It's driving me crazy and it's uncomfortable, embarrassing, and gross. I hate wearing tank tops since it feels gross to let other people see all of my spots, and I've been super careful to find swimsuits that cover as much of my shoulders as possible (and yeah those are really hard to find and usually not very cute). What could I be doing wrong that could be causing it? How can I change?

Thanks for writing! We'll do our best to help you learn about shoulder acne, so you can get it under control.

Most people know the basics of preventing acne: use a cleanser with salicyclic acne, don't pick at the pimples, wash regularly to control sebum production, et cetera. However, many of us don't know the specifics of non-facial acne, particularly shoulder acne. Three of the biggest and most frequently overlooked contributors to shoulder acne are friction, tight/heavy clothing, and sweat.

Shoulder acne causes

Friction

One of the most common contributors to shoulder and back acne is friction. Our backs, necks, and shoulders experience a lot of friction. We lay on beds, couches, and even the floor; sit with our backs and shoulders up against chairs; and wear heavy backpacks and bags that cut into our shoulders. It is not an understatement to say that we are constantly rubbing things up against our backs and shoulders. As a result, skin can become irritated, inflamed, and bumpy.

How to intervene: It's tricky to intervene on this one, since as a human being who does human things, you have to do stuff like carrying a backpack and sitting with your back against a chair. Still, there are a few things you can try.

If you carry a backpack or bag, clean it out. The less heavy it is, the better, as less pressure is applied to your skin. Be mindful of your skin and examine the spots on your shoulders to see if they're covered by your backpack when you carry it. If they are, it might be helpful to alternate between a backpack and a messenger bag, so the same parts of your skin don't undergo so much pressure. You can also try upgrading your backpack to a model that disperses the weight more evenly.

In general, it'll still be helpful for you to be mindful of where the spots are located on your shoulders. Are they in the same area that is pressed up against your pillow when you sleep? Are they right where your office chair hits your shoulders during the day? Make changes as needed. Try washing your pillowcase more often or switching to a pillow case that's designed for acne-prone skin. If it's possible, change your office chair to one that has less contact with your back, like a low-back chair.

Tight or heavy clothing

Clothing can be suffocating to the skin. When clothes are tight, they can trap sweat and debris and initiate breakouts. If you've ever noticed a breakout on your shoulders the day after a rigorous workout while wearing a tight sports bra, it's possible that your sports bra is to blame. The same goes for if you wear tight clothing while on a particularly hot day - that bodycon dress might be cute, but it also could be contributing to shoulder acne.

How to intervene: If you wear tight, nonbreathable fabrics like spandex to the gym, make sure to change ASAP. Don't wear your sweaty, tight clothes during your 20-minute drive back from the gym - change in the locker room immediately after your workout. Also, avoid tight clothing especially on hot, humid days, or in other environments where you'll get sweaty. This might mean switching to a strapless swimsuit so there are no straps pressed up against your shoulders, or wearing looser, lighter fabrics when it's hot (hello, cotton sundresses.) You could even just wear clothing that is bare in the spots that you're most likely to get breakouts - for example, if you're prone to acne on the tops of your shoulders, switch up your wardrobe with some off-the-shoulder tops.

Don't just think about tight clothing in the summer - you can also get unexpectedly sweaty during the winter. This is common when people walk in from the cold and cozy up by a fireplace, sweat at the gym and then cover up with a heavy winter coat on the way home, or hit the dancefloor in a crowded bar or club. Since your clothes will be heavier (because, you know, winter), there might be a greater likelihood of sweat being trapped up against your skin. The same rules apply: wear breathable, loose clothes whenever possible (though this is admittedly trickier in the winter - it'll help if you dress in layers so you can shed clothes as needed), change out of sweaty clothes ASAP, and ditch the spandex in favor of cotton as frequently as possible.

Sweat

This won't come as a surprise if you read the above section on tight and heavy clothing - sweat is a big contributor to shoulder acne. Besides reducing the amount of sweat-trapping clothes that you wear, you can also take steps to care for sweatiness as a whole before or after it contributes to shoulder acne.

How to intervene: First of all, prevent/lessen sweating by keeping yourself cool. Wear more breathable clothing overall, not just on your shoulders and back. Switch from dark colors to lighter colors, such as whites, beiges, and pastels. Compared to blacks, these colors are less likely to absorb and retain heat. Drink iced beverages and bring a desk fan to work. If you're a night sweater, keep a box fan pointed at you when you sleep or run an air circulator in your bedroom. When exercising indoors, keep plenty of ice water on hand and have a fan pointed directly at your face. When exercising outdoors, make an effort to get your workout in during the early morning, when the temperature is low.

If there's nothing you can do to prevent yourself from getting sweaty, your goal will be harm reduction. Rinse off in the shower twice a day, morning and night, and get cleaned up as quickly as you can after a workout. Change out of sweaty clothes as quickly as you can, regardless of if they're loose or tight. If you sweat at night, change your bedsheets once a week, or even switch to antibacterial sheets. Wash with antibacterial soap and grab a body brush if you're unable to reach the problematic spots on your shoulders.