Shoulder Acne: Causes, Treatments, Similar Conditions, and More

• Shoulder acne is a common skin disease that occurs when pores become clogged with oil, debris and dead skin cells
• This disease can be either noninflammatory or inflammatory, and ranges from mild to severe 
• Shoulder acne can be treated and managed with over-the-counter or prescription medication as well as simple lifestyle changes

Acne is a very common chronic disease that typically affects both adolescents and adults. It develops primarily in those areas that contain the most oil glands, such as the face, back, chest and in this case, the shoulders. Symptoms of shoulder acne can range from mild to severe and fluctuate in severity. 

While acne can’t be cured, it can be managed with a range of over the counter (OTC) and prescription topical and oral solutions. Combination therapy not only targets the multiple factors that cause acne but achieves higher efficacy when used together rather than individually.    

Why You Get Acne on Your Shoulders

Acne develops on the shoulder for the same reason it does elsewhere. When pores become clogged with dead skin cells, sebum (oil) and other debris pimples, blackheads and whiteheads form. These are all symptoms of noninflammatory acne.

If lesions are left untreated, inflammatory acne can develop when Cutibacterium acnes (formerly, Propionibacterium acnes) bacteria become trapped within pores. The body’s immune system reacts and sends an inflammatory response to the area. This causes pus-filled pustules nodules and cysts to form.

As with all acne, shoulder acne is thought to have a genetic component which can impact the effectiveness of the immune system in fighting P. acnes bacteria. There are two types of acne that can develop on the shoulder and these can be exacerbated by certain lifestyle and habits. 

Hormonal Acne

Fluctuations in hormone levels play a strong role in acne development and affects about 80% of adolescents; it is slightly more prevalent among males. It also commonly develops among women during pregnancy and menopause. 

In adolescence, hormonal changes trigger a rise in androgens, such as testosterone and dihydrotestosterone (DST). This increase activates sebum production, affects skin cell activity and results in inflammation. This increase in androgen also stimulates oil production in pregnancy to increase the risk of acne. 

For women who experience acne around menopause, estrogen levels fall sharply while androgen levels decrease gradually to late menopause.

Polycystic ovary syndrome (PCOS) is a hormonal disorder that is thought to develop due to genetic and environmental causes. PCOS causes the ovaries to produce an excessive amount of androgens. Unlike shoulder acne, lesions typically appear along the jawline, neck and chin.

Acne mechanica

While acne mechanica can develop anywhere on the body, the shoulders are particularly vulnerable. This is due to prolonged friction, rubbing and pressure on the skin as a result of too-tight clothing, pressure from sports bras and athletic equipment, hats, backpacks or prolonged bed rest. 

When left unchecked, trapped heat and accumulated sweat irritate skin, and sedum from oil glands on the shoulders block pores. Without further intervention, comedones (pimples) will form and progress to inflamed papules and pustules. 

Lifestyle and habits 

Several causative and aggravating factors of shoulder acne include:

• Diet: Studies show a relationship between high-glycemic foods and the development of acne
• Hygiene: Allowing sweat and oil to accumulate on skin and rewearing clothing can clog pores and increase surface bacteria
• Smoking: Studies have shown a link between smoking and acne
• Comedogenic products: Using oil-based skin and hair care products can clog pores and  cause acne to develop

Certain medications such as lithium, steroids and anticonvulsants can cause a skin reaction called acneiform that resembles acne but isn’t considered acne.

Similar Conditions 

Several other skin conditions that can be mistaken for acne: 

• Folliculitis is an inflammatory condition affecting the hair follicles and is caused by bacteria, viruses and fungi; it presents as small red pus-filled bumps 
• Keratosis pilaris causes a buildup of keratin within hair follicles, resulting in hard, white or flesh-colored bumps on the skin; they are rough to the touch
• Eczema, or atopic dermatitis, is a chronic inflammatory skin disease that causes redness, swelling bumps and crusting of the skin

How to Treat Shoulder Acne 

The medication for your shoulder acne will be based on the severity of your condition and your response to treatment. Mild cases of shoulder acne are usually managed with OTC topicals. For moderate to severe shoulder acne, or for treatment-resistant situations, your doctor will prescribe a combination of topical and oral medications. 

Home remedies and lifestyle changes can also greatly contribute to easing symptoms and preventing shoulder acne breakouts.

Over-the-counter topicals

Topical therapy is the standard first-line treatment for mild to moderate shoulder acne and includes washes, foams, gels and creams of varying strengths and concentrations. 

These products provide different mechanisms of action by: 

• Decreasing oil production and buildup
• Exfoliating skin
• Killing acne-causing bacteria
• Reducing inflammation 
• Unclogging pores 

Azelaic acid

Azelaic acid is a dicarboxylic acid with antibacterial, anti-inflammatory and antioxidant properties to ease the redness and swelling associated with shoulder acne. As a mild keratolytic, it helps loosen and exfoliate dead skin cells, and removes excess sebum. 

Azelaic acid has been found to be as effective as 5% benzoyl peroxide in treating mild to moderate acne. You can find this acid in creams, gels and foams at up to 10% concentrations.

Benzoyl peroxide 

Benzoyl peroxide is one of the cornerstones of acne treatment and can successfully treat both inflammatory and inflammatory shoulder acne. It can kill C. acnes bacteria, clear pores of excess oil and debris, and dry acne lesions.

Importantly, benzoyl peroxide is not associated with bacterial resistance, which can commonly occur with antibiotics and when used alongside other treatments, it can increase their efficacy.

You can opt for a cleanser, foam, lotion or gel; they can be found in both cleansers and as a leave-on treatment in concentrations of 2.5–10%.  

Retinoids

Topical retinoids are standard medications to treat comedonal and inflammatory acne, and are also used as maintenance therapy after a course of antibiotics. They are very effective at clearing the skin of oil, dead skin cells and residue, which in turn helps other topical medications better absorb into the skin. They can target inflammation and redness.

Retinoids can also penetrate deep within the skin to stimulate collagen and elastin production.

Both actions strengthen the skin and work against acne formation.

Multiple studies have shown that adapalene is well tolerated and very effective in treating acne. This retinoid is available OTC in serums, gels, creams, lotions and wipes at a 0.1–0.3% concentration.

Salicylic acid

Salicylic acid is another strong option for treating mild forms of shoulder acne. It penetrates deep into pores to dissolve sebum and sloughs off dead skin cells. It encourages cell turnover and clear skin of pimples, whiteheads and blackheads.

Salicylic acid is available in a variety of products such as cleansers, washes, serums and spot treatments in concentrations of 0.05–5%. Many products can be used in the shower – a benefit for hard-to-reach areas such as the shoulders. 

Prescription medications

When your shoulder acne doesn’t respond to topical treatments, your dermatologist will prescribe a stronger medication or a combination of medications depending on the severity of your acne.

Topical and oral antibiotics

Antibiotics work by killing acne-causing bacteria on the skin; they are available in both topical and oral formulations. 

Topical antibiotics are the first-line of treatment for moderate inflammatory acne and are best used with other medications due to their synergistic properties.

The most commonly used topical antibiotics are clindamycin 1% and erythromycin 2%. Both are effective in treating inflammatory acne.

Oral antibiotics are used to treat moderate nodular acne, as well as moderate to severe pustular acne. In addition to antibacterial properties, some antibiotics such as tetracyclines (doxycycline, minocycline and tetracycline) are also anti-inflammatories.

Doxycycline, minocycline and sarecycline are currently the preferred oral antibiotics for moderate to severe inflammatory acne, due to their low side effects and efficacy. 

Antibiotics are typically used for the short term and combined with other medications, after which time your dermatologist will switch you to another treatment as maintenance therapy.

Oral isotretinoin

Oral isotretinoin is a retinoid that is typically prescribed for severe nodular acne or treatment-resistant acne. This medication can reduce the size of sebaceous glands and effectively reduce oil production. It treats inflammation and reduces bacteria. 

There is a long list of adverse effects with this medication, some severe; the course of treatment will be as short as possible, while maintaining effectiveness and you will be monitored by your dermatologist for any symptoms. 

Hormonal therapy

For shoulder acne brought on by fluctuations in hormones, estrogen or spironolactone can help stabilize levels in women with moderate to severe shoulder acne. Estrogen suppresses androgen production, while spironolactone blocks androgen from stimulating oil glands. 

Home remedies

Home remedies can soothe the redness, irritation and inflammation that accompanies shoulder acne. 

Green tea

With potent antimicrobial and anti-inflammatory properties, topical application of a green tea extract can reduce noninflammatory lesions but has been shown to be most effective in treating inflammatory lesions. It also soothes irritation and redness.

Tea tree oil

Tea tree oil is a natural compound that has earned the reputation of having strong antibacterial and anti-inflammatory properties. It has antimicrobial compounds, called terpenes, which can effectively kill P. acnes and prevent future flare-ups.

This oil can significantly reduce the number of mild to moderate acne lesions and is as effective as benzoyl peroxide, but with fewer side effects. 

Best overnight treatments

There are several overnight treatments you can choose from to reduce inflammation, redness and pain.

• Lemon juice is an alpha hydroxy acid and has antibacterial properties; it can dry up and heal acne lesions
• Aloe vera has anti inflammatory and antibacterial properties; it can bring down swelling and redness, and help heal blemishes 
• Hydrocolloid bandages soak up excess oil, and  reduce redness and inflammation

How to prevent shoulder acne

You can be proactive in preventing shoulder acne by making some simple changes to your daily routine. 

• Choose noncomedogenic skin and hair products to prevent your pores from clogging 
• Add a gentle exfoliating body wash to your shower several times a week to slough off dead skin cells and excess oil
• After any strenuous activity, shower and change into fresh clothes made of breathable fabrics
• If your hair tends to be on the oily side, choose a hairstyle that keeps it off your shoulders to avoid exacerbating your acne  
• Change sheets and pillowcases weekly as they can accumulate dirt, oil and dead skin cells
• Avoid picking at or touching any lesions as doing so can spread bacteria and worsen your acne

Acne Scars on the Shoulders 

Depending on the type and severity, your shoulder acne could cause depressed or raised scars. Although scarring is more likely with severe acne such as cysts and nodules, mild acne lesions that are picked at could also leave scars as well.

To treat acne scars on the shoulders, there are several effective treatment options available. 

• Laser resurfacing therapy focuses high-intensity light on your skin to break up scar tissue, promote healing and stimulate collagen production
• Chemical peels work by removing top layers of skin and promoting the growth of new skin cells, to lessen the appearance of scars  
• Microdermabrasion removes the uppermost layer of the skin, which triggers the body’s wound-healing response and increases collagen production 
• Microneedling creates microwounds on the skin surface, which increases collagen production and stimulates wound healing

Takeaway 

Shoulder acne is a very common skin disease that can be treated effectively by a wide range of OTC and prescription oral and topical treatments. Your dermatologist will prescribe a personalized treatment regimen that is based on your unique needs and the severity of your acne.

Shoulder acne can be treated and managed with OTC and prescription medication as well as simple lifestyle changes. There are a wide range of effective products available, all having different mechanisms of action. While it can take time to find the right medication for you or the right combination of therapies, with time and patience, you should see an improvement in your shoulder acne.