Dealing with zits on your face is one thing but back acne is another level of annoying. At least when you’re wrestling with an angry blemish in your T-zone you can see what you’re doing. Not so when pimples pop up on your back. It’s hard enough just getting soap back there, applying zit cream between your shoulder blades is like a pulled muscle waiting to happen. And it might not work anyway, because the skin on your back doesn’t respond well to many of the acne treatments you use on your face. Though acne and back acne are caused by the same things, you need to treat them differently. Acne is caused by increased oil production, bacteria, pore blockage, and irregular skin cell turnover. Sebaceous glands in the skin produce oil, which can collect along with dead skin cells in the pores, plugging them up and giving bacteria a perfect breeding ground, all of which can lead to redness, whiteheads, blackheads, and sometimes infection. Hormones can play a large role, which is why you might break out more around your period, for instance. And if you’ve noticed that your breakouts pop up in similar places as other family members, that could be acne’s genetic components at work.

While the root causes of acne are basically the same in both places, the skin on your face is very different from the skin on your back, which has its upsides and downsides. The skin on the face has more blood supply, which helps acne heal faster and reduces scarring. But the skin on the back is much thicker than the skin on the face. That means that the back is more resilient, and can handle stronger treatments that would be considered too harsh for the face. The ingredients doctors most commonly recommend for body acne are generally the same as what you’d use on your face, but the products themselves are usually stronger. Salicylic acid is attracted to the oil in the sebaceous glands; and once there, it helps to loosen the sticky cells and oil to clear clogged hair follicles. Benzoyl peroxide is a topical antibiotic that will work to kill bacteria and clean pores. Salicylic acid and benzoyl peroxide products with concentrations over 2 percent can dry out the skin on the face. But since the skin on the back is a bit thicker and less sensitive, you can use formulas with higher percentages. Any benzoyl peroxide above 5 percent is unnecessary; it’s no more effective but causes more side effects.

Because back acne tends to cover a large swath of skin, and because it’s harder to reach your back to apply spot treatments, many products will come in the form of body washes and face scrubs that you can put on in the shower. It is recommended to leave these cleansers on for a few minutes before washing them off to give the products time to truly treat the acne. In addition, try using products with retinol, which helps loosen up dead skin cells and regulate cell turnover. Retinoids not only treat the acne you have today, they also change the way the cells turn over, reducing your development of acne tomorrow. To make sure you don’t miss a spot when applying topical creams and gels, it is recommended that you use an applicator to help you get to those hard to reach areas. Sulfur is another lesser known ingredient that works by killing acne-causing bacteria. Choose a cleanser with the active ingredient, rather than creams, many of which can have a rotten egg smell.

Back acne scars can be worse than acne scars on the face. Pimples on the back are more likely to scar than those on the face. The face will heal better because it has better skin cell turnover, more healing potential, and better blood supply. What’s more, the back is more prone to getting keloids, which are raised, overgrown scars. Antioxidant-rich formulas are key to getting the redness left behind to fade quickly. It’s important to start treatment right away. When scars have healed but are still red or pink, it is recommended to use topical antioxidants twice daily. Remember to apply morning and night, and you’ll be ready to rock that backless dress in no time.

When it comes to prevention, here are some pro tips, and rookie mistakes to avoid. Just like on your face, there are bad habits that can lead to breakouts on your back. You wash your face when it gets dirty and sweaty, right? For the same reason, you’ll want to change out of your sports bra soon after a workout, so that the sweaty clothing against your back doesn’t become a breeding ground for bacteria. In general wearing tight clothing with body-hugging fabrics can trap natural oils and shedding skin in pores, which can lead to breakouts. If you’re prone to back acne, you might want to avoid tight fitting fabrics, and instead opt for breathable materials that wick moisture and keep your skin as dry as possible. The way you wash your hair can have an impact on back acne. While the oils in hair treatments might be good for nourishing your hair, they can be bad news for the skin on your back. That’s why you should rinse conditioner off to the side instead of letting it run down your back. Also, try waiting until you’ve completed all of your hair treatments before washing your body. That way you can wash off any oily residue, clearing the way for your acne treatments to do their thing.