Truncal Acne: A Neglected Entity

December 2019 | Volume 18 | Issue 12 | Original Article | 1205 | Copyright © December 2019

James Q. Del Rosso DO,a Linda Stein-Gold MD,b Charles Lynde MD,c Emil Tanghetti MD,d Andrew F. Alexis MD MPHe

aResearch Director/Clinical Dermatology, JDR Dermatology Research/Thomas Dermatology, Las Vegas, NV
bDirector of Clinical Research, Department of Dermatology, Henry Ford Hospital, Detroit, MI
cDepartment of Medicine, University of Toronto, Canada; Lynde Institute of Dermatology and Lynderm Research
dCenter for Dermatology & Laser Surgery, Sacramento, CA
eDepartment of Dermatology, Mount Sinai St. Luke’s and Mount Sinai West, Skini of Color Center, New York, NY

Abstract
Truncal acne – acne vulgaris involving the chest, back, or shoulders – is thought to be present in more than half of patients with acne. Because the study of acne has been focused on the face, there are sparse data in the literature about the clinical characteristics and management options for truncal acne. It is thought that the pathogenic process is similar between the face and the back, suggesting that treatments studied on the face may be suitable for use on the back. It is not uncommon for patients to omit discussion of truncal acne with their treating physician, and it is likely that non-facial acne is under-diagnosed and under-treated. Scarring and pigmentary problems are common sequelae of acne on the trunk, underscoring the need for early and effective treatment as a preventive measure.
Truncal acne merits consideration and should be more thoroughly studied. Initiating treatment with a topical retinoid combined with an antimicrobial agent is logical for most patients with truncal acne, and mirrors recommendations for facial acne; however, there are additional considerations for truncal acne such as extension of the lesions, risk of antibiotic resistance due to large surface areas treated for a prolonged duration, accessibility of lesions, and discoloration of clothing or bedding due to topical products. Oral isotretinoin is the treatment of choice when truncal acne is severe. This article reviews available information as well as recent recommendations for treatment.

J Drugs Dermatol. 2019;18(12):1205-1208.

INTRODUCTION

Acne vulgaris is a very common skin disease with a complex, multifaceted pathogenesis and a clinical presentation that encompasses a spectrum of lesions which occur subsequent to inflammation of the pilosebaceous unit.1 Although most of the medical literature has focused on facial acne, the disease also commonly involves skin of the chest and back, areas that also have a high density of pilosebaceous units.2 There is currently very little information in the medical literature about the entity of truncal acne.3 In addition, awareness of truncal acne among both the public and healthcare practitioners is low. Expert recommendations and guidelines for the management of acne have been focused on facial acne, with little, if any, attention given to truncal acne.4-7 At the time of writing, there were no treatments specifically indicated for truncal acne.

TRUNCAL ACNE: WHAT IS KNOWN ABOUT IT?

Epidemiology
The epidemiology of truncal acne has not been well character- ized. Del Rosso et al conducted clinical examinations of 300 consecutive acne patients aged 14 to 20 years, and reported the presence of at least moderate truncal acne in 47%, with a slightly higher rate found in males vs females (54% vs 43%).8 In a study of 965 acne patients referred to dermatologists, Tan et al reported 61% had chest acne and 45% had back acne.9 In the largest study to date, Dreno et al observed a 35.6% prevalence of acne lesions on both the face and trunk among 2,926 patients with mild-to-moderate acne.10 This group also found that the frequency of truncal acne was significantly higher in patients who had a family history of acne (P<.0001).10

Consistent with the authors’ clinical impressions, it has been reported that many patients (25%) do not voluntarily mention torso involvement, but that the majority (78%) want treatment.3 Scarring and dyschromia are common and bothersome sequel- ae, and Graber et al report that these may be more common in males than in females and that Asians and Black patients are prone to keloidal scars.11 As with facial acne, scarring likelihood on the trunk increases with increasing acne severity.3,11 Lauer- mann et al noted scarring in 17% of those with chest acne and in 8.2% of those with anterior chest acne in a cohort of 2,201 ado- lescent males.12 The potential for scarring indicates that early diagnosis and efficacious treatment are important for prevention.2

Truncal acne is not limited to acne that occurs in adolescence.