Though an oft-neglected area of one's skincare routine, our necks see the same unfortunate issues our faces do—acne included. "Anyone who gets acne on their face can get it on their neck," explains Heidi Waldorf, MD, director of laser and cosmetic dermatology at Mount Sinai Medical Center in New York City. "In the sebaceous gland, cells get stickier and don’t turn over correctly, and oil glands make oil that is thicker and bacteria proliferate." In other words, clogged pores lead to pimples, even on the neck.
Hormonal acne may also manifest itself in the neck area and, while it's not at all uncommon, that doesn't make it any less irritating. In fact, breakouts on the neck can be even more of a nuisance than those on the face—and they're a lot harder to cover up with makeup, due to sweat and clothing rubbing against the area. Fortunately, it is possible to treat—and prevent—neck acne.
Meet the Expert
Heidi Waldorf, MD, is the director of laser and cosmetic dermatology at Mount Sinai Medical Center and an associate clinical professor at the Icahn School of Medicine of Mount Sinai University. She is an expert in the field of skin rejuvenation and practices at Waldorf Dermatology Aesthetics.
We spoke with Waldorf for her expert take on the various types of neck acne, causes. Keep reading to see how to treat it.
Types of Neck Acne
• Pustules: Bumps that are red, tender, and usually filled with pus.
• Papules: A solid elevation of the skin, often occurring in clusters (similar to a rash) and often noticed around the hairline and on the neck.
• Nodules: Deep, painful lumps that develop deep within the skin. Nodules sometimes require medical intervention and can't always be treated with over-the-counter products.
• Hormonal cystic acne: Breakouts of often painful cysts, which come about due to a hormonal imbalance. These can occur during pregnancy or the menstruation cycle.
Causes and Prevention of Neck Acne
• Overproduction of oil: The first thing to know about neck acne is that it's caused by the same things that cause facial acne. Though acne on the neck can affect anyone who sees breakouts on their face, Waldorf notes that dermatologists tend to see neck acne a lot in men’s beard areas "and in women with hirsutism (male pattern hair) who overpluck that area and irritate the follicles. Those women create the acne," she says.
• Comedogenic (i.e. pore-clogging) products: The overproduction of oil can be exacerbated by people neglecting to tend to their necks. "People forget to treat the neck like the face," says Waldorf, "and makeup, sunscreen, moisturizer, and sweat mix and move about—even if it is all noncomedogenic." Look for products formulated for sensitive skin and those free of fragrances and excess oil.
• Failure to wash off your makeup: Even if you are opting for noncomedogenic products, they can still wreak havoc on your skin if not washed off at night or after hitting the gym. "So after exercising and before bed, include the neck area in your cleanup," says Waldorf. "Even a pre-moistened makeup remover towelette will do the job. And for the back of the neck, make sure that hair products—leave-in conditioner or gels or pomades are removed from the skin of the neck."
• Aggressive treatment or exfoliation: Treating breakouts is a slippery slope, and too much of a good thing is possible. Aggressive exfoliation, or trying too many products (especially those containing harsh ingredients, such as glycolic acid or benzoyl peroxide) might exacerbate a breakout, making the problem even worse.
• Stress: While stress alone usually isn't the cause of acne, it certainly doesn't help. In fact, a 2007 study of adolescents found that psychological stress is associated with increased sebum production. In other words: more stress, more problems.
Reach for products containing acne-fighting ingredients.
Waldorf says that any acne therapy you are utilizing on your face should be extended to the neck area. That means utilizing ingredients that fight acne, such as sulfur, benzoyl peroxide, and salicylic acid. "Treat neck acne the same way as acne on the face," she says. "Salicylic acid and benzoyl peroxide are the most common ingredients found in over-the-counter cleansers and medications. Just remember that benzoyl peroxide can bleach fabric, so let it dry before clothing touches it."
These acne-fighting ingredients have anti-inflammatory properties and work to prevent comedones (i.e. blackheads and papules) from forming and can actually destroy acne-causing bacteria beneath the skin. In other words, they offer a one-two punch: drying up current breakouts and preventing future pimples from forming. Because they are so drying, however, both salicylic acid and benzoyl peroxide can lead to red, flaky skin—so be sure to use a daily moisturizer in conjunction.
Clean your clothes regularly.
Because the neck so often comes in contact with your clothing, an unwashed shirt (or an item of clothing in a non-breathable fabric like polyester and rayon) could be the culprit of a breakout. Those who exercise frequently should turn to moisture-wicking clothes, which repel sweat from the body, rather than sticking to the skin. Similarly, a breakout could be the result of an allergy to a detergent. Reach for those marketed for sensitive skin, free from dyes and fragrance, and avoid fabric softeners, which contain a lot of additives that might cause breakouts.
Other common items—sheets, pillowcases, even cellphones—should be cleaned frequently, as well, as they tend to accumulate dirt, oil, and debris. Those with breakout-prone and sensitive skin should aim to wash their pillowcases once per week (though every three days is ideal).
Try laser hair removal.
If breakouts are being noticed along the hairline on the back of the neck, they might be related to ingrown hairs. Folliculitis—which mimics an acne breakout—often occurs around the neck (or anywhere on the body that contains hair follicles). Waldorf says, "Consider laser hair removal in a dermatologist's office so that any inflammation that comes up from ingrown hairs can be treated at the same time."
Not only does the procedure work to remove the hair follicle in the targeted area, but it also closes the skin pore, so infection (and breakouts) are reduced, as a result. Hair removal appears to be especially helpful in targeting breakouts among those who suffer from acne on the neck. In fact, a 2012 study found that those who underwent laser hair removal saw a "significant improvement" in acne keloidalis nuchae, a type of acne that occurs on the scalp and neck.
Visit a professional.
If you've exhausted most of your options, and your neck breakouts are not improving, "see your dermatologist," advises Waldorf. Not only can a dermatologist help determine the root cause of the problem, but they can also prescribe either a topical or oral treatment for acne, such as a prescription-strength retinoid or a pill like Spironolactone.
While antibiotics are most often reserved for those with severe acne and shouldn't be used long-term (as that can lead to antibiotic resistance), they can make a marked improvement in the skin. Recently, though, doctors have begun relying on a combination of therapies, mixing antibiotic treatment with topical creams and laser therapies. A study published in 2019 in the journal Dermatologic Clinics by a group of Rutgers University scientists found that oral antibiotics can aid in reducing acne-causing resistant bacteria strains.
Keep your skin clean by removing makeup effectively.
As Waldorf notes above, some breakouts could simply be the result of failing to wash off all your makeup before or after a workout or before going to bed. Here are the all-natural makeup remover wipes we love (that also happen to feature—and help—adorable polar bears) along with other helpful products for clearing sweat and oil from pores.
Josie Maran's wipes are gentle enough for everyday use, fortified with argan oil (Maran's signature) and a slew of other good-for-you ingredients, like chamomile, aloe vera, and cucumber. They're also biodegradable, making them an eco-friendly choice, and they help support the environment. A portion of the proceeds from every package sold goes toward protecting endangered polar bears.
It might seem counterintuitive, but keeping the skin moist may be integral in warding off breakouts. Kate Somerville's moisturizer is oil-free, so it keeps skin hydrated without clogging pores. It's also fragrance-free and therefore safe for sensitive skin.
Two types of salicylic acid in this cleanser work to treat breakouts and clean pores, even after the product is washed off. The gel-based product also contains green tea extract, which promises to soothe skin.
Maximum-strength sulfur works to dry up oil and acne breakouts while bentonite clay and kaolin are meant to absorb excess oil on the skin. It's not too drying, though, thanks to aloe vera and can be used two to three times per week or as needed.
These little stickers contain salicylic acid to clear pores as well as vitamin A and aloe vera to soothe skin. After cleansing and drying skin, just place one of the stickers over a pimple and wear overnight. After removing, the blemish will be noticeably smaller.
A convenient spray bottle allows for easy access of hard-to-reach areas like the back of the neck. The alcohol- and fragrance-free formula contains a trio of acne-fighters: salicylic acid, lauric acid, and licorice root. The spray can be used daily on clean skin.
Seven percent glycolic acid helps increase cell turnover, combatting dullness and offering mild exfoliation—so the remnants of old breakouts go away and your new skin can shine. With continued use, the product helps keep the skin clear of breakouts. Be warned, though: It's intended for nightly use and should only be applied once per day.
Yosipovitch G, Tang M, Dawn AG, et al. Study of psychological stress, sebum production and acne vulgaris in adolescents. Acta Derm Venereol. 2007;87(2):135-139. doi:10.2340/00015555-0231
Kraft J, Freiman A. Management of acne. CMAJ. 2011;183(7):E430-E435. doi:10.1503/cmaj.090374
Esmat SM, Abdel Hay RM, Abu Zeid OM, Hosni HN. The efficacy of laser-assisted hair removal in the treatment of acne keloidalis nuchae; a pilot study. Eur J Dermatol. 2012;22(5):645-650. doi:10.1684/ejd.2012.1830
Marson JW, Baldwin HE. An overview of acne therapy, part 1: Topical therapy, oral antibiotics, laser and light therapy, and dietary interventions. Dermatol Clin. 2019;37(2):183-193. doi:10.1016/j.det.2018.12.001
Tang SC, Yang JH. Dual effects of alpha-hydroxy acids on the skin. Molecules. 2018;23(4):863. doi:10.3390/molecules23040863