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We need to talk about bacne: meet the Bacne Buster, Pamela Marshall

Suffering from bacne? We got your back

Bacne. Aka back acne. Aka the less talked about, less visible, but nonetheless equally irksome relative of acne. Despite the growing skin positivity movement, thanks to years of entrenched stigma not everyone feels entirely comfortable embracing their pimples. And that’s ok. Because, from salicylic acid to benzoyl peroxide, the market is saturated with products promising to clear your skin. However, so far these products have been marketed mainly to treat your face. But, of course, it’s not just the pores on your face that get clogged. Acne can appear anywhere on your body where sweat glands are present, including your hard-to-reach, hard-to-see back. So what should you do when bacne crops up?

To find out, who better to call on than Bacne Buster Pamela Marshall. We caught up with the clinical aesthetician and co-founder of bespoke skin clinic Mortar & Milk to get to the bottom of bacne.

How did you become the Bacne Buster?
Pamela Marshall:
I think it spread through word of mouth that I have a way with acne. Everything I've done leading up to now has always been about being on this path. I suffered from acne myself, bacne included, in my late 20s and early 30s. I was a journalist at the time, and once I cleared it, I knew I had to help other people.

I am utterly fascinated with how the skin functions, and how the body affects our skin. I trained as an Aesthetician in California and had my own clinic for years. When I moved to London in 2010 I did further study through Sally Durant Consulting and earned my Clinical Aesthetician title. That training was a defining moment for me. My husband Nick and I opened Mortar & Milk on a whim and a prayer with the idea that we could change the way skin was looked at. Three years on, I believe we've done that. 

What is it you do specifically? Why do you do it?
Pamela Marshall: We work differently that most other clinics. Every new client, no matter who you are, must begin with a two hour treatment. The first hour is an exhaustive consultation followed by an hour long treatment. We are investigators. We will ask questions that seem so random and out there, but those questions allow us to put a puzzle together. We are trying to figure out the 'why'. Rather than just do a treatment and send clients on their way, we dig deep to figure out why things are going awry.

We also keep in close contact with our clients. This means they have access to us daily. Keeping that connection is important because it means the client has us to bounce thoughts off of, to ask questions, and sometimes just to say “what the fuck is happening?” I created this because I've sat on the other side. I know how awful it feels to walk out in public with cystic acne. It can consume your every thought and that's just not healthy. I have, for the most part, figured out the acne answer and I want to share it with as many people as possible. There is not much better feeling than having a client send you photos saying "thank you for changing my life". We get these nearly every day.

Can you tell us a bit about bacne? What is it? What causes it?
Pamela Marshall:
Bacne is literally acne on the back and can happen for a multitude of reasons. Hormonal changes (high androgen levels), excessive sweating (taking up a new fitness regime and not changing/showering soon enough), sleeping in dirty sheets, wearing clothes that don't breathe. The list goes on.

How is it different to acne? What is it about the back that lends itself to acne?
Pamela Marshall:
It's not actually that different from the acne we have on our face. The difference lies in the thickness of the skin on our back versus the thickness of the skin on our face. The thicker the skin, the harder it is to clear. We also wear clothes on our back all day long. So if we sweat, or have bacteria built up, or are wearing dirty or non-breathable fabrics, then we are disrupting the functionality of the skin. Underneath every pore we have something called a pilo-sebaceous unit. It's a tear-drop shaped and I always talk about it as being the "engine room" of our skin. The PSU really likes equality and homeostasis, so if we have too much bacteria, or dead skincell build up, or excessive oil production, the PSU goes a bit nuts. Its inside lining swells to a close. The contents (sebum, dead cells and bacteria) are desperately trying to get out, but because the PSU is swollen, they can't get out. So it creates an inflammatory response....or a spot.

Who gets it?
Pamela Marshall: Anyone can get bacne. In males, it tends to happen in teens and 20's, although it can happen at any age. Boys and young men have high Androgen (male hormone) levels. Androgen (when in abundance) will send a message to our sebaceous glands (which sit on the outside of the PSU) to produce oil. Our sebaceous glands go into oil production overload. As I mentioned before, when there is too much of any one thing the PSU swells to a close ultimately causing a spot. As a man ages, generally their Androgen levels decrease and acne and bacne will calm down. However, fitness people who use whey protein will often experience acne on the face and back. This is due to whey protein increasing our hormone IGF-1 levels, it also increases our cell production and inflammation. This all comes back to that PSU wanting homeostasis. Women/teens are more likely to deal with acne and bacne off and on throughout their lives, rather than waning off as they age like men do. Women are consistently having hormonal fluctuations, so we are always fighting imbalance. It works the same way, but as women we will find it hard to keep the body in harmony.

What are the different treatments out there for it?
Pamela Marshall:
This is a tough one. I am a big believer in lifestyle changes. Getting clients off of whey protein, cleaning their sheets once a week, sorting out gut function, and changing their clothes/showering after a workout are critical to success. Alongside this we will use Mandelic Acid in treatment at a low pH to clear out the pore. Mandelic is lipophilic so goes into the PSU and breaks down the excess sebum, bacteria and dead cells. At home, I always recommend Clinisept which is a neutral pH spray that kills bacteria, and a moisturiser called Night Renewal Hydragel which is a combination of Mandelic Acids (an AHA) and Polyhydroxy Acids (PHA). PHA's work beautifully alongside AHA's to clear out spots, but increase hydration so that the sebaceous glands are not continually triggered to make more oil. Outside of hormones, when the skin is dehydrated it will actually send messages to the PSU (just like Androgen does) to produce more oil. Therefore, deep hydration is critical to calming and eliminating all acne.

What are the misconceptions about bacne?
Pamela Marshall: A lot of people think it happens due to people being dirty. While that can be the case, it's often isn’t. Hormonal fluctuations are bastards and you can be the cleanest person in the world, and still have bacne.

How do you hope to challenge the stigma of it?
Pamela Marshall: Through education. If I can educate each client individually, and then educate the masses through interviews and written education, not only do I hope to reduce the stigma, but also to reduce the occurrence of any kind of acne or inflammatory skin conditions. Knowledge is power. If you give your clients the correct scientific knowledge, not brand-speak, then that's half the battle.

By “busting” bacne do you worry that you are furthering the stigma surrounding it? Should bacne be busted?
Pamela Marshall: Yes, bacne (and acne) should be busted and no I don't feel I am furthering the stigma around it. Acne of all sorts, and inflammatory skin conditions, stem from our body and lifestyle being off balance. If I can have clients make a few changes in their lifestyle, including some diet changes and being more hygienic, then I have helped them find a better physical wellness, but more importantly mental wellness. Acne is a bitch and I plan to knock her out. 

What are the most rewarding parts of your job?
Pamela Marshall: There are days where I am metaphorically on my knees running a business. It's not for the faint at heart. We get very emotionally involved in our clients. It can be incredibly overwhelming. But then you get a text or email from a client that says "thank you so much for changing my life... or making me look beautiful on my wedding day...or making it so that I don't feel embarrassed to go out in public,” those messages are everything. They keep us all going in what is a very emotional job. I love seeing the look on someone's face when I teach them about molecular weight and pH and they have an ‘aha’ moment. The eyes widen, and they suddenly go "ah that's why nothing has ever worked before". It's an incredible feeling to be able to lend knowledge and empower another human.

What are your skincare dos and don’ts?
Pamela Marshall: Do use PHA's in most of your products, do sort your gut out, do take your cleanser off with a flannel, do make sure you're drinking plenty of water and getting your essential fatty acids daily, do wash your sheets weekly, do clean your make-up brushes, and for the love of all things disinfect your phone every single day. Don't sleep in dirty sheets. Don't touch your face. Remember to wash, condition and rinse your hair in the shower and THEN wash your back and body. Conditioner is formulated to adhere to the hair shaft which can cause bacne and acne on the bum cheeks. Don't, above all else, use too many AHA's on your skin. AHA's are glorious in doses, but not every day. They create a wound and if you wound yourself every day, it will never heal causing more acne and acne scarring. Don't listen to the noise, and do your homework. Do not go straight to Roaccutane. Watch this space as we try to get out information out to the masses.

What are you working on at the moment? 
Pamela Marshall: I spend an enormous amount of time in the treatment room, but we are trying to open our second location, create a single clinical product for happy skin, AND writing a book that takes science and puts it into words that are understandable. No one should suffer, so I want to educate.