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Acne Mechanica

After removing his football helmet, Walt, a high school football player, notices acne developing on his forehead and chin where his helmet rubs his face. Jim, a twenty-year-old soldier, is getting acne on his shoulders and back. Sharon, a professional violin player, is bothered by acne on her neck that appears just below her ear, where she tucks her violin against her neck when playing.

What all of these people have in common is acne mechanica, a form of acne caused or aggravated by heat, covered skin, constant pressure and repetitive friction against the skin.

Causes
Common sports-related causes of acne mechanica are:

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      Helmets and helmet straps, especially those worn by football and hockey players and motorcycle riders
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      Shoulder pads and straps worn by football players
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      Tight uniforms made of synthetic fabric
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      Tight headbands worn by soccer players and runners
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      Straps and packs on backpacks

Other common causes of acne mechanica are:

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      Straps used by soldiers for weapons and equipment
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      Headbands worn for long periods of time
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      Musical instruments, such as the violin, tucked against the neck for hours
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      Tight fur caps worn for long periods of time
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      Tight clothing, such as jeans and underwear made of synthetic fabric
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      Snug bra straps
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      Adhesive tape that remains on the skin for several days (occasionally)

   



A typical outbreak of acne mechanica that developed on the thigh of a 24-year old man who wore tight jeans. The acne consists of papules on his thighs and calves.


(Photo used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides)

Some factors that increase the likelihood of developing acne mechanica are:

Having sandpaper acne. Small, undeveloped lesions (microcomedones) on the skin that are nearly invisible but feel rough to the touch are called sandpaper acne. When aggravated, sandpaper acne can quickly become the more active and inflamed acne of acne mechanica.

Predisposition for non-facial acne. Teens and people in their 20s who have a predisposition for developing acne on the shoulders, back and buttocks have an increased risk for developing acne mechanica when factors, such as constant friction, are present.

Being a soldier in the tropics. The heat and humidity of the tropics can also aggravate the skin, especially for soldiers in their teens and 20s. When heat and humidity are combined with the pressure and friction caused by packs and weapon straps, this creates what is called “double whammy” and greatly increases the likelihood of a soldier developing acne mechanica.

Prevention
The good news is that there are measures that may help prevent acne mechanica. These include:

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      Wear a clean cotton T-shirt under a sports uniform. Cotton absorbs perspiration and reduces friction against the skin from the uniform.
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      Shower immediately after athletic activities. Wash the chest, back and buttocks and areas that were under straps, padding or tight uniform. Liquid cleansers containing salicylic acid are useful for removing surface oils and unclogging pores.
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      Avoid covering the forehead with a headband or cap for prolonged periods

Treatment
Applying a topical (applied to the skin) acne medication that contains salicylic acid or benzoyl peroxide to the lesions as soon as they appear is often effective. Another effective method is to eliminate the cause of acne mechanica. This, of course, is not always possible. A professional violinist cannot stop playing the violin. Soldiers cannot stop carrying packs and weapon straps. A dermatologist may be able to suggest other effective treatment.