If I remember correctly, Acne on back and shoulders indicates hormonal problems. Since it's the liver that regulates most hormones, it should go away with flushing. Just be prepared that it might take 10+ flushes. You also need to do a thorough Colon Cleanse simultaneously as skin problems are heavily related to colon health too. Go to askshelley.com and read the faq there, it was very useful info.