We get asked this all the time! You get one of those enormous zits right at the worst time and you just want it gone. We understand. But, is it okay to take matters into your own hands and start squeezing away?
The short answer is: it really is best to keep your hands off! Definitely do not pick at your acne. Picking will put you on the path to infection, scarring, and worsening acne. However, if you must do something about that giant pimple that seemed to have popped up overnight, try to see your dermatologist first. You must make sure you know what you’re treating, and your dermatologist can guide you best on a case-by-case basis. As dermatologists, we offer in-office treatments that are safer and more effective than those you might try at home. However, if you just can’t wait, it is important to consider the type of “zit” you have before you proceed to squeeze away. To help guide you, let’s talk about the different kinds of acne lesions:
1. Blackheads and whiteheads: We call these “comedones” in doctor-speak. They are clogged sebaceous glands (“pores”) that develop a black plug (blackhead) or are covered by skin (whitehead).
If you have a lot of blackheads, you can often gently exfoliate them away or have them extracted. You can also use a blackhead remover (such as Biore pore strips) or a mask (such as one with salicylic acid) to help loosen them up. Using an exfoliating cleansing brush like Clarisonic can help as well, however you don’t want to be too aggressive or you can irritate the skin and cause more redness. In the office, we can extract problematic blackheads and help reduce them with topical creams and washes. We know it is tempting to squeeze them out yourself, but be gentle! Too much squeezing can cause rupture of the blackhead and the follicle around it, leading to inflammation, so that you actually can cause a pimple to form! You can use two cotton swabs and use gentle pressure or try a comedone extractor, but go easy so you don’t make conditions worse. And it is best to do extractions when your skin is hydrated and warm, such as after a warm shower or from steam from hot water running in the sink. (Be careful! Don’t use boiling water and don’t burn yourself!)
Those whiteheads are a different matter–these plugged pores lead to tiny whitish or skin-colored bumps on the skin but are not actually red pimples since they are not inflamed. Whiteheads are not to be confused with pustules, which are red bumps that appear white or yellowish in the middle because of pus in them. Since there is actually skin overlying whiteheads, it’s important not to squeeze them out as the resistance you face will probably cause damage to the skin and trigger inflammation (redness and swelling)! Let your dermatologist help you tackle those.
2. Inflammatory Papules: These are those red bumps that can be quite tender. They may go on to become pustules as the inflammation becomes more localized near the surface of the skin, but while they are red, squeezing won’t help a bit. So don’t try to pop these! Instead, you can try an anti-acne cream, such as one with benzoyl peroxide. Avoid using steroid creams such as hydrocortisone, as this can actually lead to more acne over time! Warm compresses, such as cotton balls soaked in warm water and applied to the spot, may help the bump come to a head, and ice (wrapped in a clean washcloth) may help with the soreness, redness, and swelling, so alternating between those can help move things along. If you get a lot of these, see your dermatologist so we can treat and help prevent new ones.
3. Cysts: These are the really difficult acne lesions because they are larger (often ¼ inch or bigger), deeper set and usually painful. Cysts may never come to the surface but rather can stay lurking deeper down. Because cysts can become very inflamed, they can lead to increased risk of scarring and discoloration. It’s very important that you leave these lesions alone and don’t try to pop them, as you’ll only make the problem worse and risk infection, skin discoloration, and scarring. Using warm compresses can help them come to a head, while cool compresses for very tender lesions can help with the symptoms until you can be seen in the office. We often inject these in the clinic with a cortisone shot to help calm down the inflammation, and work on a strategy to prevent them from forming.
4. Pustules: Many inflammatory papules eventually become pustules, where the inflammation forms a ball of pus under the skin. These usually break on their own over time, draining the pus and eventually healing. While we don’t recommend that you do a lot of pimple popping, pustules may sometimes be safely drained at home, if you follow the proper steps. First, you’ll need to wash your hands and clean the pustule properly, such as with soap and water or an alcohol wipe. You can then use a pin that has been sterilized, such as with alcohol or with a match held to it for 10-15 seconds (let it cool!), to lance the pimple. But don’t go straight into the pimple–ouch! Hold the pin parallel to the skin and just make a small opening in the top of the pimple through the skin. This shouldn’t hurt because there are no nerves in the very top layers of skin. Then very gently use two cotton swabs or a comedone extractor with mild pressure to help the pustule drain. Try not to squeeze too hard, and if you get blood, stop! You’re not going to help it by draining blood, and any squeezing can drive some of the pimple contents deeper into the tissue, making things worse. Hold gentle pressure or ice (wrapped in a clean washcloth) to the area, then dab some a topical acne medication such as benzoyl peroxide on the spot. If you have a lot of pustules, be sure to have a dermatologist take a look. Some bacterial infections can look like acne, so let a professional weigh in.
So, now you’re prepared for any acne emergency! Remember, it’s best NOT to treat your own acne by popping pimples, but if you must, use the least traumatic and most gentle technique to avoid unwanted consequences. When in doubt, keep your hands off! You don’t want the spot to get worse, become infected, or end up with a brown spot or a scar. We’re here to help, so come on it if you need help with your acne, whatever the type.