If you struggle with acne or just develop pimples at certain times or in specific areas, you may have experienced under-the-skin pimples. These deeper pimples are often more painful and challenging to treat. According to Dr. Chase Kwon of U.S. Dermatology Partners in Fairfax, Virginia, “When pimples develop beneath the skin, people typically need to receive professional treatment from dermatologists and change up their skincare routine to minimize the associated discomfort, facilitate healing without scarring, and prevent future under-the-skin pimples from developing. Learning to recognize the warning signs of under-the-skin pimples and responding quickly to treat them before they become worse is essential.” In this blog, Dr. Kwon discusses the different types of pimples that may occur under the skin and how they’re treated, in addition to sharing some skin care tips and tricks to prevent breakouts.
Types of Pimples Under the Skin
When it comes to types of pimples, Dr. Kwon says, “Comedones are the types of acne that most people are used to seeing. There are open and closed comedones. Open comedones are frequently referred to as blackheads. They develop on the surface of the skin when pores are clogged but still open. The blackhead that you’re seeing is the clog. A closed comedone is often called a whitehead. A whitehead also represents a clogged pore, but there is a layer of skin cells over the top. These open and closed comedones occur in our pores and hair follicles, so technically they are under the skin. However, they are clearly visible and easily identified on top of the skin. When we talk about under-the-skin pimples, we’re referring to the less common kinds of blemishes that develop deep within skin’s layers.” Many different types of pimples develop under the skin, including:
- Papules & Pustules – These can actually occur on top of or beneath the skin, often presenting as small red bumps. They develop when an open or closed comedone becomes infected. Sometimes, the infection stays on top of the skin. Other times, it goes deeper beneath the skin.
- Nodules – This type of pimple develops within the deeper layers of the skin. While there aren’t always visible signs of nodules, they can be painful to touch.
- Cysts – This type of pimple develops within deeper skin layers, but it usually leads to large, painful lumps or bumps encroaching upon the surface of the skin. It can be tempting to “pop” such cysts to relieve the painful pressure and improve the cosmesis, but this can push the infection deeper and increase the risk of scarring.
- Cystic Acne – This form of acne is characterized by blackheads, whiteheads, and cysts, which tend to be more prevalent than the surface-level pimples, and can be challenging to treat.
- Nodulocystic Acne – This form of acne is marked by cysts and nodules and is often refractory to conventional acne treatment.
- Acne Conglobata – This is a severe form of acne that occurs when people develop numerous nodules below the skin that spread and connect to each other, forming nodule clusters that can be extremely painful.
Why Beneath-the-Skin Pimples Develop
Acne and pimples of all kinds typically first appear during the teenage years when hormone levels fluctuate, leading to increased production of the skin’s natural sebum (oil). This is also true for pimples that develop beneath the skin, but these deeper types of blemishes are less common. Cystic acne, in particular, is linked closely to the increased production of androgen hormones and rapid cellular growth characteristic of adolescence. In addition to the changes to the skin and body that occur during teen years, Dr. Kwon outlines some of the common causes of pimples beneath the skin including:
- Hormone shifts outside of adolescence, including pregnancy, menopause, various forms of hormonal contraception, and exogenous testosterone
- Reactions to cosmetics, skincare products, or cleansers and detergents
- Living in areas with high humidity
- Sweating frequently or excessively, especially while wearing materials that don’t allow air flow including face masks
- Exposure to chemicals, toxins, allergens, or irritants in the environment
- Genetic inheritance if one or more family members struggle with acne
- Use of certain medications, including many cancer treatments, various B vitamins, lithium, and systemic and topical corticosteroids
How to Get Rid of Pimples Beneath the Skin
Before you try to extract a pimple beneath the skin at home, Dr. Kwon cautions, “No matter how many pimple-popping videos you watch online, you should not try to pop or extract a pimple at home. This is especially true for pimples that develop beneath the skin. You’ll only be able to see and access a small part of these pimples, and in many cases, the underlying pimple is much larger and more serious. It’s very important to consult with a dermatologist who can safely remove the pimples or provide other treatments to relieve them.”
Some dermatologic treatments that may be recommended for pimples beneath the skin include:
- Surgical removal or drainage – A dermatologist will safely remove and/or drain a cyst or other pimple. With professional removal, you minimize the risk of scarring and serious infection.
- Steroid injections – Injected steroid treatments (cortisone injections) are often recommended to help reduce inflammation, pain, and swelling related to pimples beneath the skin, allowing patients to heal more comfortably, in addition to providing a quick and easy fix before important social events
- Topical agents – Medicated cleansers or creams (over-the-counter or prescription as needed) may be used to clear up the pimple and promote healing, in addition to minimizing the development of new acne.
- Isotretinoin (Accutane) – A highly effective form of systemic treatment to decrease the effects of pimples under the skin by helping to clear up existing breakouts and prevent breakouts in the future. It is often recommended for cystic acne, nodulocystic acne, and acne conglobata.
- Oral contraceptive pills – Teenage girls and young adult females with moderate to severe forms of treatment-resistant acne may be prescribed oral contraceptives to stabilize hormone levels and diminish the frequency and severity of acne breakouts, especially ones that seem to occur every month during the week prior to menses and/or favor the jawline.
Preventing Under-the-Skin Pimples
According to Dr. Kwon, “The deeper pimples that develop beneath the skin can be much more difficult to treat. They are associated with an increased risk for scarring and infection, and they can spread beneath the skin if not properly addressed. For this reason, it’s essential that a dermatologist helps with the initial and ongoing treatment of these deeper blemishes. However, there are some at-home skincare steps you can take to prevent breakouts and promote healing during an active breakout.”
To prevent breakouts, you can take the following preventive skincare steps:
- Wash your face in the morning and evening using a gentle, non-comedogenic (won’t clog your pores) face wash. You should also wash your face any time you sweat, but don’t over-wash by using strong astringents or washing too often as this can cause unnecessary irritation, ultimately leading to more pimples and inflammation of the skin.
- You should exfoliate regularly but gently. Exfoliants that are too harsh can cause swelling and irritation that may keep pores clogged and increase the risk of pimples beneath the skin. However, it is important to remove dead skin cells, so they don’t become trapped and clog pores. If you need help developing an effective exfoliating routine that won’t irritate your skin, talk to your dermatologist. You can also explore the variety of dermatologist-recommended exfoliants available from DermSkincare.
- Apply acne spot treatments as necessary to the affected areas during an active breakout. The Epionce Purifying Spot Gel is a great option to soothe inflamed skin and promote healing.
- Use a moisturizer every time you wash your face. It may seem counterintuitive to moisturize skin, especially if oiliness is a contributing factor in your breakouts, but if you don’t moisturize, your skin will continue producing excessive amounts of sebum oil, increasing the risk of breakouts.
- Avoid picking at skin, popping pimples, or using harsh exfoliants during a breakout. This can increase skin irritation and inflammation, which makes it more likely for the skin to scar. Popping or picking at pimples also increases infection risk.
- For the same reason, it’s important to be very careful when removing hair on or around pimples. Plucking, waxing, and shaving all impact the hair follicles, and causing irritation in the hair follicles can trigger inflammation that traps oil, skin cells, and other materials inside the follicle, leading to the development of pimples beneath the skin.
- Evaluate all cosmetics, skincare, and cleaning products carefully. Find products that are labeled as non-comedogenic, non-acnegenic, acne-free, or oil-free. This will help to prevent clogging pores. You should also look for products with acne-fighting ingredients like salicylic acid, benzoyl peroxide, and topical retinoids.
- Take stress relief into account. Stress causes an increase in cortisol production, which has been closely tied to acne breakouts. By reducing stress, you can help minimize the risk of breakouts and ensure you heal more quickly during an active breakout.
Always Consult with a Professional
When acne develops, especially under-the-skin acne, it is very important to consult with a dermatologist. Our skincare professionals, like Dr. Chase Kwon, partner with patients to help you treat existing breakouts and develop a long-term plan for effective ongoing skincare routines so that you can feel healthy and confident in the skin you are in. If you need help dealing with under-the-skin pimples or any other skin-related concerns, please reach out to the trusted team at U.S. Dermatology Partners. We will be happy to help you explore treatment options and find the best skincare products for your daily routine. Getting started is quick and easy. Simply take a few moments to complete our online scheduling request form. A member of our team will be in touch to finalize the details of your visit.
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