“If topical treatment alone does not improve acne, or if acne is severe or extensive, oral medications are the best option. If you’ve tried several topical medications without success, or if your condition is severe, oral acne medications are usually the next step in the treatment process. Treatment usually includes oral antibiotics and applying a prescription gel or topical cream to the skin. Depending on people with acne, treatment may include using prescription creams to prevent acne, taking antibiotics to kill bacteria that contribute to acne, or, if acne is severe, taking stronger medications such as like isotretinoin, or even minor surgery. Even if you have tried topical acne treatments such as creams or gels without any lasting results, laser therapy may be the right solution for you. While I would like you to try natural remedies first, if you are not seeing improvement and severe hormonal acne is making your quality of life worse, other treatments can make a real difference. While it may take a while, treating hormonal acne from the inside out until your hormones are in their natural, happy balance will allow your skin to truly heal.

While my approach isn’t an instant solution, and won’t replace everyone’s multi-drug regimen, hormonal acne can be very sensitive to a more holistic approach, which means less medication and more patches. While the studio treatments offered by Carolina Skin Care can be very effective in treating acne, patients should also commit to taking care of their skin at home. Multiple topical treatments, whether it’s steroids for eczema or topical antibiotics for acne, topical treatments may help in the short term, but in the long run, it can damage the skin, making you more likely to take it in the future. In addition to other treatments, you can take the most obvious step to soothe stress-related acne: reduce stress. If the creams and antibiotics you have been prescribed are not working, or if you cannot tolerate the side effects that medications may cause, you may want to consider acne treatments, which can be provided at your doctor’s office. Other treatments include birth control pills to control acne, hormonal drainage and extraction, and laser and phototherapy.”

Here’s a breakdown of why huge pimples form and how to treat them properly:

1. Why Huge Pimples Form:

A huge pimple (usually called a cystic acne pimple or nodule) forms when a pore gets severely clogged with oil, dead skin cells, and sometimes bacteria. This causes the follicle to swell, and the body reacts by inflaming the area. The pimple fills with pus (a mixture of dead white blood cells, bacteria, and tissue), which is what leads to that pressure and, ultimately, the “squirt” when you try to pop it.

2. The Danger of Popping Pimples:

Popping a pimple—especially a large one—can cause more harm than good. Here’s why:

• Infection: When you pop a pimple, you create an opening in the skin, which can allow bacteria to enter and make the infection worse.
• Scarring: Squeezing can damage the skin and lead to scarring, which can last far longer than the pimple itself.
• Spreading Bacteria: The pressure from popping can push bacteria deeper into the skin, which can cause more pimples to form around the area.

3. What to Do Instead:

If you’re dealing with a large, painful pimple, here’s how you can treat it properly:

a. Apply a Warm Compress:

A warm compress helps to reduce swelling and brings the pimple to a head. Soak a clean cloth in warm water and place it on the pimple for 10–15 minutes, several times a day. This can help soften the pimple and make it easier for it to heal naturally.

b. Topical Treatments:

• Benzoyl Peroxide: This ingredient helps to kill the bacteria inside the pimple and reduce inflammation. You can find it in over-the-counter treatments.
• Salicylic Acid: This can help exfoliate the skin and break down the clogged oils inside the pore. It can also reduce swelling and redness.
• Hydrocortisone Cream: For really painful, swollen pimples, a tiny dab of hydrocortisone cream (like 1%) can help reduce inflammation and pain. But only use it for a short time to avoid thinning the skin.

c. Avoid Touching or Picking:

As tempting as it is, try to leave the pimple alone. Picking or squeezing it can make it worse, as mentioned earlier. If you really feel like you need to get rid of it, try to use an acne patch (hydrocolloid patch) to draw out the pus while keeping the area clean and protected.

d. Seek a Dermatologist for Cystic Acne:

If you get huge pimples regularly (cystic acne), it might be worth seeing a dermatologist. Sometimes, strong topical treatments or even oral medications (like antibiotics or retinoids) are needed to keep acne under control.

4. If You Really Can’t Resist:

If you absolutely must pop a pimple, follow these steps to minimize the risk:

• Wash Your Hands: Always wash your hands thoroughly before touching your face.
• Clean the Area: Gently cleanse the area around the pimple with a mild cleanser.
• Sterilize a Needle: Sterilize a needle with rubbing alcohol, and gently puncture the head of the pimple (just the top, not deep into the skin).
• Gently Apply Pressure: Use clean tissue or cotton swabs to gently apply pressure around the pimple. Don’t force it! If it doesn’t come out easily, stop.
• Apply an Antiseptic: After, apply an antiseptic (like hydrogen peroxide or an acne treatment) to prevent infection.

5. Long-Term Management:

To prevent future huge pimples, you may need a consistent skincare routine that includes:

• Cleansing: Cleanse your face twice daily to remove excess oil and dirt.
• Exfoliating: Exfoliate with products containing salicylic acid or alpha-hydroxy acids to prevent clogged pores.
• Non-Comedogenic Products: Make sure all your skincare and makeup products are non-comedogenic (won’t clog pores).

1. Formation of Huge Pimples (Cystic Acne):

Huge pimples are often referred to as cystic acne or nodular acne. These types of pimples occur deeper within the skin and are often more inflamed, painful, and filled with pus.

How Do They Form?

• Clogging of Pores: When pores become blocked by a mixture of sebum (skin oil), dead skin cells, and bacteria, the follicle becomes clogged. If the clog is deep in the skin, the body reacts by increasing inflammation in the area, resulting in a red, painful pimple that can grow large.
• Bacterial Infection: The clogged follicle can harbor bacteria, specifically Propionibacterium acnes (P. acnes), which further exacerbates the inflammation and pus production.
  • Reference:
    • “Pathogenesis of Acne Vulgaris: A Review of the Literature” by M. Zouboulis in The Journal of Dermatology (2009) discusses the microbiology of acne and the inflammatory processes involved in the formation of cystic lesions.

2. Why You Should Avoid Popping Pimples:

Popping pimples can lead to various complications, including scarring, infections, and worsening of the acne.

Infection and Bacterial Spread:

• When you pop a pimple, you create a small wound in the skin, which can allow bacteria (even more P. acnes) to enter and lead to further inflammation and potential infection. Additionally, squeezing the pimple can push bacteria deeper into the skin, leading to more breakouts.
• Reference:
  • A study published in The Journal of Clinical and Aesthetic Dermatology (2012) states that squeezing pimples can lead to the risk of post-inflammatory hyperpigmentation and scarring, particularly with cystic acne.

Scarring:

• Squeezing a pimple can damage the skin and the underlying tissue, which increases the chances of scarring. The more you pop pimples, the more you risk permanent scars, which are much harder to treat than the pimple itself.
• Reference:
  • In a review from The British Journal of Dermatology (2011), it was highlighted that repeated trauma to the skin, such as popping pimples, significantly contributes to the formation of acne scars.

3. How to Treat Huge Pimples Safely:

Warm Compress:

• Applying a warm compress to a large pimple helps soften it and encourages the pus to surface naturally. The heat helps open up pores, reduces swelling, and can provide some pain relief. Applying it 3–4 times a day for 10–15 minutes can significantly help.
• Reference:
  • A study published in The Journal of Dermatological Treatment (2009) discusses the effectiveness of warm compresses in reducing inflammation and promoting the drainage of large acne lesions.

Topical Treatments:

1. Benzoyl Peroxide:
   • Action: Benzoyl peroxide is a well-known acne treatment that helps kill acne-causing bacteria, reduce inflammation, and prevent clogged pores.
   • Reference:
     • In a study from Dermatology and Therapy (2015), it was found that benzoyl peroxide significantly improved both inflammatory and non-inflammatory acne, including large cystic acne lesions.
2. Salicylic Acid:
   • Action: Salicylic acid is a beta-hydroxy acid (BHA) that penetrates the pores, helping to exfoliate dead skin cells and break down the sebum that causes clogged pores. It also helps reduce redness and inflammation.
   • Reference:
     • Research in The Journal of Drugs in Dermatology (2006) supports the use of salicylic acid for reducing comedonal and inflammatory acne, including cystic acne.
3. Hydrocortisone Cream:
   • Action: A small amount of hydrocortisone cream (1%) can help reduce inflammation and pain associated with a large pimple. However, it should only be used sparingly and not on a long-term basis, as prolonged use can thin the skin.
   • Reference:
     • A study in Clinical Dermatology (2003) mentions that corticosteroids like hydrocortisone are effective in reducing acute inflammation in inflamed acne lesions, but they should be used cautiously.

Acne Patches:

• Acne patches (hydrocolloid patches) are a non-invasive way to treat large pimples. These patches help absorb excess fluid and reduce the size of pimples overnight, while also protecting the area from bacteria and dirt.
• Reference:
  • In a study published in The Journal of Clinical and Aesthetic Dermatology (2018), hydrocolloid patches were shown to be effective in promoting the healing of acne lesions by reducing moisture loss and preventing secondary infection.

4. Long-Term Acne Management:

Topical Retinoids:

• Action: Retinoids (e.g., tretinoin) promote skin cell turnover, preventing pores from becoming clogged with dead skin cells. They also help with inflammation and can prevent acne scars by speeding up healing.
• Reference:
  • The British Journal of Dermatology (2009) found that topical retinoids significantly improve acne by preventing the formation of comedones (blackheads and whiteheads) and reducing inflammation.

Oral Medications:

For people with frequent cystic acne, a dermatologist may recommend oral treatments such as antibiotics (to reduce bacteria and inflammation) or oral retinoids like isotretinoin (for severe acne).

• Reference:
  • According to The Journal of the American Academy of Dermatology (2016), oral isotretinoin is highly effective for treating cystic acne that doesn’t respond to topical treatments.

Conclusion:

While it’s tempting to pop large pimples, doing so can worsen the situation and lead to long-term skin damage. Instead, using warm compresses, topical treatments like benzoyl peroxide, salicylic acid, or hydrocortisone, and letting the pimple heal naturally is the safest approach. If acne becomes a chronic issue, consulting a dermatologist for prescription treatments or professional procedures like chemical peels or laser therapy is a great option.

References:

1. Zouboulis, M., “Pathogenesis of Acne Vulgaris: A Review of the Literature”, The Journal of Dermatology, 2009.
2. “Post-acne scarring: A review of the pathophysiology, prevention, and management”, British Journal of Dermatology, 2011.
3. “Topical therapies for acne vulgaris”, Dermatology and Therapy, 2015.
4. “Use of Salicylic Acid in Acne Treatment”, The Journal of Drugs in Dermatology, 2006.
5. “Treatment of Acne with Benzoyl Peroxide and Salicylic Acid”, The Journal of Clinical and Aesthetic Dermatology, 2018.

Short-Term Solutions (Immediate Relief)

1. Warm Compress

• Why it works: A warm compress helps bring a pimple to a head by softening the skin and encouraging the pus to surface. It also reduces inflammation and can alleviate some pain.
• How to do it:
  1. Soak a clean washcloth in warm water (not hot!).
  2. Place it over the pimple for about 10-15 minutes, 3-4 times a day.
  3. Re-soak the cloth as needed to keep it warm.
• What it does: This helps to bring down swelling and encourages the pimple to naturally heal by bringing the pus to the surface.

2. Topical Treatments (Spot Treatment)

• Benzoyl Peroxide (2.5%-10%):
  • How it works: Benzoyl peroxide kills the bacteria P. acnes inside the pimple, reduces inflammation, and dries out excess oil.
  • How to use it: Apply a thin layer directly to the pimple once or twice a day after cleansing. Start with a lower concentration to avoid irritation.
  • Reference: A study in Dermatology and Therapy (2015) found that benzoyl peroxide is effective for both inflammatory and non-inflammatory acne lesions.
• Salicylic Acid (0.5%-2%):
  • How it works: Salicylic acid penetrates pores to break down the oil and dead skin cells, reducing congestion and helping to clear out the pimple.
  • How to use it: Apply a small amount directly onto the pimple once a day. It can be found in many over-the-counter acne spot treatments.
  • Reference: Research in The Journal of Drugs in Dermatology (2006) confirms that salicylic acid is effective in treating cystic acne and reducing the frequency of breakouts.
• Hydrocortisone Cream (1%):
  • How it works: Hydrocortisone helps reduce swelling and pain associated with large pimples. It’s a mild steroid that calms the inflammation.
  • How to use it: Apply a thin layer directly to the pimple, no more than once a day for a few days.
  • Warning: This should only be used short-term to avoid thinning the skin.
  • Reference: Clinical Dermatology (2003) explains how hydrocortisone works to reduce inflammation in inflamed acne lesions.

3. Acne Patches

• Why it works: Hydrocolloid patches (like Mighty Patch or Cosrx Acne Pimple Master Patch) can absorb excess pus and fluid from the pimple, while protecting the area from bacteria and dirt.
• How to use it:
  1. Cleanse the area and dry it thoroughly.
  2. Place the acne patch directly over the pimple.
  3. Leave it on overnight, or as directed by the product.
• What it does: The patch creates a barrier, reduces pressure on the pimple, and can help heal it more quickly.
• Reference: A study in The Journal of Clinical and Aesthetic Dermatology (2018) showed that acne patches reduce healing time and protect the area from further irritation.

Long-Term Solutions (Prevention & Ongoing Care)

1. Topical Retinoids (e.g., Tretinoin, Adapalene)

• Why it works: Retinoids increase skin cell turnover, preventing clogged pores and reducing the formation of new pimples. They also help reduce inflammation and promote faster healing of acne.
• How to use it:
  1. Apply a pea-sized amount to your face at night after cleansing, avoiding sensitive areas like around the eyes and mouth.
  2. Start with a lower concentration (0.025% or 0.1%).
• What it does: Retinoids prevent acne by speeding up cell turnover, which helps keep pores clear of oil and dead skin cells.
• Reference: In The British Journal of Dermatology (2009), it was found that retinoids are highly effective for treating both inflammatory and comedonal acne, including cystic acne.

2. Oral Antibiotics (For Persistent or Severe Acne)

• Why it works: Oral antibiotics like doxycycline or minocycline are often prescribed for moderate to severe acne. They reduce inflammation and target the bacteria that cause acne.
• How to use it: These are usually prescribed by a dermatologist, and you take them as directed for several weeks or months. Your doctor may also recommend topical treatments alongside oral antibiotics.
• What it does: Oral antibiotics reduce bacterial growth and calm inflammation, helping to prevent new breakouts from forming.
• Reference: A review published in The Journal of the American Academy of Dermatology (2016) notes that oral antibiotics are highly effective for managing moderate to severe acne, including cystic acne.

3. Isotretinoin (Accutane) – For Severe Cystic Acne

• Why it works: Isotretinoin (brand name Accutane) is one of the most powerful treatments for severe acne. It works by reducing the size and activity of sebaceous glands, thereby lowering oil production and preventing clogged pores.
• How to use it: This is an oral medication that requires a prescription from a dermatologist. It’s typically taken for 4-6 months.
• What it does: Isotretinoin works on a deeper level to treat cystic acne by reducing oil production, preventing clogged pores, and reducing inflammation.
• Warning: Isotretinoin can have side effects, including dryness, and it’s important to monitor it with a healthcare provider. It’s also not recommended for use during pregnancy due to risks of birth defects.
• Reference: The Journal of the American Academy of Dermatology (2016) reports that isotretinoin is highly effective for treating severe cystic acne that hasn’t responded to other treatments.

4. Gentle Skincare Routine

• Why it works: A consistent skincare routine can help prevent acne by keeping your skin balanced, clean, and properly hydrated. Use gentle, non-comedogenic products that won’t clog pores.
• How to do it:
  1. Use a gentle, sulfate-free cleanser twice daily (morning and evening).
  2. Follow with a moisturizer to keep the skin hydrated and prevent dryness.
  3. Apply sunscreen daily (SPF 30 or higher) to prevent sun damage, which can worsen acne and lead to pigmentation issues.
• What it does: Keeping your skin balanced prevents overproduction of oil and helps reduce acne flare-ups.
• Reference: The Journal of Clinical and Aesthetic Dermatology (2015) found that consistent, gentle skincare can help reduce acne and promote overall skin health.