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Pimples

Find out the best way to treat acne.
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Written by
William Fix, MD.
Resident in Dermatology, Montefiore Med Ctr/Einstein-NY
Medically reviewed by
Foundation Skin Surgery and Dermatology
Last updated January 5, 2021

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What are pimples?

Pimples are a type of acne, a skin condition that occurs when hair follicles become clogged with oil and dead skin. The clogged pores cause bacteria to grow, which results in the classic pimple. Acne also causes whiteheads and blackheads.

Pimples are the most common type of acne. They are most likely found on the face and upper trunk, where there are many oil glands and hair follicles.

Acne typically results from physiologic changes beyond your control. However, it can be treated with good skin care and using over-the-counter and prescription acne medication.

Most common symptoms

There are different types of pimples. They can be flesh colored, they can have a black center (blackheads), or they can be filled with pus. They may or may not be red and painful.

In some cases, pimples may become infected or may grow into larger, deeper lumps in the skin, which is called cystic acne. After pimples go away, they may leave behind dark spots or scars.

Sometimes, other rashes or skin infections may look like pimples. Pain, itching, growth into larger bumps, and accompanying fevers are signs that you may need to see a doctor.

Main symptoms

  • Closed comedones: Small, flesh-colored or white, non-inflamed smooth bumps. They may hurt if you touch them, and may have a little pus in them if you pop them.
  • Open comedones: Small pimples with a brown or black spot at the head. This is caused by skin pigment, not debris.
  • Inflammatory acne: Red, tender papules and pustules that may drain pus or progress to larger cysts and nodules. These may be painful when you touch them.

Other symptoms you may have

  • Pigmentation: When acne goes away, the skin may appear redder or darker than usual. This typically fades over time, but may take a while.
  • Scarring: Scars are more common when you have inflammatory acne. They look like small, healed pits, depressed areas, or cause uneven skin texture.
  • Excoriations: It can be tempting to pick at your skin, especially if you have anxiety. This increases the risk of scarring and pigmentation. It can lead to crusted over pimples and damage from picking, which can then lead to more scarring.

Dr. Rx

Acne can have a major impact on someone’s quality of life, particularly older acne patients. People with severe acne and acne scarring have been shown to have increased levels of anxiety and depression as well as workplace discrimination. Acne is more than skin deep and treatment is not simply a cosmetic intervention. —Dr. Mollie MacCormack

Next steps

See a dermatologist if your acne bothers you in any way—with treatment, your skin will likely improve. You should see a dermatologist immediately if you have features of severe acne, like large inflamed lumps, open cysts, or fever. Getting treated can help prevent scarring and ensure that your diagnosis is acne and not something more serious.

What is the best treatment for pimples?

Many treatment options are available for pimples, and the type of treatment depends on how serious it is. Your doctor may suggest using a single treatment or a combination, and you may use topical (applied to the skin) and/or oral medications.

Medication

  • Topical retinoids, such as tretinoin (Retin-a), adapalene (Differin), and tazarotene come in creams, gels, or lotions. They work by keeping pores unclogged and are among the most effective medications. They may dry out and irritate the skin so it is best to start with a low-dose product, using it once every day or two. You can increase the strength and frequency as you tolerate it. Some are over-the-counter, while others require a prescription.
  • Salicylic acid is in many over-the-counter toners, pads, and creams, and also works to prevent pores from clogging. It can be used with retinoids to improve the effects.
  • Benzoyl peroxide is an antimicrobial medication that is found in many over-the-counter and prescription acne products. It may be particularly helpful for inflammatory acne.

Pro Tip

Happily, no matter what type of acne you have, there are medical treatments that can improve the health of your skin and limit long-term side effects such as scarring. —Dr. MacCormack

  • Topical antimicrobials, including antibiotics, are prescription drugs such as clindamycin, erythromycin, and sodium sulfacetamide (sulfur). They are used to treat inflammatory acne. They target bacteria that contribute to acne and can be used with retinoids.
  • Oral antibiotics (like doxycycline, minocycline, and Bactrim) are prescribed for more severe acne.
  • Oral contraceptives and other hormone-like pills (like spironolactone) can help teenage girls and women whose acne is exacerbated by hormonal cycles.
  • Isotretinoin (Accutane) is a powerful oral medication that can get rid of acne. It is a good option for people with severe or scarring acne. However, you need to be monitored by a doctor for possible severe side effects.
  • Pimple treatment: A dermatologist can do various procedures at their office to get rid of a pimple quickly.

Follow up

Continue seeing a dermatologist to ensure you are using an effective medication with as few side effects as possible. Some of the treatments listed above, like Accutane and oral antibiotics, require careful follow-up for your safety.

Causes of pimples

Pimples and acne are very common. About 85% of adolescents have had acne, and 35% of these people continue to have it as adults.

Pimples occur when your hair follicles get clogged, which causes oils in the skin to collect. This is often worse during adolescence, when hormones cause extra oils to form, and may become worse with other hormonal changes, like menstruation (getting your period).

Clogged pores may also become infected with bacteria, which may lead to more severe acne.

Pores can get clogged as a part of the normal life cycle of skin. Other common causes are physical objects touching the skin (like sports helmets and chin straps) and cosmetics and other skin care products.

Severe acne may run in families. Acne is also more common among adolescents than it is in adults, largely because of increased hormones that trigger more oils.

Diseases associated with hyperandrogenism such as polycystic ovarian syndrome also increase the risk of acne.

Many people believe that what you eat is closely connected with acne and pimple formation. Though there is no definitive proof of this, eating a healthy diet that avoids foods high in sugar and simple carbohydrates as well as large amounts of dairy products may help.

For babies and kids

Sometimes, babies and young children have acne. Neonatal acne is acne in newborn infants, and is caused by a yeast, not bacteria or clogged pores. Infantile acne occurs in some infants and toddlers. Infants may have pimples and acne due to changes in hormones that are a part of the normal development process.

Pro Tip

Acne is not only a disease of teenagers. Some people do not have acne as a teen, but then develop symptoms later in life. —Dr. MacCormack

Preventative tips

A few ways to help prevent pimples:

  • Avoid clogging of pores: physical objects touching the skin such as straps on athletic equipment and cosmetics (makeup, skin care products).
  • Eat a healthy, low sugar, well-balanced diet.
  • Regularly clean and exfoliate (remove old, dead skin cells) your face.
  • Use a preventative low-dose topical retinoid, adding a topical antibiotic such as benzoyl peroxide as needed for inflammatory lesions.
  • Keep using acne medications as the doctor prescribed, even when your skin looks good.
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Resident in Dermatology, Montefiore Med Ctr/Einstein-NY

William C. Fix is a resident physician specializing in dermatology at the Albert Einstein College of Medicine and Montefiore Medical Center in New York. He graduated from Brown University with a BA in Economics in 2012 and obtained his MD from the University of Pennsylvania Perelman School of Medicine in 2019. William has received grants from the American Society for Dermatologic Surgery, The National Institutes of Health and the Alex’s Lemonade Stand Foundation for oncology research, and was selected for the University of Pennsylvania’s Dermatology Oncology Center (PennDOC) Research Fellowship in Dermatology & Dermatologic Surgery. William’s interests include general and procedural dermatology, cutaneous oncology, technology, and quality improvement.

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