Why
Shouldn't I Pop My Zits?
Question:
Dear
Dr. Wilkinson,
Why
shouldn’t I pop my zits? It’s really the only way
to turn a totally gross lesion into one that’s still ugly
but at least it’s not gross. I’m a guy, so makeup
really isn’t an option.
-
Craig
Answer:
Dear
Craig,
There
obviously is a certain amount of satisfaction in popping
a zit. But I’m sure you’ve noticed that the satisfaction
is short-lived. Afterwards, the affected area is larger, more
swollen, more noticeable, and likely to hang around longer. It’s
also significantly more likely to develop a permanent scar.
The main culprit is inflammation, a process that’s triggered
by your immune system, causing heat, swelling, redness, and pain.
When you get a splinter in your fingertip, for example, your finger’s
soreness, swelling, redness, and heat are at their worst a couple
days after you got the splinter, because inflammation generally
takes a couple days to get fully up to speed. Inflammation is
unpleasant, but it’s a necessary evil: There can be no healing
without inflammation. When an infection or injury happens, inflammation
is supposed to move in, help clean up the problem, and then go
away so the affected area can heal.
In
acne, however, inflammation has run amok and actually stands in
the way of healing. That’s because there are other processes
ongoing, deep within the acne-affected pore, that keep the inflammatory
fire burning for years, rather than days. So when you squeeze
an acne lesion, which is by definition already inflamed, you’re
tossing fuel on an old fire: more heat, more swelling, more redness,
more discomfort.
•
The increased heat stimulates increased production of oil. It
also causes faster turnover of cells lining the follicle, which
shed off in pore-clogging clumps.
• The increased swelling narrows the pore’s opening
and plugs it even faster.
• The damage done during the squeezing (let’s be honest,
you know it causes damage) literally kills cells that were already
sick, and damages adjacent cells that until then had been healthy.
This expands the area of tissue that’s being traumatized
by the whole process. It also increases the risk of permanent
scarring
The
best approach to healing acne — which is your ultimate goal,
after all — includes not only opening up clogged pores,
while at the same time putting out that inflammatory fire. Because
squeezing pimples escalates inflammation, it works against that
goal. So, what should you do with those zits that are practically
begging to be popped? Instead of trying to force the plug out
of the pore by squeezing, I recommend melting it away with topical
agents called keratolytics.
The
two most commonly used keratolytics are benzoyl peroxide (BP)
and salicylic acid (SA). Both BP and SA are known to be irritating,
but they can be calibrated to your skin’s individual tolerance
for such agents, so you get the best therapeutic effect with the
least possible irritation. I have seen impressive results when
BP is used at bedtime, so any increased inflammation happens during
sleep, and SA (which is somewhat gentler than BP) is used in the
morning, for calmer skin during the day, with both agents calibrated
for minimal inflammation. Another breakthrough in acne treatment
is the use of soothing botanicals and other agents that have mild
anti-inflammatory action. When combined, many of these agents
work together, synergistically, for an anti-inflammatory effect
that’s greater than the sum of their individual benefits.
As
for covering up a particularly brilliant lesion, I recommend killing
two birds with one stone: Apply the keratolytic agent of your
choice to the pimple, and cover with a small dot-type Band-Aid
so it can work undercover. Therapy without fueling the fire, Craig
— that’s the key.
