If you've experienced acne outbreaks (and who hasn't?!) you know that not all blemishes are created equal. There's your run-of-the-mill pimples - whiteheads (also called "closed comedones" because they are closed off from outside air) and blackheads (called "open comedones" because air can reach the blockage in the pore, causing it to oxidize and appear dark) - that, while annoying, are generally pretty short-lived. When acne becomes more serious and increasingly inflamed, pimples become more stubborn yet are generally responsive to topical treatments. Papules and pustules are raised bumps that either have a fluid-filled head (papules) or no visible head at all (papules). While pustules are the type of pimples that some would describe as "poppable," papules should never be popped and typically get worse if you try.
What does "worse" look like? These pimples can progress to become nodules (no visible head) or cysts (fluid-filled and may have a visible head). Despite the severity of these types of blemishes, nodules and cysts are oftentimes invisible to the eye, which is why they're commonly referred to as "blind pimples." When pimples of this type reoccur frequently, physicians diagnose it as nodulocystic or cystic acne, more severe forms of the condition.
Causes of Blind Pimples
Blind pimples start like any other form of acne. That is, four primary factors combine to wreack havoc on your skin:
- Hyperkeratinization: Cells within the hair follicle slough off more aggressively than is typical and get trapped in the pores where they bunch together and cause blockages.
- Excess sebum production: the sebaceous glands of some individuals are hyperactive, producing more sebum than is necessary or normal. That extra oil gets backed up by the blockage in the follicle.
- Cutibacterium acnes (C. acnes): This is a type of bacterium found in the skin of most healthy adults. C. acnes feeds off sebum and cellular debris and therefore colonizes in hospitable conditions where skin is plagued by blockages in the hair follicles.
- Inflammation: As C. acnes multiples, the skin becomes inflamed as it fights infection. However, research has shown that inflammation is actually "a factor at every stage of acne lesion development," leading to acne being considered an inflammatory disease.
So why do these factors create "normal" pimples in some individuals and blind pimples below the surface in others? It all depends on the location of the blockage, as well as the severity of the infection and related inflammation. When the blockage is far below the skin, things can look hunky dory way up above on the surface. While this may be good for your appearance, it makes treatment more complicated.
Treatment of Blind Pimples
The first rule of being rid of a blind pimple focuses on what not to do: don't pick at it or try to pop it. Try to pop a blind pimple and you'll only worsen the inflammation and infection, making a pimple that is already long-lasting, even more so.
When most of us breakout, the first thing we do is reach for a topical treatment. While acne treatments are today more advanced and effective than ever, relying on proven ingredients like salicylic acid, glycolic acid, benzoyl peroxide, tea tree oil, and others, to quickly clear breakouts, the challenge with blind pimples is that they are not accessible from the surface of the skin. For this reason, it is wise to visit a board-certified dermatologist who can prescribe oral antibiotics or retinoids to help get nodulocystic or cystic acne under control. They may also inject a steroid into the lesion that can reduce healing time from weeks to days.
While you're limited in what you can do at home to get rid of a blind pimple, it's worthwhile to try warm compresses. Several times a day, moisten a washcloth with hot water, wring it out and apply the warm compress to the blind pimple for 10-15 minutes. Over time, this can draw the infection to the skin's surface where it can be popped. However, proceed with caution. Most of the time we advise not popping pimples due to the risk of scarring and worsening of the acne lesion. However, if you're going to do it, it's important to know how to safely pop a pimple.
Preventing Blind Pimples
Because hormonal fluctuations can encourage the factors that directly cause acne, it may not be possible to entirely prevent blind pimples from forming without prescription medications. However, there are modifications you can make to your skin care routine and diet to minimize the potential for serious breakouts:
- Use ingredients proven effective against acne: As mentioned earlier, ingredients like salicylic acid and benzoyl peroxide are clinically proven to minimize breakouts and accelerate the healing of existing pimples. If you frequently deal with breakouts, the use of a proven acne line that addresses all four of the main causes of acne is essential. (We happen to know one!)
- Exfoliate regularly: The regular use of a chemical exfoliant helps to prevent dead skin cells from building up on the skin's surface and clogging pores. Learn how to properly exfoliate.
- Evaluate your diet: The foods your eat don't directly cause breakouts but they can encourage the factors mentioned earlier. In particular, dairy and foods high on the glycemic index, like baked goods, soda and even white bread, can cause inflammation and initiate the production of sebum. Learn more about the diet and acne connection.
If, after making these changes, you find that your skin isn't improving, it's again time to visit your dermatologist. In the meantime, learn 10 potential reasons why your acne isn't going away.