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Can I Pop This? Real Treatments for Acne, by Corinne Erickson, MD

erikson_350_300_c1_c__1I come from a family of persistent poppers.  I am the oldest of three sisters, and the youngest could be a board-certified bathroom surgeon.  I remember sitting with her on the beach, she was 6 and I was 11, and letting her convince me that there was a tiny seed inside the mole on my left wrist.  “Can I pop it out?” she asked, eyes wide with anticipation.  Disgusted with the thought of a seed in my wrist, I replied, “You can try.”  She pinched and squeezed until it bled.  “I don’t think you can pop this,” I said and rescued my wrist from her small but strong fingers. Today she is a 26 year old, mature married woman who continues to have a penchant for popping.  On a recent family vacation, she found me in the kitchen with a large “sub-dermal” on her chin with tell-tale fingernail marks surrounding it.  “Can I pop this?” she asked sitting down with her coffee.  I handed her a warm wet wash cloth and instructed her to apply it intermittently to try and bring the beast to a head. The next morning, her red sub-dermal had a nice white pustule on the surface.  “Can I pop it now?” she asked.  I told her to go take a shower and leave it alone.  10 minutes later she burst into kitchen.  “It popped itself in the shower!” she shouted with mix of joy and shock.  “Great,” I said.  “Now leave it alone.”

Banish the Magnifying Mirror!

These stories about my sister really illustrate to me a particular challenge in treating acne.  The world is full of young bathroom surgeons, many equipped with extractors and the most dreaded of all: the magnifying mirror.  Armed with a magnifying mirror my sister has claimed to actually pop her eyebrows.  I didn’t ask but suggested she try tweezers.   The magnifying mirror shows us every pore, follicle, dark spot, light spot, and we want to banish every last one of them. When I talk to patients, both adolescents and adults, about their acne, I often ask if they own one of these dreaded mirrors.  If the answer is yes, I request that as part of their regimen they remove it from the bathroom.  I don’t mean to imply that all of those whiteheads and blackheads have to stick around for ages. There are safe and effective ways to extract them that we perform regularly in the office.  The problem is that by trying to pop your own pimples, you introduce more bacteria into the area, cause more inflammation beneath the skin, and can end up with an even larger, more painful acne lesion that will take months to clear. It’s frankly counterproductive.  Just like pulling your finger out of a Chinese finger trap makes it tighter and harder to escape, trying to pop your own pimples just worsens the inflammation and gives you larger and angrier acne with a higher risk of permanent scarring.

Clearing Up Acne

So if we ban bathroom surgery, how do we abolish those pesky pimples?  It’s really different for everyone depending on the type of acne a person has.  The comedonal acne, or whiteheads and blackheads, responds great to a topical retinoid, such as adapalene, tretinoin, or tazarotene and can benefit from extractions in the office.  Note that last part: extractions IN THE OFFICE.  The red, painful deeper bumps are inflammatory acne, and sometimes nodulocystic acne.  This is a different animal, and often needs topical and systemic antibiotics, and at times isotretinoin.  The deeper lesions may even need an injection of steroids.  It really is different for every patient and every pimple. So acne patients unite!  Toss out those magnifying mirrors, put away your sharp extracting devices, and cut your fingernails.  Together we can clear you up in a way that doesn’t leave ice pick scars and open sores on your face.   You may not be able to pop your acne, but understanding that puts you months closer to clearing it.