Should I Pop My Zits?

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.

- Anonymous Acne Sufferer

Answer:

Dear Acne Sufferer,

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 and salicylic acid. 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 — that's the key.