Ask a derm: My pimple won't surface. How ah?

Pimples are the bane of our existence and have plagued almost everyone at one point in their lives. But while they are dreadful enough on their own, it is indubitably the painful, hormonal acne that lay underneath the skin, refusing to surface, that is most annoying.

Otherwise known as blind pimples, they are unlike your typical zits and require a little more tender loving care to have them surface and treated.

We speak to Dr Teo Wan Lin, dermatologist and founder of TWL Specialist Skin & Laser Centre, about what causes them, and the things you can do the next time you get another.

What are blind pimples and what causes them?

According to Dr Teo, blind pimples are colloquial speak for acne that don't seem to have openings or heads, and are actually white heads known as closed comedones, as opposed to blackheads, which are open comedones.

"The cause of blind pimples are actually a form of acne. And even though there are various appearances of acne bumps ranging from whiteheads, blackheads, cysts and papules, they all have the same underlying set of causes," she says.

She adds that one has to be genetically susceptible to acne to suffer from it, and that excessive oil production can result in inflammation. This swelling can be worsened by the presence of a particular causative bacteria behind the development of acne.

"Another cause are acne cysts, which are larger and more painful bumps that seem to arise from under the skin and are also without heads. There is a role of secondary bacterial infection in individuals who develop these acne cysts which can also be perceived as blind pimples."

"However, these almost always start off as whiteheads, which are also considered blind since you do not see a visible tract to the surface. These then get infected by skin bacteria which could be affected in a secondary infection gram negative folliculitis."

Why can't I get my pimple to surface?

Unfortunately, a pimple may never even surface as acne is not an external issue, but an internal one.

"The very nature of acne is that it is triggered off by inflammation underneath the skin and is not due to external factors. Every pimple starts with the genetic tendency of the individual to develop mini whiteheads buried under the surface of the skin, which then develop into either white heads or black heads over the course of two weeks to a month before they appear on the skin."

Can I pop a pimple with no head?

[[nid:496363]]

It can be reaaaally hard to leave a zit alone. But take it from the professional: don't touch it.

"Popping any form of pimple is not advised," warns Dr Teo.

She adds that, first of all, your fingers and your fingernails contain bacteria, and that even if you wash your hands, it is an area of broken skin and any form of pressure or squeezing around that area will cause more internal bleeding.

"Methods that are specifically used to treat acne in a dermatologist's office have nothing to do with extracting or removing a pimple on the surface. Even if you try to extract whatever pimples there are on the surface, there will always be new ones growing under your skin. And before you even see the pimple, it is already under your skin for a good two weeks to a month."

Will a blind pimple go away by itself?

Sometimes. The dermatologist says that this can happen when the whitehead gets infected with superficial skin bacteria, which forms a pustule.

In this instance, the debris is released over a period of time and that's when you see the pimple surfacing.

How can I treat a blind pimple?

Depending on the severity, there are many treatments and preventative measures you can take to make them go away. Here's what Dr Teo suggests.

If your acne is mild…

The strategy instead should be, firstly, determining the severity of your acne. Anti-acne formulations that contain benzoyl peroxide, salicylic acid and sulphur have limited efficacy in the treatment of mild physiological acne.

But be warned that a lot of individuals who use these formulas peroxide tend to develop skin irritation because these topical treatments work by drying up the skin at the area where the acne is active, and in the absence of oil, acne inflation generally reduces.

The one that we prescribe in our clinic is a formulation based off chlorella vulgaris, which is a type of algae. Rather than drying out the skin, it actively works at the level of your sebaceous glands to inhibit the production of oil. This causes the acne swelling to reduce.

It's also infused with amino acids that function with natural moisturizing factors, as opposed to using drying prescriptions like sulphur and benzoyl peroxide that often leave a red mark and turns dark after the acne resolves.

The use of natural moisturising factors as opposed to oily formulations for treatment of spot acne is critical because acne is worsened by the application of oil-based formulas.

If your acne is moderate…

However, if your acne doesn't respond to topical over the counter creams you may want to visit an accredited dermatologist.

Inflammatory acne that is of moderate severity, would require a course of topical prescriptive creams such as retinoids. These are not available over the counter and need to be prescribed.

Regular use of a topical retinoid can help to reduce the formation of blind pimples, blackheads as well as inflammatory acne overall.

If your acne is severe…

However, some individuals will require oral medication. In genetically susceptible individuals, there is no other way besides taking oral medications such as doxycycline erothrymecin to suppress the body's tendency to produce inflammation.

And if you fail treatment with this, then with move on to isotretinoin or oratane accutane medication. While acne generally does go away, when one enters into adulthood, the process of recovery will involve treating acne scars especially if the acne itself is deep.

Depending on the individual, some might respond better to chemical peels and blue light treatments. Chemical peels are effective at regulating epidermal cell turnover. This means the bacteria on your skin will have less dead skin cells to feed on.

Microdermabrasion is also effective in removing white and blackheads while infusing plant acids without traumatising the skin.

In my clinic, we advocate individuals who have been suffering from persistent blind acne to use a home device that is based off the principles of microdermabrasion.

So...what can I do to prevent it?

An important thing to note, is the general hygiene of the individual who is acne prone. Somebody who produces a lot more oil and is living in a tropical climate like Singapore, is going to be susceptible to both acne as well as fungal acne.

Start with an anti-bacterial face wash

When you control oil production with topical, we are looking at anti-bacterial face washes. I generally recommend against very lathering cleansers as they contain salicylic acid and in Singapore's climate, it can cause individuals to be rather sun-sensitive result in dry skin.

This will then dehydrated skin on top of the acne.

Use a gentle topical

There are chemical ones based off the active ingredient triclosan, but personally I prefer to use a formulation based off medical grade honey which is a natural derivative with no issues of bacterial resistance.

Secondly, it helps to rebalance the skin's moisture levels to prevent overproduction of oil due to very harsh cleansers that strip your skin off oil completely.

In terms of topicals that can be used to control oil production, zinc oxide and certain plant oils will be helpful.

My patients use an anti-inflammatory powder formulated as a loose powder that is infused with zinc oxide which actively inhabits sebum formation which is also helpful in preventing bacterial growth.

So... what can I do to prevent it?

Incorporate Vitamin C

The use of vitamin C serums are also helpful. I would advise using a cosmeceutical formula such as ascorbic acid or sodium ascorbyl phosphate. I tend to favour the latter as a derivative of vitamin c because it is a neutral compound and doesn't cause irritation.

Soluble vitamin c, when absorbed in the skin, provides a very unpleasant environment for acne bacteria to thrive in. And because it is an antioxidant, it overall contributes to the health of your skin and lightens scars.

Get a moisturiser that is not oil-based

You need to moisturise even with oily skin, but avoid creams as they have a higher concentration of oil as opposed to water. The active ingredients we are looking at would be hyaluronic acid.

There are different sizes of hyaluronic acid molecules but the most beneficial in terms of aiding your skin absorption would be one with multi-molecular formulations. The second most important ingredient is polyglutamic acid.

It's 4-5 times more effective in its water-holding ability than hyaluronic acid but can be considered quite expensive for beauty companies to produce. The third would be free amino acids.

This article was first published in CLEO Singapore.