Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 13, 2015

Pimples are the bane of many teenagers, but adults have struggles with them too. There are many manufacturers of soaps, creams, etc., that claim miraculous results in eliminating pimples. While these sound great, the best bet in dealing with pimples is understanding their cause and using the best proven remedies in treating them.


Definition & Facts

Pimples are reddish or whitish bumps on the skin that form when the skin's oil glands become plugged and infected. Pimples are among the most common skin conditions, with basic acne being called "acne vulgaris". Vulgaris does not mean ugly, but refers to common and could be translated "common acne". While there are a wide variety of skin infections called "pimples", here are the most common:

  • Comedones - These are the basic bumps that form into pimples
  • Blackheads - Pimples that are open with black infection visible
  • Whiteheads - Full blown, closed pimples with white bacteria visible inside
  • Papules - Whiteheads that have a red area surrounding them due to inflammation
  • Pustules - Very similar to papules but may contain yellow pus
  • Nodules - Hard lumps that do not have any visible infection
  • Cysts - Big pimples that may ooze pus and are painful


Acne is caused by the clogging of pores and eventual infection, but why does this happen? Changes in hormones is the most common cause, which explains why teenagers are the most susceptible. An increase in hormones causes the body to produce more sebum, an oil that helps keep skin from getting dry.

Other causes include certain medications, such as lithium or steroids, and certain endocrinological conditions that may increase sebum production. Stress is also known to make acne worse. Specific foods, notably chocolate and greasy foods, have been thought to worsen acne, but there are still differing opinions on this. While these causes can be managed to some extent, even eliminating all the causes does not mean that acne will not occur.

When to see a doctor

Deciding to consult a doctor is, in small cases, a matter of tolerance. If a sufferer doesn't mind small, occasional breakouts, a trip to a doctor may not be necessary. When breakouts become frequent, do not go away, or more than 20 percent of the affected area is involved, it is time to visit a doctor. In cases of nodules, pustules, or cysts, it is always important to see a doctor.

These pimple types can cause scarring if popped or left untreated. Pimples can also affect the emotions of the sufferer. If the presence of pimples is causing depression, social isolation, or suicidal thoughts, a visit to a doctor is imperative. It is important to visit a doctor if an outbreak or bump is not clearly acne. There are many other skin conditions that can mimic acne and require special treatment.

Treatment & Therapy

When seeing a doctor, there is a progressively aggressive system that attempts to use the least amount of medication possible. The first step is usually a prescription-strength benzoyl peroxide cream or gel. If this works, no further medications are necessary. Should this fail, a topical antibiotic cream or gel is often added.

This helps by killing off any stray bacteria that may be resistant to the benzoyl peroxide. If the acne is still a problem after these treatments, an oral antibiotic can be prescribed. This assists the body in killing the bacteria from the "inside out" and can clear up acne quickly. Oral antibiotics are not designed for long-term use, and doctors will usually try to scale them back or eliminate them if the skin clears. This can become a problem if acne fades when oral antibiotics are used and then recur when they are stopped. As there are many antibiotics available, doctors may opt to try different ones until an effective type is found.

If none of these remedies works, Accutane® may be considered. Accutane® is a powerful drug with many potential side effects. Women must be on two forms of birth control in order to use this drug, as pregnancies while on the medication causes birth defects. Extreme spikes in cholesterol, triglycerides, and back pains are also potential side effects. It is important to thoroughly understand what Accutane® does and the risks involved before considering using it. Other medications may include Retin-A® based products, but insurance companies may bristle when asked to cover these since they can also be used for eliminating wrinkles.

Eliminating wrinkles is not considered medically necessary by insurers. Depending upon the doctor, UV light therapy may be recommended. This is done using a specially prepared machine and is not accurately reproduced by over-the-counter machines. Many aesthetic dermatologists use skin peels for stubborn cases of acne, but these are only a temporary solution and are seldom covered by insurance. In time-crucial situations, a steroid injection can quickly eliminate a pimple. However, this is used before a wedding, prom, school picture, etc., where a lengthier regimen will not work.

Prevention & Prophylaxis

While there is no surefire way to stop acne, there are some ways to lessen the odds of an outbreak. The first routine to be used is daily face washing. This can be done using ordinary soap or acne-fighting soap. As long as the pores get at least some of their buildup removed, the frequency of pimples will be reduced.

Avoid using any makeup that is not non-comedogenic. This means that the makeup may contribute to clogging pores and producing more acne. Avoid steroid use on the face. While using an occasional dab of hydrocortisone for a face rash is okay, frequent use of steroids on the face leads to steroid-induced acne.

Do not pick at pimples. Frequent, prolonged picking can result in permanent skin damage called acne excoriee. For women who notice breakouts during periods, taking 2 mg of vitamin B6 a day during the period can ease the hormone fluctuations that can occur during menstruation.

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