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By Dr. Ying-Chin Wu

How do I rid pimples and why do I grow pimples long after puberty? -- The complete guide to pimple treatment! 

What are pimples

The medical name for pimples is acne vulgaris, a skin disease caused by inflammation in the follicle and sebaceous gland. If our pores are clogged by buildup of old skin cells while the sebaceous gland is actively secreting sebum, we may have excess waste trapped inside the pores that makes it an ideal environment for bacteria (especially propionibacterium acnes) to grow, which causes the follicle to become inflamed and form pimples on the outside. So what is the difference between the conditions known as pimple and acne? The difference lies in the stage and severity of the condition; acne refers to the early stage when the skin has yet to become inflamed, whereas pimple refers to the stage when the skin becomes so inflamed that pustules or papules have formed on the surface. Severe cases of cystic acne may even leave behind acne scars after treatment.   

The medical name for pimples is acne vulgaris, a skin disease caused by inflammation in the follicle and sebaceous gland. If our pores are clogged by buildup of old skin cells while the sebaceous gland is actively secreting sebum, we may have excess waste trapped inside the pores that makes it an ideal environment for bacteria (especially propionibacterium acnes) to grow, which causes the follicle to become inflamed and form pimples on the outside. So what is the difference between the conditions known as pimple and acne? The difference lies in the stage and severity of the condition; acne refers to the early stage when the skin has yet to become inflamed, whereas pimple refers to the stage when the skin becomes so inflamed that pustules or papules have formed on the surface. Severe cases of cystic acne may even leave behind acne scars after treatment.   

The true cause behind persistent pimples

Pimple formation has a lot to do with the excessive buildup of old skin cells at pore openings and over-active secretion of sebum. Excessive buildup of old skin cells clogs up the pore and has to be addressed by improving renewal of the stratum corneum. Meanwhile, over-active sebaceous gland may be attributed to genetics, hormone, drug side effect, improper use of cosmetic/skincare solution, irritating substance, compression/friction, stress, or hot, humid environment, and we can reduce sebum secretion only if we know the root cause. If all we do is treat pimples on the surface instead of the root cause, the condition will surely resurface over time.  

Why do I grow pimples long after puberty

As explained above, hormonal change is one of the causes of persistent acne. During puberty, for example, we have more androgen in our body that stimulates the skin to secrete sebum, which is why teenagers are more prone to pimples than people of other age groups. Adult women, too, experience hormonal changes as they go through their menstrual cycles. Pimples usually pop up few days before menstruation and disappear quickly afterwards, and some women experience pimples after they stop taking birth control pills. Stress is another cause of hormone imbalance, and may lead to more severe conditions than natural hormonal changes.  

The difference between pimple and acne

Simply put, acne is the stage where the skin has not become inflamed to develop pimples, whereas pimple is the appearance of inflamed acne. Acnes/pimples generally develop in one of the four main ways below: 
1. Excess secretion of sebum near the follicle, which builds up and clogs up the pore.
2. Abnormal buildup of old skin cells at the opening of the follicle, which clogs up the pore.
3. Excess growth of propionibacterium acnes near the follicle, causing local infection.
4. Localized inflammation of the follicle and nearby skin tissues; i.e. folliculitis that gives rise to the appearance of pimple on the surface.
Routine care and prevention against pimples
1. Get enough sleep: Lack of sleep makes pimples worse, so try to avoid staying up at night
2. Do not over-clean: Use facial cleansers that are gentle to the skin, and wash 2-3 times daily with warm water. Do not clean too frequently, use hot water, or rub excessively as doing so will remove too much lipids and moisture from the face. Use of facial cleansers with abrasive particles or scrubs is not recommended, as doing so may irritate the wound.
3. Avoid over-consumption of sugary, oily, salty, and dairy foods: These foods may affect our hormones and stimulate activity of the sebaceous gland, and are considered acnegenic. Instead, eat more vegetables and fruits that are high in fiber and drink adequate water to keep the bowel moving. 
4. Avoid staying in poorly ventilated or polluted environments for extended period of time: Fine particulate matters such as PM2.5 may cause free radicals that lead to skin conditions such as pimple, widened pore, spot, aging etc.
 
5. Avoid excessive exposure to UV ray: While sun exposure stimulates the creation of vitamin D, UV ray may worsen spots or pimples that have already developed on the skin, which is way there is a higher chance of pimples during summer. Make sure to protect yourself from the sun when going outdoors, and choose sunscreens that have a refreshing texture.
 
6. Avoid facial treatment and squeezing: Facial treatment in general and squeezing of acnes can rupture pustules, leaving wounds that are prone to inflammation, infection, and acne scar. Instead, it is recommended to use acid-based skin renewal solutions, such as mandelic acid, to stimulate renewal of old skin cells and drain sebum buildup to rid pimples and acnes at the root.
7. Avoid overly greasy skincare solutions: Skincare solutions that are overly greasy or designed to cover up the skin can easily clog up the pores. People with acne-prone skin should choose solutions that are non-acnegenic. Those with oily skin may choose products that have a refreshing texture, and those with dry skin may choose products that provide some form of hydration.
8. Make informed decisions about anti-acne products: Minor pimples/acnes can be removed at home by adopting lifestyle change, proper cleaning, or use of solutions that contain mandelic acid or salicylic acid. Severe pimples will have to be treated with the help of a dermatologist. The choice of medication is very important in the treatment of pimples, and physicians usually prescribe a combination of oral and topical medications depending on severity. 

Pimple treatments

Pimple is one of the three most common diseases in Taiwan. If you are dealing with the condition on your own and do not see progress after two months, you might consider seeking professional treatment from a dermatologist for faster and painless result without leaving scars.

Dermatologists treat pimples generally by prescribing topical and oral medications. Most minor conditions only require topical medication, whereas more severe conditions would require the use of both oral and topical medications, and usually take several weeks to six months to heal. Level of severity is usually determined based on the stage of inflammation and infection, which requires the professional judgment of a physician.  

Benzoyl peroxide, antibiotics, retinoic acid, and hormones are common substances used for pimple treatment.

Benzoyl peroxide: The substance works by releasing oxygen and creating a high-oxygen environment that kills anaerobic bacteria, which in turn stops inflammation of the skin. Compared to other anti-bacteria drugs, benzoyl peroxide has less concern for drug resistance. 

 

Antibiotics: It improves symptoms by inhibiting growth of propionibacterium acnes inside the follicle. However, there are risks in using antibiotics for treatment, as underdosing, inadequate duration, early stoppage, not following physicians' advice etc. may all cause bacteria to develop drug resistance. Possible side effects include flaking, redness, itching, and roughness. 


Retinoic acid: The substance affects growth of skin cells and helps remove buildup of old cells inside pores, thereby minimizing chances of pore blockage and inflammation. It also inhibits secretion activities of the sebaceous gland. However, retinoic acid comes with stronger side effect and induces photosensitivity. In addition to sun protection, pregnant women should also be aware of the risks of birth defects. Furthermore, retinoic acid is not the first-line medication for acne; physicians usually prescribe it only if other treatment approaches have failed to deliver results, and is not covered by the National Health Insurance except through special request.  


Hormones: Considering how androgen stimulates secretion of lipids and causes pimples, it is possible to use birth control pills as a pimple treatment, as they contain estrogen and progesterone that inhibit secretion of androgen. However, there are other risks associated with birth control pills, and should be used after discussing with a physician. 

Aside from drugs, other methods such as phototherapy and intralesional injection can also be used to treat pimples.

Phototherapy: Procedures such as laser treatment and Thermage can inhibit growth of propionibacterium acnes, regulate over-active sebaceous glands, and reduce inflammation. In the case of blind pimples, however, drugs should be used in conjunction for optimal result.

Intralesional injection: The treatment involves injecting a diluted solution of steroids or antibiotics directly into the pimple. The antibiotics will kill off bacteria while the steroids inhibit inflammatory reaction, but it also means that the solution does not work on pimples that have not inflamed. The advantage of intralesional injection is that it removes pimples quickly with minimal damage and scarring of skin tissue, but it comes with side effects such as change in pigmentation, skin thinning, and adverse capillary growth. It is often used for treating pimples that are deeper and more severe. 

It is worth noting that propionibacterium acnes takes 8 weeks to grow, and people should expect to undergo pimple treatment for several weeks or even months before seeing changes. Going on and off treatment from time to time does not yield positive results. Furthermore, it is important not to stop taking prescriptions early or take prescriptions without medical consultation, because bacteria may develop resistance to certain drugs over time, in which case the prescription will have to be adjusted based on the state of recovery, so be sure to coordinate closely with the physician when treating pimples. 

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