Although acne covers off several different possible manifestations – “this includes blackheads, closed comedones (whiteheads), nodules, cysts and pustules,” says leading dermatologist Dr Justine Kluk – the latter can be particularly difficult to treat.
The pus-filled poster kid of acne (they’re more of a diva than little blackheads), pustules can take some steely resolve to defeat without going gung-ho and popping the little sucker.
Given 95% of people aged 11-30 will suffer from varying degrees of acne at some point, it’s a problem we can’t seem to get away from. Almost all of us will have had our parade rained on by a whopper spot turning up uninvited.
We’re told we shouldn’t pop them, but can we really? No, really? And what – dear Lord – does it take to whisk them away once and for all? Here to answer all our burning questions are leading dermatologists, Dr Justine Kluk and Dr Anjali Mahto.
What is a pustule?
“A pustule is basically a pus-filled spot. These can be painful and take a long time to go down. However, there are lots of treatments out there that can help,” explains Dr Anjali. “They tend to be smaller than 5–10 mm in size,” adds Dr Justine.
What is the white pus?
Pus occurs when there is an infection or blockage in our body or skin. In acne pustules, this can happen when the skin becomes clogged with sebum and dead skin cells. It sparks the production of neutrophils (white blood cells designed to heal inflammation). The resulting pus is a purulent material composed of the oil and dead skin cells as well as these neutrophils, explains Dr Justine.
What causes acne pustules?
“They are caused by a build-up of dead skin cells and sebum in the pores as mentioned above and influenced by a species of bacteria called cutibacterium acnes,” says Dr Justine. “The cause of all types of acne is usually multifactorial and includes genes, hormones, diet, lifestyle, stress and cosmetic products,” she adds.
Acne pustules in particular, can be prominent during hormonal shifts, explains Dr Anjali. “Over time, blackheads can become more inflamed and small red bumps known as papules or pus-filled spots can occur.”
Where do they tend to appear most commonly?
“Acne can occur on our faces, backs and chest most commonly. This is because this is where we have the highest density of oil-producing glands,” says Dr Anjali. “However, it really does vary person to person as to the exact locations within these areas where acne occurs. Spots on the forehead may be related to heavy waxes or sprays being applied to the hair when styling – known as ‘pomade acne’ – and use of heavy, oil-based foundations can lead to blocked pores, otherwise known as ‘acne cosmetica’. Spots on one cheek could be related to mobile phone use, where a dirty screen surface, combined with heat and occlusion, may stimulate the oil glands,” she adds.
Aside from acne, “there are other conditions that can cause pustules. These include rosacea, psoriasis, bacterial and fungal skin infections and drug reactions,” says Dr Justine.
Is it possible to spread pustules and is there anything we can do to avoid this happening?
“Spots should not spread if you treat them correctly. When you pick spots or scabs, you interfere with the healing process, leaving marks in the tissues that appear as scars. By leaving the inflammation alone, you can reduce redness and prevent spots from spreading or getting larger,” says Dr Anjali.
“The only way for a pustule to spread is if they are due to an infectious cause such as bacteria or fungi,” agrees Dr Justine. “You cannot spread acne pustules per se.”
Can we/should we pop them?
The advice from the pros is unanimous on this subject. “I’d advise against this. Squeezing spots can introduce infection, delay healing and increase the risk of scarring. Using an on the spot remedy with benzoyl peroxide, salicylic acid or tea tree would be preferable,” says Dr Justine.
“By popping spots, you can squeeze the inflammation deeper and this can cause scarring of the skin,” agrees Dr Anjali.
What’s the best way to treat pustules?
In mild cases, just make sure that you cleanse your face twice a day. “Products that contain salicylic acid and zinc may be beneficial,” says Dr Anjali. “After a couple of weeks, start using a chemical exfoliant (like glycolic acid) once a week. This will remove the upper layer of skin cells and help reduce blackheads. Thus, hopefully, reducing the likelihood of pustules forming.”
If it persists, “the most effective way to treat pustular acne is with prescription treatment,” says Dr Justine. “Topical antibiotics and benzoyl peroxide may be useful if they are few in number. Oral acne treatments such as antibiotics, the pill or dermatologist-only medication, such as isotretinoin, may be needed for more widespread or severe cases.”
Overall, acne is a treatable skin disease, but it’s important to seek help early. “No one should have to suffer in silence and early access to your family doctor or dermatologist is key,” says Dr Anjali. “Although not life-threatening, the damage that acne can cause should not be underestimated. It can lead to scarring of the skin in addition to having profound effects on self-esteem. It is important to deal with these at an early stage to prevent lasting physical and psychological effects.”