WTF Causes Blind Pimples? I Asked Dermatologists

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You know those pimples that feel like they've embedded into your face, creating a throbbing sensation that no one else can see but you can most definitely feel? The kind of cystic acne that requires a whole lotta ice to quell the swelling and anger? They're called blind pimples, and they're v normal and natural, but annoying as hell. I got a blind pimple recently (and before a vacation, no less!). While it's not nearly as unsightly as a traditional whitehead or blackhead, it's significantly less simple to treat. My run-of-the-mill spot treatments and pimple patches don't touch a blind pimple, unfortch.

Why, though? Well, a blind pimple is a type of cystic acne that lives deep beneath your skin and is usually very inflamed. So although you can't necessarily see it, you can feel it—and it's usually pretty damn painful. Because of this, it won't go away with your typical acne skincare routine; however, that doesn't mean you're stuck with no options. I chatted with three dermatologists about how to get rid of blind pimples, the best treatments they recommend to patients, and how to prevent them from invading your face again in the future.

What is a blind pimple?

Blind pimples are inflamed cysts that develop beneath your skin and have no connection to the surface of your skin. Since they’re so deep, blind pimples often have a little-to-no raised bump (hence blind), but they’re always tender and sore, so you’ll know if you have one lurking somewhere. Sometimes, blind pimples can look slightly red or brown, depending on your skin tone, but mostly, they’re just an under-the-skin, painful lump you can feel.

What causes blind pimples?

Blind pimples are caused by the same thing as all types of pimples: clogged pores. According to dermatologist Geeta Yadav, MD, blind pimples can form when a mix of bacteria and excess sebum clog a pore and cause inflammation below the skin—which, you know, is similar to how all cystic zits form. So, what’s the difference? Welp, unlike other breakouts, “blind pimples are not at the skin’s surface, but deeper in the skin at the subcutaneous level,” Dr. Yadav notes. And that, my friends, is why they’re impossible to pop, slow to heal, and pretty painful to deal with.

Generally, blind pimples are triggered by hormones, so they’re often more likely to appear during hormonal fluctuations, whether that’s due to your period or if you’re receiving testosterone therapy. You may also just have hypersensitive hormone receptors that trigger breakouts, regardless of the timing (thanks, DNA). Whatever the case, these hormones can tell your body to “overproduce oil, allowing bacteria to grow and inflammation to ensue,” says dermatologist Karan Lal, MD.

How long does blind pimple last?

If left alone, a blind pimple can last from a few weeks to multiple months due to the trapped inflammation beneath the skin, says Dr. Yadav. (Don’t worry—your derm can help it heal faster—more on that in a sec.)

But that doesn’t mean that blind pimples can’t go away on their own. In fact, dermatologist Neal Schultz, MD, says that 50 to 80 percent of the time, blind zits do eventually heal by themselves. And no, squeezing them isn't going to hurry the healing process along—it’ll just create more inflammation, push your pimple deeper and bigger, and leave post-inflammatory marks.

Though it’s perfectly fine to go with the wait-and-see approach, it’s worth noting that the longer an inflammatory bump hangs out on your face, the more long-term damage it can do to the underlying tissue. For some people, that damage results in hyperpigmentation (i.e., pink, red, or brown scars), while for others, an untreated blind pimple is “more likely to cause an atrophic scar, which is like a crater or an ice-pick scar,” Dr. Schultz adds. However, seeing a dermatologist who can inject the zit with a cortisone shot (I’ll get to that later) can cut the healing time from a few months to less than a week.

Why are blind pimples so painful?

Blind pimples freakin’ hurt, and it’s all thanks to the inflammation deep within your skin. “The rapid development of pus creates a pressure buildup in the cyst that triggers your skin's sensory nerves and causes pain,” says Dr. Yadav. If you need to ease a bit of discomfort, Dr. Yadav suggests taking the recommended daily dose of an NSAID, like ibuprofen or naproxen sodium (like Aleve), for a few days, and dabbing on 1 percent hydrocortisone cream once a day for up to five days to help cut redness and pain.

Is it okay to pop a blind pimple?

Nope, you shouldn't try to pop a blind pimple (or any pimple, fwiw). It never really comes to a head, so if you try to squeeze it, you'll just cause more inflammation, says Dr. Yadav. “The inflammation is what makes up the majority of the bump, and squeezing it won’t improve it,” she says. And even if yours does develop a visible whitehead, you should still consider it un-poppable.

In fact, you're better off just leaving your blind pimple alone, because your body knows what to do. TBH, with time, the pimple will break down and dissolve under your skin, which will flatten it out and avoid creating a potential long-lasting acne scar. Which brings us to...

What happens if you pop a blind pimple?

If you do try to pop or squeeze a blind pimple, you’ll just push all of the inflammation even further into your skin, creating an explosion of inflammation, says Dr. Lal. Not only that, but trying to pop a blind pimple also introduces new bacteria from either your fingers or whatever tool you’re using, which can increase inflammation and lengthen the time it takes for your pimple to go away, all of which ups your risk of scarring.

Even worse, Dr. Lal explains that because blind pimples are so deep under the skin, there’s collagen and scar tissue around it trying to help heal it from the inside. When you try to break open the pimple by popping it, you can end up pushing the inflammation below that scar tissue, making the pimple feel smoother, but still just as painful and likely to come back. So, yeah, just pls, don’t try to pop it.

How do you get rid of a blind pimple fast?

If you want to get rid of a blind pimple fast, you’re going to have to face some disappointing news: A blind pimple won’t go away overnight, or even over a few nights. Even the most effective treatments take up to five days to start working, which is why prevention is key when it comes to cystic and inflammatory acne (don’t worry—I’ll break down your options later on).

Still, the next time you do have a blind pimple appear on your face, take note of the following treatment options, from professional methods to at-home products:

Professional treatments for blind pimples:

• Cortisone injection: a steroid-based shot that neutralizes inflammation to shrink your blind pimple, speeding up your healing time from a month to a week or two. Insurance usually covers an injection (call ahead to confirm), but if you’re paying out of pocket, the cost ranges from $50-$100 total.

• Prescription retinoids: Tretinoin, one of the strongest retinoids (only available by prescription), both speeds up and regulates cellular turnover to keep acne-causing bacteria from settling in your pores, meaning it’s able to help treat existing blind pimples while also preventing them.
  
  Tretinoin can be highly irritating at first, so start slow: Smooth half-a-pea-sized dab over your entire face (no spot-treating) one night a week for one week, two nights a weeks for two weeks, three nights a week for three weeks, and if your skin still isn’t feeling dry or irritated, every other night indefinitely, always followed by a rich moisturizer.

Tretinoin

Custom Formula Rx for Acne

• Prescription topicals: Your dermatologist will likely suggest other non-retinoid topicals too, the most popular of which include: (1) Winlevi, a clascoterone-based cream that helps block some androgens in the skin to decrease oil production and inflammation; (2) Aczone, a gentle, antibiotic-like gel with anti-inflammatory properties; and (3) Finacea, a 15 percent azelaic acid foam or gel used to treat rosacea and acne.

• Prescription medications: Another treatment your dermatologist might prescribe if you've got persistent blind pimples is medications, including antibiotics to help kill the bacteria leading to inflammatory acne, as well as hormone regulators like spironolactone and birth control. (More on these below!)

• Red and blue LED treatments: a form of light therapy that helps kill acne-causing bacteria on the skin (that’s the blue light) and reduce inflammation (red light). Even though LED is painless, quick, and relatively affordable ($60-$100), it’s not a fast-acting or first-line treatment (injections, oral medications, and prescription topicals are significantly more effective and well-studied).

At-home treatments for blind pimples:

Tbh, there aren’t that many great at-home remedies for a blind pimple because it’s so far beneath the surface of the skin that most of what we can do at home won’t be able to go that deep. But when you just need a little bit of relief while you wait for your doctor’s appointment or for that blind pimple to simply GTFO, try one of these:

• 1 percent hydrocortisone cream: a topical, low-dose steroid that helps reduce inflammation. It’s not a long-term solution (dab it on your zit twice a day for up to five days max), and it’s even more effective when layered over a benzoyl peroxide spot treatment to help kill some of the additional acne-causing bacteria that may re-inflame your skin.

• Cold compress: Wrap an ice cube in a paper towel and hold it against your blind pimple for 1-2 minutes in 30-minute intervals throughout the day to help constrict your blood vessels and reduce some swelling and inflammation.

• Hydrocolloid pimple patch: Sometimes the best thing you can do is stick on an opaque pimple patch to “hide” the discoloration from yourself and to keep yourself from picking at the zit and making it even more inflamed.

Micropoint for Blemishes Hydrocolloid Acne Spot Treatment Patch

PM Overnight Spot Patches

How to prevent blind pimples

While a consistent skincare routine (filled with exfoliating acids and retinoids, which I’ll explain below) can help prevent blind pimples to an extent, you’ll find that the most effective prevention against cystic acne will be topical and oral medications that either speed up cell turnover (topically) and/or regulate hormones and oil production (systemically). But let’s get into all of your options, starting with:

1. Get a good skincare routine

Unfortunately, washing your face and applying moisturizer won’t be enough to magically prevent blind pimples, but it will help keep your skin barrier healthy and prevent product residue and bacteria from accumulating in your pores. And when it comes to under-the-skin pimples, your skin barrier will need all the help it can get to stave off additional inflammation.

Benzoyl peroxide is the at-home gold standard for cystic acne since it can help kill acne-causing bacteria. A benzoyl peroxide cleanser is known to be a bit drying and potentially irritating, especially on anyone with sensitive skin, so stick with the lowest possible dose, like 2.5 or 5 percent, which has been shown to be as effective as 10 percent formulas, but with fewer side effects. Make sure to layer on a moisturizer before bed and don’t use your BP cleanser at the same time as retinol (or at all, if your skin is super sensitive).

CeraVe Acne Foaming Cream Cleanser

Benzoyl Peroxide Cream Cleanser 5%

Differin Daily Deep Cleanser

Acne Foaming Cream Cleanser

Once you’re using a cleanser and moisturizer consistently, you can add a chemical exfoliant toner, pad, or serum to help slough off dead skin, minimize oil, and make your skin ultra smooth. Both AHAs (alpha-hydroxy acids) and BHAs (beta hydroxy acids) can help dissolve dead skin, soften the bumpy texture, and fade the hyperpigmentation left over from blind pimples.

AHAs (think glycolic, lactic, malic, and mandelic acid) are best for those with dry skin, while BHAs (salicylic acid and willow bark extract) are oil-soluble, so they’re great for oily control and blackheads. Neither will necessarily get rid of or prevent blind pimples, but the fewer dead skin cells and excess oil on your skin, the less it’s likely to clog your pores and lead to inflammation.

Skin Perfecting 2% BHA Liquid Salicylic Acid Exfoliant

Effaclar Clarifying Solution Acne Toner

2. Unclog pores with a retinoid

When your oil production is triggered by hormonal fluctuations, the excess oil (plus dead skin cells) will clog the pore faster than it can shed, giving bacteria a space to thrive. A high-strength retinoid, however, speeds up the pore’s shedding process, helping to prevent your pores from getting clogged in the first place. But it’s important to note not all retinoids will help with acne. In fact, if you’re trying to treat blind pimples, you’ve only really got two options: (1) prescription retinoids and (2) adapalene.

Your doctor can prescribe a retinoid on its own, like tretinoin (often called Retin-A) or tazarotene (like Arazlo). These can be pretty drying and irritating, so only use a pea-sized drop for your whole face and slather on an occlusive cream at the end of your skincare routine to hold onto moisture. Or your doc could recommend a retinoid cocktailed with another acne-fighter, like Twyneo (a new medication that combines tretinoin and benzoyl peroxide), Epiduo Forte (adapalene and benzoyl peroxide), or a retinol serum combined with a topical clindamycin antibiotic.

The only prescription-strength retinoid for acne that you can get at the drugstore without going to a doctor is adapalene, a strong exfoliator that helps keep dead skin and oil from clogging your pores under the skin’s surface. It's still strong—though definitely better tolerated than tretinoin—so you'll want to start slow with this one too.

Acne Treatment Gel

Adapalene Gel Acne Treatment

3. Ask your doctor for a prescription medication

If you have hormonal reoccurring acne, or if the only breakouts you tend to get on a regular basis are cystic and blind, your doctor will likely suggest an oral medication (it’s truly the most effective option for inflammatory acne). “There are four categories of internal acne treatments: antibiotics, birth control pills, Accutane, and spironolactone,” says Dr. Schultz. “The root cause of cystic acne is excess oil stimulated by hormones, and all of these treatments in some way reduce the production of oil or the effect bacteria has on that oil.”

Here’s a quick breakdown of each one:

• Antibiotics: Your doc might prescribe a short-term course of antibiotics to help calm inflammation and reduce acne-causing bacteria. Common options include broad-spectrum doxycycline or narrow-spectrum Seysara (a new antibiotic that targets acne-specific bacteria, making it less likely to impact your gut microbiome).

• Birth control: Combination birth control pills (i.e., contains estrogen and progesterone) help reduce your body’s androgens (a class of “sex” hormones, like testosterone, that trigger sebum production), which can lead to fewer breakouts after three months.

• Spironolactone: Spironolactone is used off-label (it’s technically a blood pressure medication) to help block your androgen hormones from overproducing oil. It’s generally well-tolerated with very few side effects and is usually prescribed with birth control pills for cystic acne and blind pimples. It usually takes about three months to start noticing results, but for many people (including myself and other Cosmo beauty editors), it's pretty damn life-changing for cystic acne.

Spironolactone Oral Acne Medication

Spironolactone Hormonal Acne Treatment

• Accutane (isotretinoin): For persistent hormonal acne that doesn’t respond to other treatments, your doctor may recommend a course of isotretinoin, which permanently shrinks your oil glands, making it harder for oil to seep through and cause inflammation and pimples. It requires monthly blood tests and monitoring for 4-6 months, but it’s the most effective and long-term solution for persistent inflammatory acne.

Final thoughts:

Listen up: Only mild cases of blind pimples will respond to at-home methods, so if you’ve been cold compressing, benzoyl-peroxide-treating, pimple-patching, and retinol-ing for six weeks to no avail, it’s time to see your derm. They might suggest a steroid injection to finally get rid of that blind pimple or a prescription treatment to prevent them from emerging again. But whatever you do, I’m begging you and reminding you to never, ever pick at it—the scars are not worth it, bb.

Meet the experts:

• Geeta Yadav, MD, is a board-certified dermatologist and the founder of Facet Dermatology in Toronto, ON, CA. Dr. Yadav is an expert in both medical and cosmetic dermatology, as well as in treating concerns of BIPOC patients.

• Neal Schultz, MD, is a board-certified dermatologist in New York, NY and the founder of Park Avenue Skin Care, his dermatology practice, and Beauty Rx—a skincare line of products for acne, dark spots, oily skin, and more.

• Karan Lal, MD, is a double board-certified adult, pediatric, and cosmetic dermatologist at Affiliated Dermatology in Scottsdale, AZ. You can also catch Dr. Lal responding to viral beauty trends and myths on Cosmo's TikTok.

Why trust Cosmopolitan?

Beth Gillette is the beauty editor at Cosmopolitan with four years of experience researching, writing, and editing acne stories that range from how to get rid of butt acne to scalp acne. She’s an authority in all skincare categories, but is an expert when it comes to hormonal acne, thanks to a decade of asking dermatologists how to cure her own chin pimples. She regularly tests and analyzes skincare products for efficacy, while working with the industry’s top dermatologists to assess new formulas and brands.

Brooke Shunatona was the senior beauty editor at Cosmopolitan for nearly five years and has eight years of experience writing about beauty and lifestyle across print and digital, including what to do when you get a pimple in your nose and how to get rid of oily skin.

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