Acne Under Skin

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Bump staring back at you, it’s tempting to go IN on your face. When it comes to most face bumps and pimples under skin though, dermatologists agree that a hands-off approach is definitely best.

Meet Our Experts: Dendy Engelman, MD, board-certified dermatologist at Manhattan Dermatology and Cosmetic Surgery in New York City, Noelani Gonzalez, MD, FAAD, director of cosmetic dermatology at Mount Sinai West, Joshua Zeichner, MD, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital, Rebecca Marcus, MD, FAAD, board-certified dermatologist and founder of Maei MD, Joel Schlessinger, MD, board-certified dermatologist, Mona Gohara, MD, Connecticut-based dermatologist and associate clinical professor at Yale University

Acne Causes & Treatment

“Popping anything causes your skin to physically break apart, making it more susceptible to infection and an even bigger problem than what was originally there in the first place, ” says Dendy Engelman, MD, board-certified dermatologist at Manhattan Dermatology and Cosmetic Surgery in New York City. You're also pretty-much guaranteeing scarring and a drawn-out healing process if you don't resist the pop, says Noelani Gonzalez, MD, FAAD, director of cosmetic dermatology at Mount Sinai West.

The best move is to stock up on derm-approved, over-the-counter skincare products—or let professionals handle it in their offices with skin-safe lasers and gadgets you don't have access to at home. The smartest treatment will depend on what exactly is causing your annoying skin issues—whether it's a hard pimple underneath the skin or tiny white bumps on your face.

Cystic pimples occur very deep under the skin's surface, forming a red, tender nodule that’s not only painful but much harder to treat with OTC meds. “The inflammation that accompanies cystic acne can hinder the healing process and often lead to permanent scarring that’s impossible to eliminate, ” says Dr. Engelman.

Cystic Acne: What Is It, Symptoms, Causes And Treatment

Picking at these bumps under the skin won’t help either. “The cysts occur so far beneath the skin that you won’t even come close to reaching the bump, and you’ll be left with a bloody spot, ” says Joel Schlessinger, MD, a board-certified dermatologist.

The cause: “Cystic acne is caused by hormonal fluctuations and acne bacteria, ” says Dr. Schlessinger. “High hormone levels trigger an overproduction of oil, causing pores to swell. When this oil cannot reach the skin’s surface, it ruptures underneath and causes inflammation to spread to the surrounding tissue.” Other causes include bacteria in hair follicles and slowed cell turnover in acne patients that lead to keratin buildups in pores, says Dr. Gonzalez.

The treatment: Instead of going at it with your fingers, book an appointment with your dermatologist, who can properly treat the situation (usually in the form of a cortisone shot to instantly kill the swelling) and may even be able to save you from scarring altogether.

The Different Types Of Acne: What Type Of Bumps And Blemishes Are Affecting Your Skin

Ever notice how those tiny white bumps on your face (aka milia) refuse to pop no matter how hard you try? Well, rest assured. They are truly un-poppable—at least without a dermatologist or esthetician’s help.

The cause: Milia are not actually filled with dirt, oil, or grime. They are tiny, harmless cysts that occur when dead skin cells get trapped under your skin, says Dr. Schlessinger. “Picking at them often has little to no effect, and attempting to pop them will likely leave your skin red, irritated, and inflamed, with the milia still intact, ” says Dr. Schlessinger. Ouch.

The treatment: “If it’s bothering you, schedule an appointment with your dermatologist, who will likely extract with a heated, sterilized tool, ” says Dr. Engelman. You can also use a retinoid cream to help smooth them out faster, although milia generally clear up on their own.

How To Get Rid Of Acne Under The Skin

The cause: “Ingrown hairs occur when the hair shaft becomes trapped beneath the skin’s surface, ” says Dr. Schlessinger. “The red bumps that follow are often itchy and inflamed, but it’s never a good idea to use tweezers or manual force to pluck them. Squeezing them will only make the inflammation and irritation worse, he adds. (Hello, unsightly red marks that last for months.)

The treatment: Apply hydrocortisone, which reduces redness, itchiness, and irritation—and wash the affected area with an exfoliating cleanser to help the hair reach the skin’s surface. If the painful bumps persist, Dr. Gonzalez says you can go to a dermatologist who will nick the skin and remove the hair or inject it with steroids to reduce the inflammation. Pro tip so you don't have to deal with them at all: Exfoliate before you shave, and shave in the direction your hair grows instead of against it.

“Skin tags are extra growths of skin that typically occur on the neck and underarms, ” says Joshua Zeichner, MD, director of cosmetic and clinical research in dermatology at Mount Sinai Hospital. But there are a few reasons why you shouldn’t pick at the small bumps. Namely, skin tags are made from flesh, and attempting to remove them will cause pain and bleeding, says Dr. Zeichner. It could also increase your risk of infection.

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The cause: “They often occur in areas of friction, like by the neck, underarms, and groin, and they are thought to be caused by skin rubbing on skin or on clothing, ” says Bruce Katz, MD, a dermatologist in New York City.

The treatment: This one's definitely a job for pros. A professional can remove skin tags by freezing them off (a technique using liquid nitrogen known as cryotherapy), lightly burning them off with cautery, or surgically removing them by snipping them off, says Dr. Gonzalez. And if your skin tags are large enough to interfere with your daily life, your insurance company might even take the bill off your hands, says Dr. Zeichner.

Unless you’re looking to inspire a whole army of these bad boys, don’t even think about touching them—no matter how much that cold sore looks like a pimple. Picking at cold sores could very easily lead to the formation of another sore, says Dr. Schlessinger. Popping them releases a blister-like fluid that contains the same virus and can easily spread to other areas, including someone else's face.

Ways To Treat Pimples Under The Skin, According To Dermatologists

The cause: The herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) are to blame for cold sores, and they're crazy-common, says Dr. Gonzalez. Seriously—50 to 80 percent of U.S. adults have oral herpes.

The treatment: Small sores can heal on their own with the help of OTC treatments (like this one). But if you notice cold sores popping up more frequently (or spreading to larger areas), Dr. Gonzalez says you should see a doctor for professional help for more aggressive medication and, if you have sores more than six times per year, preventative medication.

These brown or black bumps look like moles and occur on the face and neck primarily happen in skin of color. Dermatologist Mona Gohara, MD, Connecticut-based dermatologist and associate clinical professor at Yale University says, There's no concern except those bothered by them cosmetically.

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The cause: It's genetic. There is no known cause at this point, but we know it runs in families, says Dr. Gohara.

The treatment: Again, there's no harm in these marks, but if you don't like the look of them, you can get in-office removal treatments. According to Skin of Color Society, that includes scissor excision, shave excision, cryosurgery, electrodessication, curettage, dermabrasion, and laser removal. Just know with deeper skin tones, there's a risk of these procedures triggering skin coloration problems so be sure to create a post-care plan with your derm.

The cause: Often referred to as “chicken skin, ” this genetic condition is caused by a buildup of keratin—the protein that protects skin, hair, and nails from infection and other harmful environmental toxins. “The buildup forms a plug that blocks the opening of a hair follicle, ” Dr. Engelman adds.

How To Get Rid Of Cystic Acne

The treatment: Instead of picking, use a chemical exfoliant that has salicylic acid and glycolic acid, or products such as AmLactin to calm the inflammation and gradually smooth out the bumps over time, Dr. Gonzalez says. “If that doesn’t work, see a dermatologist or an esthetician who can properly treat you, ” recommends Dr. Engelman. Treatment options include the topical medication tretinoin (a.k.a. Retin-A) to exfoliate the area, pulsed dye laser to treat redness, and chemical peels, Dr. Gonzalez adds.

The cause: “Blackheads consist of the same thing as whiteheads—pores that become clogged with oil—except the oil has oxidized after being exposed to the air, giving it a black or brownish hue, ” says Dr. Schlessinger. “Squeezing them can force the bacteria even deeper and causes trauma to the skin.”

The treatment: The best ingredients for dealing with blackheads are salicylic acid and retinol. These exfoliants promote cell turnover, preventing dead skin cells from plugging up your pores.

Acne 101| How To Get Clear Skin

To work the oil and dirt out without picking at your blackheads or applying pressure, use an over-the-counter exfoliant like Differin Gel. “It will work to bring the blackhead to the skin’s surface, leaving you with a fresh face in just days, ” says Dr. Engelman.

And look for makeup and skincare products that are oil-free and non-comedogenic, to