Like most of us, Lillian Wong*, 29, has generally normal, well-behaved skin with the occasional isolated pimple that pops up. And she treats those spots like most of us do, with much disdain and by a combination of picking at it, scrubbing at it with facial exfoliators and using skincare like pimple spot gels.
Most of the time, these spots go away eventually, and the skin heals over. But this time, a particularly stubborn zit stayed embedded under her skin for a year. It’s still there, by the way, so we’ve asked the best person for advise – a dermatologist.
Here’s what derm Dr Teo Wan Lin has to tell us about this obstinate blemish.
What kind of pimple is this particular one? Why is it so stubborn?
This seems to be a deeper infected cystic type of acne, in which the original comedone becomes so badly infected by surface bacteria that the skin mounts an inflammatory response. This leads to the formation of a cyst wall around the original site of inflammation and is essentially cystic acne under the skin.
What will happen if this pimple were left untreated indefinitely?
If left untreated, this would likely become a permanent scar, which will hurt, stay red and can also get secondarily infected with time. It may develop, in the worst case scenario, an abscess which is a collection of pus under the skin.
Can she poke or pop the pimple? Either by herself or at the hands of a facialist?
Squeezing and picking it is definitely not recommended as this introduces more bacteria to the already infected cyst. Furthermore, it is extremely dangerous to manipulate the cyst using sharp objects, or even have it extracted, because they are not safe and sterilised. What this means is that there is the potential for certain bacteria to affect the area further after the facial treatment, and it can become more painful and enlarged.
What is the dermatologist-recommended course of action for this stubborn pimple?
Cystic acne like this case warrants medical intervention. I would say if a pimple has not disappeared after 2 months at maximum, visit a dermatologist for assessment. For the course of treatment, you can expect an injection of triamcinolone (which costs between $100 to $200 at Dr Teo's clinic), which is a steroid to reduce swelling and inflammation, and this would hopefully lead to the resolution of the cyst wall. On rare occasions, I have seen patients who get a serious infection of a pimples, likely caused by bacteria on unsterilised instruments, and this leads to granulomatous infection of the skin which are masses of immune cells that form at sites of infection or inflammation, then they would need several months of oral antibiotics to get rid of the "pimple".