Ask Alex: Demystifying breakouts

by Alex Hushcha

Everyone, we need to have a talk. Pimple popping. From a pro perspective this is one of the biggest points of discussion between estheticians and clients. To pop or not to pop? How do we treat and then prevent breakouts? What do our clients need to understand? I’ll discuss what’s going on when a pimple shows up, what it means, and what you should do about it.

Breakouts are not the same as acne. Acne is a condition where your skin over-produces sebum (the substance from your skin’s sebaceous glands that contributes to your skin’s protective lipid layer), which then builds up in the pore and causes your breakouts. You could have a light smattering of consistent breakouts or you could have large severe cystic spots covering your face. Both are under the umbrella of acne. Most acne care on the market tells you that breakouts are caused by oily skin and to fix your spots you need to "dry them up". This isn't 100% accurate. An overproduction of oil typically goes hand in hand with an overproduction of sebum. For those with oily skin, products that focus on drawing the oil out of the skin will be helpful. But, those with dry, normal, and combination skin types can also experience breakouts and pulling the oil out of your skin is not always going to be helpful. In fact, you could be doing a lot more harm than good. Read about the importance of your skin's acid mantle here.

Because we want to keep the acid mantle of the skin intact and to keep everything functioning healthfully the best plan is going to be as gentle as possible while still being effective. Healthy skin will heal faster. Compromising your skin when something goes wrong is like shooting yourself in the foot when you stub your toe. Most of what I am focusing on here is how to treat a breakout: a singular incident, not the long-term treatment and causes of acne breakouts. That is a much longer post for another day.

First things first, there is not one kind of pimple and therefore not one kind of treatment. Let’s briefly go over each of our options.

Image courtesy of Curology.com

Image courtesy of Curology.com

  • Comedones are the fun ones, these are your whiteheads (closed comedones) and your blackheads (open comedones). You know which ones they are because you can very visibly see what is blocking the pore whether it be oxidized oil in a blackhead or the milky white/yellow pus and sebum of a whitehead. As a professional, licensed by the state to extract pus and sebum from your skin I will only extract something I can visibly see on the epidermis of your skin and can get out in about three attempts. If an esthetician would not touch it, you absolutely should not. 
  • Papules, on the other hand, are the small red bumps where you can feel that little pus pocket waiting to come out. You know if you just squeeze a liiiiittle harder you can get it. Sound familiar? Sometimes these papules will develop that whitehead and become comedones ready to be extracted. Sometimes, they will heal on their own and within a day or two, will flatten out and disappear. With a little love applied to the skin, you can see the disappearance of these guys a lot quicker then with squeezing.
  • Cysts are the final category. These are big, they are pissed, they hurt you. Some people get these a lot. I typically get one every other month with hormonal changes. Popping these will essentially guarantee a scar. The best thing you can do here is to focus on your immune system. Support your body and it will be strong enough to fight this battle without you making yourself bleed.

To Pop?

If you have a comedone, good news: you can! Most of the time. Within reason. Bad news is, these are the ONLY pimples you should be popping. These are the only pimples your esthetician should be popping. Why? Because with anything else the infection is so deep in the skin that extraction is either impossible or so traumatic to the skin that you will create scarring and the very high likelihood of further infection. Steam is going to be your best friend here. Your skin will be moist and softened and any impacted oil and sebum will also soften to a more liquid state so extraction will require a lot less work. I think the best way of doing this at home is using a drop of essential oil (I like clove, cinnamon, lavender, or tea tree) and massaging it into the area gently before applying a clay based or charcoal mask to the area and taking a long shower.

I adore the Say Yes to Tomatoes Detoxifying Charcoal Scrub, the Origins Original Skin Retexturing Rose Clay Mask, or the First Aid Beauty Skin Rescue Purifying Mask With Red Clay. The essential oil isn’t clutch here, but it makes a significant difference, in my opinion. Be thoughtful about what you use and be aware of your sensitivities: lavender is soothing, tea tree is astringent and antibacterial, clove and cinnamon are warming and will help draw things to the surface of the skin.

After your shower, take off the mask with a warm washcloth and with clean finger or two q-tips, press down on the sides and roll inward. It is important for the motion to be downward and then inward because what we don’t want to do is inadvertently push any infection deeper into the skin, we want to force it all up and out. So “equal and opposite reaction”, right, nerds? Do not dig your nails in, which is why q-tips are helpful here. When you are extracting, you are looking to get out a plug of oil and sebum. Once you have squeezed that out, stop. You may get a bit of blood and lympthatic fluid, but there is no reason to be overly concerned about this. Just take it as a sign that your work is done.

Follow up your extraction with a wipe of toner. I like a refining toner, but if you would prefer something soothing, simple rosewater works as well. Apply tea tree oil as an antibacterial step, but I would stress anti-inflammatories here for quicker healing. A soothing serum, lavender or rose essential oils, and cortisone cream are all good options post-pop. I would also highly recommend this in the evening, before bed. Doing this rushed in the morning and then applying makeup on top is not going to work. You have created a small open wound. Concealer won't sit on top of an open wound well, if at all, and packing powder and pigment into an area you just extracted is extremely counterproductive to the healing process.

Or Not to Pop?

What we want to focus on is reducing inflammation. Spot treatments are great here if they are not too aggressive or over applied. Some of my favorites are the Kate Somervile EradiKate Acne Treatment, which utilizes sulfur and salicylic acid to purify as well as anti-irritants like camphor and calamine. The mask version, Kate Somerville EradiKate Mask Foam Treatment, is also amazing. Paula’s Choice Resist BHA 9 and La Roche Posay Effaclar Duo both use salicylic acid combined with anti-irritants and in the case of LRP, benzoyl peroxide, that create strong effective treatment.

I also really like hydrocolloid as an ingredient for especially these kinds of spots. Hydrocolloid is the same ingredient in blister bandages and draws the impurities out of the skin. I bulk order the Cosrx Acne Pimple Master Patches for myself and they usually flatten my red bumps overnight. If you are dealing with a heavy-duty cyst, spend a lot of time giving your skin TLC. Soothing masks, anti-redness serums, and cortisone cream are effective here. I am very intrigued by the Medik8 Red Alert Serum, which contains teprenone, a compound used in the treatment of gastric ulcers that also dramatically reduces redness. A cold mask out of the fridge or one that has cooling properties, such as the Peter Thomas Roth Therapeutic Sulfur Masque will also bring down the angry red lump.

Besides this, support your body and let it do its job. This is going to induce some eye rolls, but drinking lots of water and getting exercise will help. I know. Every wellness magazine and smug celebrity in yoga pants says this. But I can explain: these are two great ways to support your lymphatic system. Your lymphatic system’s entire job is to detox your body, carry toxins out and nutrients in. Lymphatic fluid is that clear, oozy stuff that comes out with the pus, blood and sebum when you pop a pimple. Lymphatic fluid travels throughout your body to your lymph nodes, which are giant water wheels of detoxification centers. Lymphatic fluid is not pumped through your body like blood. It just kind of flows as your body moves. So, moving your body and staying hydrated keep this fluid loose and flowing.

If you struggle with consistent breakouts, I would encourage you to find an esthetician who is a Certified Acne Specialist. This is someone who has had additional specialized training and has tools at their disposal that can help stop a breakout in its tracks. One such treatment is the utilization of a high frequency machine. These do a lot of things but they are especially brilliant at zapping a breakout, ridding it of bacteria and toxins, encouraging lymphatic drainage, and stimulating healing circulation to the area. A lymphatic massage is something an esthetician or a massage therapist, if you’re looking for a full body experience, can also provide for you. A lymphatic massage is a feather-light massage technique that moves the lymphatic fluid through your body to the lymph nodes. 

Final thoughts

I would also like to say, we all get breakouts. They are not necessarily a sign that you are doing something wrong or that you need to go out and buy a whole new product line of skincare products. They are caused by a variety of things and I really think we could all practice a little self-love and recognize this is part of being human and having skin. I myself experience small but consistent breakouts. They are from having naturally small pores, wearing a heavy amount of makeup during long workdays, and eating an excess of dairy. I have learned to try and adjust for the dairy here and there but if it is between no cheese and perfectly clear skin I pick cheese. Every time the cheese wins. I also love makeup and feel more prepared for the day when I leave the house wearing a look. I won’t be changing that either.

I make adjustments that make sense and have made a difference in my skin. But I am not going to live my life around avoiding a clogged pore here and there. I encourage you to do the same. Use good skincare and make smart choices, but also live your life and don’t worry too much!