There are two things those who have experienced pimples under your skin are all too aware of. Number one, they can be quite painful. Number two, if the skin is broken trying to get rid of one, it often takes a long time to heal. These types of pimples, which are believed by many to be caused by the same type of bacteria that cause skin surface acne, can at times be quite difficult to treat.
If the causes of acne were well known, this bothersome skin condition might be easier to treat, and might even be curable. Such is not usually the case however, at least not at this time. For a long time, conventional wisdom said that the main cause of acne had something to do with what you ate. If you ate a great deal of chocolate, or ate a great deal of junk food or fried foods, you were more likely to break out.
Lifestyle – More a Contributor than a Cause
The theory that food is the source of acne has never been proven and is now generally believed to be based upon a false assumption. It has not, however, been totally proven that food is not a causative factor. Food may in fact still be a contributing factor, if not a direct cause of acne and pimples. Our body works in complex ways, and our general lifestyle, as well as what we eat or drink, can often influence our health and determine what diseases or disorders we may have to put up with, including skin disorders, at least indirectly if not directly.
Testosterone Appears to Pay a Major Role
Endocrinologists believe that it is the hormones in our body that are the cause of certain skin problems, specifically acne. Acne tends to flare up when there is an excess of oil production in our skin, and the size of that oil production is a direct function of hormonal activity. The hormone which appears to be at the root of the problem is testosterone, and the oil glands in the skin just happen to be extremely sensitive to the presence of testosterone.
One of the telltale signs that testosterone lies at the root of the problem has been that most young people get surface pimples and/or pimples under their skin at about the same time as they are reaching puberty, which is the same time in which testosterone levels are increasing in both boys and girls, more so in boys of course. If pimples do occur, they most often occur on the face or neck, and especially in around the cheeks and the chin, or along the jawline. It just so happens that these areas, on the lower part of the head, are those areas of the body that are most sensitive to hormones and changes in hormone activity.
One of the characteristics of pimples under the integument is that they are much more common among adults than they are among teenagers. One of the reasons for this is that teens have a greater tendency to get clogged pores, which leads to bumps and pimples that tend to be on the surface. An adult’s skin is usually not as ‘sticky’ as that of a teenager. Consequently, adults who have acne problems have a tendency to experience the under-the-skin type of acne which is more a function of hormone fluctuations and less a function of clogged pores.
Pimples under the Skin and Cystic Acne are Usually the Same
What has been discussed up to this point sometimes goes under the name of cystic acne. Bear in mind that there are a number of different types of acne, and cystic acne is so-named because the eruptions beneath your skin are cystic in nature, which is to say they take on the characteristics of cysts. These cysts are the result of lesions that cause acute damage to the oil glands, deep under the surface of the skin. This damage causes tissue to become inflamed, which is why the bumps observed can be both sensitive to the touch and be reddish in appearance. If a cyst becomes infected however, usually due to bacteria that is already present in the pores of the skin, it can quickly become a pimple that lies beneath the surface of the skin.
If it is true that hormones are at the root of the problem, it begins to make sense why many if not most acne medications, especially acne creams don’t work, especially if these medications do not in any way influence hormonal activity. Acne medications, most of which contain either salicylic acid and/or benzoyl peroxide, will have a positive effect if they are able to destroy the bacteria that collect in oils that accumulates in the pores of the skin, but when you have pimples that lies beneath the skin, these topical treatments tend to be much less effective or not effective at all.
Where AR Genes and Androgen Receptors Enter the Picture
To really understand how it is that hormones can be the culprit, and what types of treatment might work involves a study in genetics, in particular a specific type of gene. This gene is called an androgen receptor gene, or an AR gene. An AR gene contains the recipe or instructions for making a specific type of protein. The protein is called an androgen receptor (not to be confused with the androgen receptor gene, which merely provides the instructions). What androgen receptors do is enable the body to respond appropriately to certain hormones known as androgens. Testosterone is an androgen.
When the body is not responding appropriately to testosterone in the sense that the hormone is causing a skin disorder such as cystic acne, researchers have discovered that for a treatment to be most effective, it does not treat testosterone itself, nor does it involve the AR gene; it addresses a protein, in this case the androgen receptor.
Spironolactone – Effective, But for Women Only
There are not too many medications that effectively control the activity of an androgen receptor. Chemicals present in birth control pills have been found to have a positive effect in the fight against cystic acne, but for those not wishing to take birth control pills for other than their intended purpose, there is another medication called spironolactone. Spironolactone is often prescribed as a diuretic and it is also used as a blood pressure medication, but it also effectively blocks or inhibits the binding of androgen receptors. What this does in turn is to blunt the effects of those hormonal changes or fluctuations that appear to be the primary cause of acne.
Spironolactone does not work the same as a topical cream intended to collect excess oils or destroy the bacteria that eventually cause pimples. It works internally to block testosterone. It is effective in most cases, but it can be several months before there is a noticeable improvement. Spironolactone could work for men as well as women as far as treating an under-the-skin acne or pimple problem, but it is only prescribed for women. Blocking testosterone in men is not generally considered to be a good idea. Spironolactone does have known side effects and is therefore used under the direction of a medical practitioner, and is normally given in low doses.
If men can’t or shouldn’t use a spironolactone-based medication, what can they use? In truth, there are some medications containing spironolactone that supposedly can be used by men as well as by women, but it would probably pay to read the label. There are topical applications that will help, especially if they contain retinol, but most adults rely on oral medications to rid themselves of acne. These medications can take quite some time to work in most cases, and it is always best to have a dermatologist prescribe an oral medication or recommend an over-the-counter product.
Isolaz Treatments – Effective but Pricy
There are non-medicinal treatments available for adults for under-the-skin acne. These treatments often require multiple sessions and can therefore be expensive. Relying on an over-the-counter medication that is expensive may not always be a good approach, since some medications might perform poorly or not work at all, a good reason for consulting with a dermatologist first. One type of non-medicinal treatment consists of deep pore laser therapy and is called isolaz therapy. Isolaz therapy performs the double function of cleaning out the pores while at the same time shrinking the size of the pores. Three sessions of isolaz treatments, the number generally considered to be effective, will cost in the neighborhood of $800 per session. Before going that route however, get the opinion of a dermatologist or skin specialist. Isolaz effectively treats the pores, but likely does not have any influence on hormones or androgen receptors, which may lie at the heart of the problem.
Photodynamic Therapy – LED Instead of Laser
Photodynamic therapy (PDT) does not involve a laser but instead involves the controlled use of colored light. The color is usually either red or blue, and the light source is generally LED. The colored light is used in conjunction with a photo sensitizing cream. As is the case with laser treatments, the end result is pores that have been freed of bacteria and shrunken in size. Like laser treatments, PDT treatments are performed by a professional, and they can also be costly.
Isotretinoin – Possibly the Ideal Cure, Except For the Side Effects
Whoever first said ‘there’s no such thing as a free lunch’ had it right insofar as isotretinoin treatments are concerned. Isotretinoin appears to be the only treatment for cystic acne that can result in a permanent cure. Of the treatments previously mentioned, it also happens to be the one that is accompanied by the greatest number of potentially unpleasant and even dangerous side effects. If you’re unfamiliar with the term, you might recognize it as Accutane, a drug that has been taken off the market. According to the Mayo clinic, this medication is generally used as a last resort, and should not be used at all by women who are capable of bearing children. Isotretinoin can cause dry skin. It has been known to cause hair loss in some people. Headaches and nosebleeds are other side effects that have been experienced, and this medication is also considered to be capable of causing liver damage. This method of treatment requires careful monitoring by a physician, and unless your acne is actually disfiguring, it should probably not be considered at all.
Not to Forget Warm Water
A method of treatment not yet covered, but well worth trying, is to apply a warm compress to the area where there is a pimple that lies beneath the surface of the integument. Repeated applications of warm water on a cloth will generally bring the pimple to the surface, and continuing applications will result in the pimple releasing oils and bacteria on its own accord. There is no need to squeeze the pimple, nor should you do so. The method does not address what is causing pimples to form, but can provide relief from the pain and redness they can cause. Keeping the face cleaner than usual can help as well. By all means, avoid squeezing a pimple that is below the surface but feels as if it were on the surface. The result will usually be a break in the skin that is likely slow to heal, will be subject to secondary infection, and could result in a scar. The pimple will likely still be there.
As far as treating pimples under your skin is concerned, the approach you take depends upon the seriousness of the situation, how much money you’re willing to spend, and what the dangers of the side effects are, if there are any. Most of the remedies treat the symptoms and not the problem. The problem lies with hormones. Infection is really only a by-product, but treating the infection and not the root of the problem may in many cases be a worthwhile approach.