32. Zit Spot Treatments

Doctor Jacob here, and today we're talking about zit spot treatments.

Pimples and zits can actually benefit from some spot treatments, and everything we've talked about so far with the benzoyl peroxide cleansers or topical clindamycin, or vitamin A products like tretinoin gels - those are field treatments, we treat the whole zones that are affected with acne, typically the whole face. But when you do develop a pimple or a zit, what do you do? We all know you should pick it, you shouldn't manually traumatize it, but how can we kind of help things along? That's the idea of a spot treatment for acne.

Of course, it would be better not to develop the zit in the first place, but as you know, sometimes breakouts - well, they break out. So let's talk about drying sulfur lotions. There's a great product out there which is a Mario Badescu product, it's a sulfur-based drying lotion for the treatment of zits. It can be used one spot at a time, and it's used at bed time. I'll put a link on our website to the product, so that you can order it if you choose. It's not very expensive and it works pretty well in all skin types. It helps dry up the zit a little bit faster; it's not a miracle, but it does reduce the time that the zit will be present. It's basically a high concentration of elemental sulfur placed right over the zit. You do it right at bedtime, then you don't fuss with it, you go to sleep, the sulfur drying lotion works while you sleep, and then when you wake up you wash off the lotion and enjoy the reduction in the acne.

Now let's talk about icing. So icing for deeper seated cysts can sometimes help, especially if the cyst is very inflamed. You can take an ice cube, or if your fingers are getting cold you can take a styrofoam cup with water, put it in the freezer and it makes ice, and you chisel back a little bit of the styrofoam and then put the ice up to the face. The styrofoam isn't so great for the environment, so if you're not too troubled, take a paper towel, wrap it around an ice cube and ice some of the deeper seated cysts.

I wouldn't do this for a small pimple, but for a deeper seated cyst it's not a bad way to go if you ice for 5 minutes. I wouldn't go longer than 5 minutes maybe once or twice a day. Sometimes that helps with the inflammation, helps a little bit with the pain. It's not the end-all and be-all, but it's something else that can help you if you're in a pinch.

Finally, let's talk about the spot treatment which I do the most of, it's called intralesional injection with a corticosteroid. There are chemicals, prescription drugs, pharmaceutical which are liquid forms of steroid which are injected by a trained medical professional like a dermatologist into a zit or a deeper seated pimple called a cyst or nodule. This really, really has great anti-inflammatory properties and helps these things go away, within 48 hours usually they're gone. Something that might last a week or 10 days could be gone within 24 to 48 hours. I have patients who call me up all the time saying "Hey Doctor Jacob, can you fit me in for a cyst injection?" and I inject a very dilute solution of intralesional - meaning into the cyst - Kenalog, which is usually the steroid of choice, as a very dilute solution. Usually I'm using anywhere between 2.5 mg/ml up to 10 mg/ml of Kenalog diluted with normal saline. The choice depends on the location and how big the cyst is, and this is usually something that I would only leave to somebody who's very experienced in doing it.

There are some risks involved. If too much of this medication is injected sometimes it can thin out the fat, called fat atrophy leading to a divid formation. Divid means kind of a hole or... Not an open wound, but an inward slope of the surface of the skin right at the spot there. That has to be differentiated from a scar, but intralesional Kenalog divids generally go away in about a year, so if that happens to you don't flip out. It's not forever, it goes away, but it's very rare when it's done properly, but it can happen.

Finally, for zits the best spot treatment of all - do not pick them. Great advice, and take that with you to the bank.

I'm Doctor Jacob, that's it for acne zit spot treatments. We'll see you next time.