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If you suffer from acne and breakouts regularly, or dealt with acne in your youth, chances are that you've experienced a pimple that’s turned into a hard lump under your skin.
What are these hard pimples and why do they stick around?
Hard pimples can be painful and uncomfortable, not to mention unsightly, and it can be a challenge to banish these blemishes. In fact, some hard pimples and cysts may require the assistance of a doctor to prevent them from getting worse or causing scars, and even to improve scarring condition.
In this article, we’ll take a closer look at how and why hard pimples appear on the skin. We’ll also outline several treatment options and best practices to help you clear your complexion.
Acne vulgaris occurs when hair follicles and pores become blocked with excess sebum (oil), dead skin cells, and other debris or dirt. This causes blemishes like whiteheads, blackheads, and other pimples to form. If these spots get infected, they can become inflamed and painful.
Hard pimples are a type of blemish that usually develops underneath the surface of the skin. These blemishes typically occur in the dermis—the middle layer of the skin—compared to other pimples that develop on the outer layer.
Hard pimples usually form when the skin fails to remove excess oil from the pores, leadening to the formation of protective tissue around the pore, and a lump. Hard pimples can also be:
Hard pimples are difficult to treat and heal. Normal treatment options often can’t reach the dermis to target hard pimples, which means it can take longer for them to disappear.
There are several types of blemishes that can show up as hard pimples, some of which share similar characteristics and some of which have their own unique features. All of them can cause pain, irritation, and redness, and all of them can leave a scar if treated improperly or abused. Let's take a look at the different types of skin blemishes.
Papules are tiny raised bumps that sit on top of the skin surface and which have no visible pus. They develop from excess skin cells and oil clogging the pores.
Pustules develop under the surface of the skin and contain fluid or pus. They usually appear as white pimples or bumps surrounded by red skin and can grow quite big. They can be painful and inflamed, and they can develop anywhere on the body but are most common on the face, neck, and back.
Acne nodules are the most common type of hard pimple and are small, hard lumps that form under the skin. They can be the same color as your skin or can turn red as they become more inflamed. They don't contain fluid but can be very painful to the touch.
Cysts are commonly caused by a blockage in a duct and can be caused by infection or trauma. While some cysts can develop internally (the kidneys, ovaries, neck, for example), external cysts often appear as hard lumps under the skin filled with fluid.
If you’re worried about a hard lump anywhere on your body, and it's different from other pimples or getting larger, it's a good idea to get it checked out by a physician. Most hard pimples and lumps, particularly when you can tell they’re related to acne, are nothing to worry about, but it's always a good idea to get peace of mind if you’re concerned about something larger.
When hard pimples develop on the skin, they can cause inflammation. Although this is the body's natural response to an irritant, inflammation can contribute to pain and swelling. This can make the blemish appear larger.
Hard pimples can also form when oil and other impurities become trapped and harden beneath the skin. A hard pimple will often get bigger if these substances continue to build up under the skin.
The size of a hard pimple will also increase if you are picking at the skin or trying to pop the blemish.
When you put pressure on the affected area, it can aggravate the already inflamed pore, leading to swelling.
It's always a good idea to start treatment under the guidance of a board-certified dermatologist.
A professional will be able to examine your pimples and skin to determine whether there are other underlying medical conditions at play before recommending treatment options.
These treatments may take a few weeks or a couple of months before you see visible results.
However, you should go and see your doctor if you notice more hard lumps or blemishes forming on the skin.
Post-acne scarring occurs when inflamed pimples damage or change the texture of the skin.
Hard pimples are types of inflammatory blemishes that can break down essential skin proteins—such as elastin and collagen—that are responsible for maintaining a smooth complexion.
When these proteins are damaged, the skin loses healthy tissue and becomes more vulnerable to scarring.
Hard pimples can also cause post-acne scarring if they're treated incorrectly or don’t heal completely. Scarring is common when you pick or damage acne spots, opening them to infection and creating a small wound. The wound-healing process can lead to scarring.
Without the right treatments, hard pimples can cause irritation and inflammation that harms the complexion indefinitely.
Trying to pop a hard pimple increases the risk of post-acne scarring.
When you squeeze a blemish, you risk pushing infected fluids or tissue deeper into the skin, and you risk rupturing a contained pore or blemish. This is what damages healthy cells, contributes to acne proliferation and causing scars to form.
As you may have already discovered with your own pimple-busting journey, there isn't one cure-all treatment for acne. Instead, you'll need to find the products and treatments that ease your particular type and severity of pimples.
Pustules and papules are often considered to be fairly mild types of acne. They can sometimes be alleviated using over-the-counter (OTC) treatments that contain salicylic acid or benzoyl peroxide. By following the instructions on your product, most people will generally start to see a visible difference in size and appearance in a few weeks. Keeping skin clean and clear with regular and gentle cleansing is a big part of that process.
Acne that manifests as nodules and cysts should usually be treated by a doctor experienced in these conditions. Dermatologists, as skin experts, generally have the background necessary to treat most acne types, and working with a professional like this is the fastest way to rectifying aggressive or persistent acne. These persistent types usually require more intensive forms of treatment, prescribed by a qualified clinician.
Persistent acne in the form of papules or pustules can benefit from professional expertise, too, and commonly used prescription treatments can generally help anyone with chronic or invasive acne.
A number of topical and over-the-counter treatments can be used to target hard pimples. These treatments are generally designed to reduce the amount of oil on your skin or kill the bacteria that cause your pimples to multiply. Some treatments are available over-the-counter, while others are only available by prescription from a doctor or qualified dermatologist.
Salicylic acid is an exfoliant that can help the skin regulate oil production.
It’s intended to break down and dissolve oil trapped in pores to prevent and clear blemishes. This also helps decrease the risk of breakouts in the future.
This exfoliant can also be used to remove dead skin cells from the surface of the skin to keep it free from the buildup that causes hard pimples.
Benzoyl peroxide is an exfoliating option that may be good for treating cystic acne and nodules. It can do this by:
Like salicylic acid, benzoyl peroxide is also designed to dissolve oil and other impurities trapped in the pores or underneath the skin to help keep skin clear and prevent hard pimples from forming.
Azelaic acid is an anti-inflammatory treatment option that can help reduce the severity of hard pimples and reduce inflammation that contributes to pimple formation.
It does this by stimulating the skin's cell turnover process, which is essential for removing the buildup of impurities from the surface of the complexion. During this process, the skin also generates new cells to replace dead ones. This helps repair damaged tissue and reduce irritation to reveal a smoother, healthier complexion.
Azelaic acid is also intended to help keep the skin barrier healthy. As the complexion’s essential first line of defense against pollutants, the skin barrier can keep harmful bacteria that can contribute to infected blemishes at bay.
Clindamycin is a topical antibiotic that can improve the appearance of blemishes like hard pimples. Its antibacterial properties allow clindamycin to limit harmful organisms from multiplying on the skin and causing breakouts.
Not only does this reduce the risk of deep pimples forming, but it may also heal existing breakouts by reducing infection and inflammation.
Because retinoids can increase the skin's cell turnover process, they can help repair damaged areas and heal hard pimples or scar tissue.
Retinoids help to remove dead cells, oil, and dirt from the surface to keep the pores clear and reduce the risk of a blind pimple forming underneath the skin.
Retinoids may also be effective in decreasing inflammation and swelling. This can make a hard pimple less noticeable while also reducing pain and redness.
If you consistently develop hard nodules or cysts, your doctor may recommend an oral treatment. Oral solutions for acne can include:
Low-dose oral antibiotics—like amoxicillin, tetracycline, or macrolide—can be taken until severe acne symptoms clear up. Antibiotics also help to soothe inflammation and stop the growth of acne-causing bacteria.
This can prevent infectious organisms from causing harmful buildup that turns into a hard pimple.
Birth control can be an effective acne treatment for women because they help to balance hormonal factors that contribute to acne. Hormonal fluctuations can often increase sebum production, which may contribute to clogged pores and cause acne breakouts.
Excess sebum can also become trapped beneath the skin and form hard pimples. When hormones are balanced, sebum production can be better controlled and the risk of developing hard pimples is reduced.
It's recommended that you consult your doctor before using birth control as this oral medication may also cause severe adverse reactions.
Isotretinoin is an oral retinoid used for severe acne or when nodules or cysts don't respond to other oral medications. Because it’s known for causing negative side effects, isotretinoin is often a last resort treatment option.
This medication reduces sebum production, unclogs pores, and kills harmful bacteria. It also has anti-inflammatory properties that can soothe and shrink hard pimples.
Although isotretinoin is an extremely effective oral treatment, you are more likely to experience severe adverse reactions than with most topicals. In rare cases, this may include pancreatitis and even mental health disorders.
You’ll need to speak to a dermatologist and obtain a prescription before you can start isotretinoin treatment.
If your hard pimples aren’t responding to over-the-counter or prescription topical or oral treatments, your dermatologist may suggest an alternative route.
These can be used instead of or alongside oral or topical treatments, and each case will be assessed individually. Here are some more acute hard pimple treatment options:
This treatment is used to manually extract or drain excess fluids from hard pimples.
A licensed surgeon or dermatologist typically performs this process by making a small incision in the skin to get to the cysts or nodules and drain them.
After the fluids have been removed, your doctor can remove the cysts or nodules during acne surgery.
Laser therapy is an advanced and powerful treatment option for reducing hard pimples.
It's done by passing a controlled beam of high-frequency radio waves over the affected area. The heat from this treatment causes the cells of the hard or blind pimple to break down.
This process also stimulates collagen production to help heal the wound and repair damage to the skin. Collagen also helps the skin to appear smooth and healthy.
These options are generally reserved for severe acne situations, and you shouldn’t attempt any of the above without a professional’s guidance.
This involves a cortisone injection that is administered directly into the affected area. These injections reduce pain and inflammation, which helps hard pimples to heal.
The pimple may start to shrink or disappear within a few days. Although these injections are a convenient way to treat stubborn blemishes, they should be used as a last resort. Cortisone injections can cause adverse side effects like thinning skin tissue.
This can contribute to scarring around the injection site and often change the texture of the skin. When this happens, it can also cause permanent scarring.
Although there's no foolproof way to ensure that hard pimples never occur, there are a number of things you can do to keep them at bay.
Hard pimples can appear out of the blue for a number of reasons not related to the conditions above. A dermatologist will be able to examine your pimples and skin condition to determine whether there are other underlying medical conditions at play before recommending the right treatment.
For example, rosacea (reddening of the skin) may appear as pustules and papules, but may require different treatment than acne. If your current course of treatment, whether prescribed or over-the-counter, doesn't make any difference within a few months, it's a good idea to seek help from your doctor.
Other medical issues can also look like a hard pimple in some situations, including benign or even cancerous lesions/nodes. This is generally when they are large or growing, and a dermatologist or clinician can help make a diagnosis.
Hard pimples can also leave scars or scar tissue beneath the skin surface if you treat them the wrong way or don’t let them heal properly. Picking, poking, draining, and scratching at hard pimples can lead to scar tissue formation at the surface and even well below the surface, much like a cyst.
When pimples turn into scars, retinoids are one of the best treatment options, able to help accelerate skin cell turnover and smooth rough or wrinkled patches. The best retinoids for acne scars will require a doctor’s prescription.
Hard pimples can be painful and unsightly. They can also affect your self-confidence.
The good news is that with the right products or treatments - and if necessary the professional advice of your doctor - many of these blemishes are treatable.
Our range of prescription and OTC solutions are formulated with topical ingredients known for their healing properties. These include:
Avoiding hard pimples with the right routine in the first place is ideal, and working with a professional to treat your acne can help to eliminate the risk of scarring and long-term problems –– plus get you faster acne resolution and clear skin.
Nava MD helps men and women get prescription acne treatments from home, with custom solutions shipped to your door if prescribed. Click here to learn more and start your online dermatology consultation.
This article is intended for informational purposes only and should not be considered medical advice.
Consult a healthcare professional or call a doctor in the case of a medical emergency