What to Know About Blind Pimples

Medically Reviewed by Stephanie S. Gardner, MD on July 20, 2023
4 min read

Blind pimples (nodulocystic acne) are firm swellings below the skin's surface that are often inflamed, painful, and sometimes get infected. Here’s what you need to know about the causes, treatment, and prevention of blind pimples.

Almost everyone gets acne at some point in their lives. It is the most common skin condition in the U.S., affecting up to 50 million Americans annually.

When you think of acne, you probably picture blackheads (dark spots with open pores at the center), whiteheads (tiny white bumps under the skin that have no obvious opening), papules (red bumps), or pustules (red swellings that are filled with pus). However, blind pimples — or cystic acne — are more severe.

Though the cause of cystic acne is not always clear, researchers and dermatologists have identified factors that make acne more likely.

Oil, bacteria, and dead skin. Your sebaceous glands can occasionally produce too much sebum. The excess sebum mixes with dead skin cells and can form a plug in the follicle — leading to acne. Bacteria that live on the skin can then infect the plugged follicles, causing papules, pustules, nodules, or cysts.

Hormones. Androgens are hormones that increase during puberty. They cause the sebaceous glands to enlarge and make more sebum. Hormone changes can also occur later in life, especially in women.

Family history. Acne appears to run in families, but few studies have investigated the genetic basis of acne.

Medications. Examples include drugs containing corticosteroids, testosterone, or lithium.

Researchers and dermatologists have also identified other factors that make acne more likely:

  • Irritating or comedogenic cosmetics or skin products
  • Stress
  • Pressure or friction from tight clothes, helmets, and more
  • Air pollution or humidity
  • Squeezing, picking, or scratching at pimples
  • Using harsh physical exfoliants

There are several treatment options — both over-the-counter and prescription — for cystic acne. Additionally, several acne treatments do not involve medicine.

Topical Treatments: “Topical” means treatments that go on your skin. Typically, the first approach to treating blind pimples is to try topical medications. Common topical acne medications include:

  • Benzoyl peroxide. This antiseptic reduces bacteria on the skin. It comes in either cream or gel form.
  • Retinoids. Also available as either foams, gels or creams, these work by increasing the rate of skin cell turnover and reducing sebum production. Adapalene, tazarotene, tretinoin, and trifarotene are topical retinoids used to treat acne.
  • Antibiotics. Topical antibiotics reduce bacteria on the skin that can cause acne. They're available as a lotion or gel.

Oral Treatments

If your cystic acne is very severe and does not respond to topical treatments, your dermatologist may prescribe you oral medication.

Antibiotic tablets. Certain antibiotics are used to reduce bacteria in the skin from the inside out. The most common types include:

  • Clindamycin (such as Cleocin)
  • Doxycycline
  • Erythromycin (such as E-Mycin)
  • Minocycline

Hormonal therapies. Hormonal therapies are often prescribed for women struggling with acne. Your primary care doctor or dermatologist may suggest oral contraceptives if you’re not already on them. Another common hormonal treatment option is spirolactone, a synthetic steroidal androgen receptor blocker.

Co-cyprindiol. Co-cyprindiol helps to reduce the production of sebum. It’s typically prescribed when severe acne does not respond to antibiotic treatment.

Other Treatments for Blind Pimples

Several acne treatments do not involve medicine. These include:

Corticosteroid injections. To get rid of a deep, painful acne cyst or nodule, your dermatologist may inject blind pimples with a corticosteroid. This speeds healing and reduces the risk of scarring.

Chemical peels. Chemical peels are skin-resurfacing procedures that work by removing the top layers of the skin.

Light therapy. Phototherapy with visible light, specifically blue light, has been shown to improve skin condition in cases of acne.

Topical cream. A topical antiandrogen cream called clascoterone, used twice daily, may reduce acne lesions.

Improvement of blind pimples can take several months or more, depending on the treatment and other factors affecting your cystic acne.

The best prevention for blind pimples is better skincare and hygiene habits. Though cystic acne is not caused by poor hygiene, it can exacerbate your blind pimples if you stay in sweaty clothing or forget to wash your face. Remember to do the following:

  • Wash your face twice a day and shower after a workout or hot day.
  • Be gentle. Look for products that are non-comedogenic and alcohol-free. When you cleanse, use your fingers and wash with circular motions.
  • When you get pimples, make sure not to touch, scratch, pick, or squeeze at them. If you do, your skin will take longer to clear and you increase the risk of getting acne scars.
  • Wear sunscreen, hats, and sun-protective clothing.