Acne Is Essentially a Wound, so Should We Treat It as Such?
True story: Last week I had a giant cystic pimple on my cheek that wouldn't die, no matter how many spot treatments I tried. For advice, I reached out to skincare extraordinaire Renée Rouleau, who told me not to touch it and just continue with what I was doing. But as each day wore on and the breakout continued to stare me in the face, I threw in the towel and gave it a major squeeze. Of course, this made it even redder and angrier, and it swiftly scabbed over (forgive me, Renée, for I have sinned).
As I watched the area take on new life, I was immediately transported back to my high school days when I relentlessly picked at my skin to the point where I had certified wounds smattered across my pubescent face like fiery constellations. So when Alicia Yoon recently told me that acne lesions are essentially wounds and need to be treated as such, I could relate on a cellular level. But this stands for breakouts that haven't been mangled, too. The definition of a wound is "an injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken," so in the case of acne, the impact is the inflammation and buildup within the skin.
Eastern countries took note of this many years ago, employing hydrocolloid patches (the same treatment used in medicine to heal wounds and burns) that draw buildup out of the breakout rather than dispense medicine into the area to treat blemishes. And since Western brands tend to mirror Asian beauty practices, several mainstream brands have begun marketing similar patches too, including Peace Out, Spot Medic and Skyn Iceland. (Yoon's own brand, Peach & Lily, also sells "spot dots.") Curious if this is the be-all, end-all treatment everyone should be doing, I decided to do a bit of research.
A quick Google search brought me to a 2006 pilot study in China where hydrocolloid dressings were applied to acne lesions. Twenty patients with mild to moderate acne applied the skin tapes or "acne dressing" every two days for up to one week, changed every two days. The results showed a significant improvement in redness and oiliness at days three, five, and seven. Given that the research was done over 10 years ago and the sample size was so small, we asked dermatologists if the findings hold any weight.
Raj Kanodia and Deepak Dugar, MDs, of Beverly Hills Plastic Surgeons weren't too impressed either, giving "little to no clout" to the study. "Wound dressings may become another tool toward fighting acne, but alone, it will likely never be purely a solo treatment," they said. "There is excess oil in the sebaceous glands of the skin, which harbor bacteria, and the multiplication of the bacteria is what causes the breakouts."
Instead of putting all of your cards into the wound treatment, Kanodia and Dugar recommend sticking to traditional treatments. "Topical retinols and topical intentions of reducing the oil in the glands to decrease the colony of bacteria is needed. Oral antibiotics can also be helpful with dealing with wounds and acne breakouts," they explain, but not without giving hydrocolloid bandages a bit of street credit. "This acne dressing is likely just another tool, which, if it helps, is exciting."
Michele Farber of Schweiger Dermatology Group in NYC has a bit more optimism. "Wound dressings can be a helpful adjunct for acne," she explains. "The 2006 study examined hydrocolloid dressings as an acne treatment and showed that they reduce oiliness, redness, and pigment changes as acne resolves. Hydrocolloids do work for acne spot treatments and are already on the market as acne dots. They work by drawing out excess oil out of skin to help acne resolve more quickly."
Similarly to Kanodia and Dugar, however, she wouldn't recommend them as a sole remedy, especially in the case of more austere lesions. "They are great for a few bumps, but depending on the severity of the breakout, other medications may be necessary," she told us.
Melissa Kanchanapoomi Levin, MD, a board-certified dermatologist and clinical instructor at NYU Langone Medical Center and Mount Sinai Hospital, shares similar sentiments. "The water-attracting film [in a hydrocolloid dressing] is applied directly to an open wound. In dermatology, we use hydrocolloid dressings for the treatment of chronic wounds and ulcers. To me, hydrocolloid bandages are a part of treating breakouts but not the entire answer. It's important to stay on your skincare regimen with anti-acne ingredients like topical retinoids such as over-the-counter prescription-strength acne retinoid, since retinoids work by preventing as well as treating pimples. It's not one or the other."
While the mechanics of wound dressings may not solve all your pimple problems, though, their physical design alone intrigues dermatologists. First, the dressings foster a moist environment to allow for faster and improved healing time. Second (and this is a biggie for this editor), they prevent you from being able to pick.
"For me, this is one of the biggest benefits," says Farber, "since it's human nature to want to pick and squeeze, but picking a pimple increases inflammation and not only slows down the healing process, it increases pigmentation and scarring."
Lastly, covering a breakout with a patch protects it against sunlight and "therefore minimises exposure UV radiation to minimise hyperpigmentation," explains Levin.
So why not just use a Band-Aid, you ask? According to Farber, with continued use, plain bandages have the potential to irritate the skin on the face. Plus, they don't have the same moisture-inducing, water-attracting material that hydrocolloid bandages do.
Okay, last thing: What about topical wound ointments? Those are antibacterial, so they have to help, right? Not so, says Farber. "Neosporin is best for actual cuts and scrapes—stick to your acne products for your face. Neosporin is in a petroleum base, which can potentially clog your pores. It's also best to use antibiotics directed at acne, as Neosporin is directed at different bacteria. Acne products contain combinations of medications that are aimed to treat the bacteria that cause acne as well as other causes of acne." Levin agrees: "We want the glands and pores to be cleared and not sealed over."
The bottom line: While wound dressings will help draw out oil and reduce redness, topical retinoids or antibacterial topicals will be more effective as a whole at ameliorating acne lesions. To choose the best measure for your specific type of acne, speak with a dermatologist.