Ever wondered why the doctors always tell you not to pop your pimples? I mean, it’s just a little bump, right?! And you’ve popped them your whole life and nothing bad ever happened! Well nothing ever happened to you, at least nothing more than a prominent scar or a dark mark that took a longer time to disappear. But for some people, a popped pimple turns into a nightmare!
What causes a popped pimple to wreak havoc? First let me explain how the pimple forms in the first place. A pimple forms when a hair follicle (the tiny chamber in the skin from which a strand of hair emerges) somehow gets blocked, usually from a build up of dead skin cells, although sometimes skin products can block the pores as well. With the follicle being blocked the secretions of oil etc (sebum) cannot escape to the surface. Bacteria from the surface of the skin get into the follicle and with the stagnation, the bacteria multiplies. The body notices this and so fighter cells (white blood cells = WBCs) are sent to the region to prevent an out of hand infection. What forms in the follicle is pus, a combination of the fighter WBCs, bacteria, dead skin cells etc. When there is enough pus, it becomes visible at the surface of the skin as a pimple, which may have a red border with a whitish center of pus.
Pimples are common on areas of the skin which secrete more oil such as the face, upper chest and back, since there are some skin germs that like this oily environment. Pimples may also occur in hairy areas of the body such as in the arm pits and groin as there are other types of germs that like to hang out in these areas, particularly Staphylococcus or “staph” type germs.
Now for the real reason pimples should not be popped…popping a pimple usually involves squeezing it at the sides to express all the pus. Sometimes, however, the pus has not yet reached the surface and quite a bit of squeezing has to be employed to get it out. The thing is, the more squeezing that occurs, the greater the trauma to the surrounding tissues. The trauma causes quite a bit of bruising and the surrounding tiny blood vessels (capillaries) may burst. Depending on the amount of bruising, some of the tissue may be damaged beyond repair and actually die. Germs love dead tissue. And, because the tiny blood vessels got busted, there isn’t that good blood supply to the area to wash away the germs with the fighter WBCs in tow.
In most cases the pimple is quite small and over time the bruising will resolve and the localized infection will clear. Sometimes however, things get out of control. This happens particularly with a good sized pimple, or a boil, and…usually in someone with an immune system that is not the strongest (uncontrolled diabetes is a big culprit). With a weakened immune system things can quickly get out of control and the germ or germs can escape the pimple (hair follicle) into the surrounding tissues. Depending on how aggressive the germ is, there can be spread along a large area of skin. Essentially, any part of the body can be involved from the face, to the chest, to the leg. This spreading infection is called cellulitis – an infection of the skin and underlying structures.
Extensive inflammation from the skin infection can result in the germ escaping into the blood stream from the tiny, bruised blood vessels. The blood stream is one of the few areas of the body that is supposed to be sterile, with no germs flowing in it (compared to the skin, for example, on which are a lot of mostly harmless germs). Therefore germs in the blood stream can potentially wreak havoc with the production of chemicals (or cytokines) in response to fighting the infection, resulting in chills, fever, weakness, etc. In worst case scenarios, one may become outright septic requiring admission to the hospital for strong antibiotics.
The worst case scenario mentioned above (sepsis) is not what we see daily but it is certainly not uncommon. Admittedly however, most of us will squeeze pimples throughout our life and never suffer a major consequence. If not squeezed, our immune systems will cure the pimple over a short time. A bigger pimple or boil may sometimes need antibiotics by mouth or even minor surgery to incise (lance) it and drain out the pus.
Persons prone to bad skin infections, or those known to have a weakened immune systems, such as from diabetes, should NEVER squeeze pimples. Sepsis in diabetics and other immunocompromised persons can end up being a deadly situation. When in doubt, always seek medical attention.