An Overview of Acne Pustules

A pustule is an inflamed red pimple with a white top or head  that is filled with pus, oil, and cell debris. While almost everyone has had a pustule sometime in their life, they are especially common among teenagers and young adults who are undergoing hormonal changes. Like other acne lesions, pustules are usually caused by clogged pores, and can be treated in a variety of ways, depending on their severity. If you're not familiar with the word pustules, you may know these acne blemishes by their more common names—whiteheads or zits.

Pustules look like other kinds of acne except for the pus-filled head, which is surrounded by an inflamed area. They can appear anywhere on the body, but are usually found on the face, back, chest, and shoulders—places that tend to be near oil glands. Pustules can vary in size, from small to fairly large. When the top is pierced or broken, the secreted pus is white, cream, or yellow in color. You may also see a brownish dot in the middle of the whitehead. This brown spot is the comedonal plug.

Unlike non-inflamed acne lesions, such as blackheads, milia, and comedones, pustules can be tender.

The primary cause of pustules is acne. Like other types of acne, a pustule begins as a clogged pore that causes a lesion to develop on the skin. The pore is filled with oil (called sebum), bacteria, and cell debris.

When the walls of the affected pore or pores begin to break down, the red, swollen lesion created is called a papule. White blood cells converge on the papule—like an army of soldiers overtaking the enemy—forming a whitehead. This is the immune system's attempt to fight any infection from the dirt or bacteria that has entered the pore. At this point, the papule has become a pustule. 

But not all whiteheads are pustules. If a whitehead on your skin is a hard, white bump, it may be what is called a milia. Pustules can also become hard and painful, in which case they are called cysts.

Aside from acne, other dermatological conditions that can cause pustules include:

• Psoriasis. An infection, stress, and some several medications can trigger an attack of pustular psoriasis. This type of psoriasis differs from the classic form characterized by dry, red skin lesions covered with silvery-white scales. In pustular psoriasis, the lesions form tender pustules, but without the inflamed red border. They are usually closely clustered and set atop a patch of red, inflamed skin.
• Rosacea. A form of rosacea, called inflammatory rosacea, can lead to pustules.
• Chickenpox. This highly contagious (primarily) childhood disease can cause skin lesions that become pustules as the disease progresses.
• IgA pemphigus. Pustules are a symptom of this rare condition in which the immune system turns on itself.

Pustules can resemble boils and other types of acne lesions, so it's sometimes best to see a doctor if you're not sure what you have. Sometimes, an especially large pustule may be a more serious type of skin lesion. A large pimple under your arm, for example, may be a boil, not a pustule. In this case, you may want to see a doctor, preferably a dermatologist, who can examine your skin and provide an accurate diagnosis.

Most acne pustules will heal on their own over time without any special treatments. However, there are several rules and remedies that may help if you prefer to be pro-active in dealing with your pustules.

• Keep skin around the pustules clean and free of oil. Wash the area twice a day with warm water or apply warm compresses.
• Over-the-counter (OTC) creams, ointments, and soaps can help, particularly those that contain salicylic acid, sulfur, or benzoyl peroxide. But acne products can sometimes dry out the skin. If you have sensitive skin, look for products that are less irritating and may also moisturize. Stop using any products if your skin becomes more inflamed.
• Pustules that show no sign of healing may require a prescription acne medication.

While acne pustules are very common and harmless, they can be distressing and upsetting to people who have them. We all want clear skin. So there are a number of effective treatments—from simple home remedies to prescription medications—that can help rid you of pustules. If these don't work, don't hesitate to see a doctor, who can prescribe stronger medications that may do the job. In the meantime, we understand how tempting it is to pick or pop your pustules, but try to resist. It's never a good idea to pop any blemish because it can lead to more skin damage and infection and prolong the healing process.