Acne spot treatment: when dabbing one pimple helps

A spot treatment is an acne product you dab onto one pimple. It is useful in a narrow set of cases. This guide explains what the labels and the American Academy of Dermatology (AAD) say about treating a single spot, which ingredients to use, and why people who break out often get more from treating the whole area. It is part of the guide on how to get rid of acne.

What a spot treatment is

In the US, a spot treatment sold for acne is an over-the-counter acne drug. It uses one of the active ingredients the FDA allows in its acne monograph, the rule for acne medicines sold without a prescription:

Ingredient	Strength allowed	What the label adds
Benzoyl peroxide	2.5 to 10 percent	Can bleach hair and dyed fabric. Avoid unnecessary sun and use sunscreen
Salicylic acid	0.5 to 2 percent	Standard acne warnings
Sulfur	3 to 10 percent	Apply only to areas with acne. Not on broken skin or large areas
Sulfur with resorcinol	3 to 8 percent sulfur	Rinse right away if it gets in the eyes

The product may be a gel, a cream, a lotion or a patch with an ingredient in it. The form does not change the rules. The ingredient and its strength are printed in the Drug Facts box.

What the labels say about spots

The FDA's directions for every monograph acne product read: clean the skin well, then cover the entire affected area with a thin layer, one to three times a day, starting once a day. The affected area is the skin where acne appears, which is larger than a single pimple.

The adapalene gel label is more direct. Its consumer leaflet says it is not a spot treatment and should not be used to treat a single pimple. The Drug Facts box says to apply it to the entire face if that is where your acne is. How to start adapalene without irritation covers how to use it.

Sulfur is the one ingredient whose label points the other way. The FDA requires sulfur products to say apply only to areas with acne, and not to use them on large areas of skin.

When dabbing one pimple makes sense

The AAD's advice for a deep, painful pimple includes a spot step. First, bring the pimple closer to the surface with a clean, warm, damp washcloth for 10 to 15 minutes, three times a day. Then, the AAD says, acne medicine works better once the pimple is at the surface. It names four ingredients: adapalene, azelaic acid, benzoyl peroxide and salicylic acid. It adds a warning: apply a thin layer, because too much can irritate the skin even more.

So a spot treatment fits:

• one pimple on skin that is usually clear,
• a pimple that has come up to the surface,
• a person who is not already using another acne product on the same area.

Why the whole area works better for regular breakouts

The AAD lists "apply acne medication only to your blemishes" as one of ten habits that can worsen acne. Its reason: it makes sense to treat what you see, but this approach fails to prevent new breakouts.

The AAD's fix is to spread a thin layer evenly over your acne-prone skin. If you tend to break out on your forehead, nose and chin, the treatment goes on all three areas. AAD dermatologist Julie Harper, MD, says the same about adult acne: medicine on all acne-prone skin treats the acne you have and prevents the next breakout.

Skinli's plan uses this approach. Its two gels, benzoyl peroxide 2.5 percent and adapalene 0.1 percent, go on in a thin layer over the whole area that gets pimples, a pea-sized amount of each.

Matching the ingredient to the spot

The AAD describes what each of its four spot ingredients does, which helps you pick one for the pimple in front of you.

The spot	Ingredient to reach for	Why, per the AAD
Red, sore pimple	Benzoyl peroxide, 2.5 percent to start	Reduces acne-causing bacteria on the skin
Whitehead or small bump with a clogged pore	Salicylic acid	Opens clogged pores and exfoliates the skin
Pimple that tends to leave a dark mark	Azelaic acid	Works on acne bacteria, reduces inflammation, and can fade the dark spots acne leaves
Deep, sore lump with no head	Warm, damp washcloth first, then one of the above once it surfaces	Medicine works better when the pimple is at the surface

Use one ingredient at a time on a spot. Two ingredients on the same pimple add irritation, and the FDA label warning about using two acne medicines together applies to spots as well.

Test a new spot product first

The FDA allows acne labels to include an optional sensitivity test for a new user: apply the product sparingly to one or two small affected areas during the first 3 days, and if there is no discomfort, follow the normal directions. A spot treatment is already used on a small area, so the first three days are your test. If the skin around the pimple turns red, itchy or swollen, stop. How to patch test a new skincare product has the full steps.

How long a treated spot takes

A pimple takes days to heal even with treatment. The AAD says skin sometimes heals from a breakout in 7 to 10 days without leaving a sign. A deep lump that you keep squeezing can take much longer, and the AAD says picking makes acne take longer to clear and raises the risk of scars. If you want a spot gone within a day or two, only a doctor's injection comes close. Can you get rid of a pimple overnight? covers what one night can do.

Spot treatment during pregnancy

Check with a doctor before using any acne product while pregnant or trying to get pregnant. AAD dermatologist Ramone Williams, MD, says some acne treatments sold without a prescription are not safe during pregnancy. The adapalene label says to ask a doctor before use if you are pregnant or breastfeeding. The UK NICE guideline says topical retinoids, the group adapalene belongs to, should not be used during pregnancy.

Using a spot treatment without irritation

It is easy to use too much of a spot product. Keep these rules in mind:

1. Thin layer only. A thick blob does not work faster. The adapalene label says applying more than directed will not give faster or better results but may worsen irritation, and the AAD says the same about prescription combination creams.
2. Start once a day. The FDA directions say to start with one application a day, because the skin can dry out.
3. Do not stack products. The FDA requires every acne product to warn that irritation and dryness are more likely when you use another acne medicine at the same time. If you already use a whole-face treatment, adding a spot product on top raises that risk.
4. Cut back if it dries or peels. The FDA label says to reduce use to once a day or every other day if dryness or peeling bothers you.
5. Protect fabric and skin. Let benzoyl peroxide dry before it touches a pillowcase, and use sunscreen in the morning.

If the area burns, swells or blisters, stop and ask a doctor. The benzoyl peroxide label says to stop use and ask a doctor if irritation becomes severe.

Spot treatment and pimple patches

Some patches contain an acne ingredient listed in a Drug Facts box, and some are plain hydrocolloid patches with no active ingredient. The AAD mentions a hydrocolloid patch as a way to protect a pimple and help it heal. A patch with an active ingredient is a spot treatment in patch form. Pimple patches covers what the small studies show.

Spots a spot treatment will not fix

A spot product treats the surface of one pimple. Other problems need other care:

• Deep, painful lumps that stay under the skin. The AAD says these are nodules or cysts, and that a dermatologist can inject a corticosteroid, which flattens most within 48 to 72 hours.
• Many pimples at once. That is acne that needs whole-area treatment. The best acne treatments by guideline shows the options.
• Pimples that leave scars or dark marks. The AAD says these are reasons to see a dermatologist.

If single pimples keep coming back in the same place for more than 4 to 6 weeks, the AAD says a dermatologist can help.