Tretinoin on a popped pimple: is it safe?

Tretinoin labels tell patients to keep the medicine away from open wounds, and a freshly popped pimple is open skin. The patient leaflet for tretinoin cream says: "Keep the medication away from the corners of the nose, mouth, eyes and open wounds." So the label's answer for that one spot is to leave it out. This page shows what each label says, what two small wound studies did, and what dermatologists suggest for the spot. For the drug itself, see the tretinoin guide.

Skinli gives general education and is not a doctor. Tretinoin is a prescription drug, and your prescriber is the person to ask about your own skin. General care for a popped pimple has its own guide, what to do after popping a pimple.

What the labels say about open skin

The labels are published on DailyMed, the National Library of Medicine's database of drug labels.

Product	What its label or leaflet says
Generic tretinoin cream	"Keep the medication away from the corners of the nose, mouth, eyes and open wounds."
Ziana gel (tretinoin with the antibiotic clindamycin)	"Do not get ZIANA Gel in your eyes or mouth, on your lips, on the corners of your nose, or on open wounds."
Tri-Luma cream (tretinoin with two other drugs)	Keep it "away from the eyes, nose, angles of the mouth, or open wounds because these areas are more sensitive to the irritant effect."
Trifarotene cream, a related retinoid	"Avoid application of AKLIEF Cream to cuts, abrasions, or eczematous or sunburned skin."
Adapalene 0.1 percent gel, a related retinoid sold without a prescription	Do not use "on damaged skin (cuts, abrasions, eczema, sunburn)"

An abrasion is a scrape, and eczematous means affected by eczema. The labels in the table name open wounds, cuts and scrapes. A pimple that has just been squeezed open fits those words, although no label mentions pimples by name.

Adapalene is one of the two gels in Skinli's own plan, so the same rule applies there: its label says not to use it on damaged skin.

Why the labels warn about open skin

The Tri-Luma label gives the reason in plain terms. Open wounds are among the areas "more sensitive to the irritant effect."

A figure on the label for Renova, a tretinoin cream for fine wrinkles, adds to this. In studies of how much tretinoin passes through the skin, the amount "ranged from 1% to 31% of applied dose, depending on whether it was applied to healthy skin or dermatitic skin." Dermatitic means inflamed. Those studies compared healthy and inflamed skin, with no wounds involved, and the condition of the skin changed how much of the drug passed through.

The labels treat other damaged skin the same way. The tretinoin cream label says patients with sunburn should not use the product "until fully recovered", and that tretinoin has caused severe irritation on skin with eczema.

The rest of your face that night

The leaflet lists open wounds in the same sentence as the corners of the nose, the mouth and the eyes. Those are places to keep the medicine away from while the rest of the treated area gets its usual thin layer. The leaflet adds: "Spread away from these areas when applying." One popped pimple does not change the label directions for unbroken skin.

If you have picked at many spots, or a whole area is raw, ask your prescriber before the next dose. The label gives a prescriber three choices for irritated skin: "use the medication less frequently, discontinue use temporarily, or discontinue use altogether."

Does tretinoin help a wound heal?

Two small studies tested tretinoin and wound healing. Neither one supports putting tretinoin on a pimple at home.

• A 1995 study in the British Journal of Dermatology involved four older men with sun-damaged forearms. They applied tretinoin to unbroken skin every day for 16 weeks. Doctors then made small test wounds. The wounds on skin that had been treated beforehand were 35 to 37 percent smaller on days 1 and 4, and 47 to 50 percent smaller on days 6, 8 and 11, than the comparison wounds. Tretinoin was never put on an open wound.
• A 2001 report in the Journal of the American Academy of Dermatology described 5 patients with leg ulcers, which are open sores, that had lasted a long time. A tretinoin solution was "left in contact with the ulcer bed for a maximum of 10 minutes daily and then rinsed" off with salt water. The authors wrote that the treatment can irritate.

Both were done under medical care, on wounds unlike a pimple, in four and five people.

What to do for the popped spot

The American Academy of Dermatology (AAD) has a page on caring for a cut, scrape or other skin injury. Its steps:

1. "Gently wash the area with mild soap and water to keep out germs and remove debris."
2. "use petroleum jelly to keep the wound moist."
3. "As long as the wound is cleaned daily, it is not necessary to use anti-bacterial ointments."
4. "Apply sunscreen to the wound after it has healed."

On its page about deep, painful pimples, the AAD says "a hydrocolloid acne patch can be applied to protect your skin and improve healing." That is a small adhesive patch made to cover one spot. See the pimple patches guide.

Keep other strong products off the open spot too. MedlinePlus says: "Do not apply topical salicylic acid to skin that is broken, red, swollen, irritated, or infected." The AAD says: "Never exfoliate if you have open cuts or wounds or if your skin is sunburned."

Then leave the spot alone. The AAD says: "Keep your hands away from your face. Touching, picking, and popping can worsen acne." It explains that when you pop a pimple, you often push some of the contents deeper into the skin, which increases inflammation, and that bacteria on your hands can cause an infection. The guide on whether you should pop a pimple covers the risks.

When to treat the spot again, and when to see a doctor

No label read for this guide gives a number of days. For sunburn, the tretinoin label's rule is to wait "until fully recovered", and the leaflet's rule for open wounds has no end date. Ask your prescriber when you can apply tretinoin to that spot again.

See a doctor if the spot becomes more painful or more swollen over the next days. See a dermatologist if you get deep, painful pimples often, or if popped spots leave scars. The AAD says a dermatologist can treat a deep, painful cyst or nodule in the office, and NICE, the guideline body in England, says that persistent picking or scratching of acne spots can increase the risk of scarring.