If You Leave Pustules Alone, Scars Get Bigger: There is a Specific Time to Pop Them

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The Reality of Acne — 1.1 Folliculitis vs Acne

The Fork in the Road to Permanent Scars — 2.1 Scar Risk by Size and Type

How to Stop Now — 3.2 Understanding Intralesional Injections properly

Caring for Remaining Marks — 4.1 PIH, PIE, Atrophy, and Hypertrophy

You may have heard that you should never pop acne. While that holds true for deep stages like nodules or cysts, pustules that have formed a yellow head in the center are a different story. If you do not clear out the pus and inflammatory substances inside them in a timely manner, the inflammation can spread to the adjacent dermis, leaving long-lasting marks that eventually harden into shallow scars. The real factors that determine scarring are 'when' and 'how' you extract them.

You may have heard that you should never pop acne. While that holds true for deep stages like nodules or cysts, pustules that have formed a yellow head in the center are a different story. If you do not clear out the pus and inflammatory substances inside them in a timely manner, the inflammation can spread to the adjacent dermis, leaving long-lasting marks that eventually harden into shallow scars. The real factors that determine scarring are 'when' and 'how' you extract them.

The saying "it will just absorb if you leave it alone" is only half true

Small pustules near the surface can indeed be naturally absorbed within a few days. However, if they grow in volume and develop thick pus, the pressure pushes against the pore walls and spreads sideways. This causes the inflammation to spread to adjacent pores and the dermis, sometimes turning a single pustule into a cluster of small nodules in just a few days.

Many people experience their acne suddenly spreading all at once, and it often happens this way. If you catch the right moment when the first pustule appears as a warning sign, you can stop the cycle of it spreading to adjacent areas.

When you see a yellow head, it is time to extract

For pustules, the safest time to extract is when they rise close to the surface and a central yellow head becomes visible. The appearance of a yellow head means the contents have risen to a 'shallow depth'. At this point, applying gentle pressure will only direct the force upwards.

Conversely, do not try to pop them while they are still flat, red, and hard. The content is still deep in the skin, so instead of coming up, the pressure will push it sideways or downwards. This is the most common start of a scar.

Why squeezing with hands makes scars deeper

Fingertips have a wide surface area, making it difficult to control the direction of pressure precisely. The moment you squeeze, some pressure goes upwards, but even more pressure goes sideways and down into the dermis. The pus and inflammatory factors pushed to the side cause new inflammation, while the downward pressure crushes dermal collagen*, hardening into a depressed scar*.

Squeezing or twisting with fingernails can scratch the epidermis, leaving long-lasting brown marks (PIH). So, when they say "it's better not to squeeze," what they actually mean is "it's better not to squeeze like this."

* Dermal Collagen: The protein network in the dermis layer that supports the skin. When a certain area collapses all at once, it is difficult to regrow, and if that spot hardens while depressed, it becomes an atrophic scar.

How is clinical drainage in a clinic different?

The Incision & Drainage (I&D)* used in clinical practice involves making a 'very tiny' incision on the surface with a thin needle (around 18G) or an 11-blade scalpel, and then releasing the pressure with sterile tools. Unlike the broad pressure from fingers, the incision hole acts as an 'upward exit', significantly reducing the pressure pushed sideways and downwards.

The difference in recovery is even more obvious in terms of scar risk. Even for the same pustule, extracting it through a hygienic clinical incision and drainage often leaves just a faint brown mark. On the other hand, squeezing it by twisting with fingers increases the risk of it hardening into a shallow boxcar scar. These clinical differences are also emphasized in the General Practice Guidelines of the Korean Dermatological Association.

* Incision and Drainage (I&D): A clinical procedure where a small incision is made on the surface of pustules or cysts using an 18G needle or an 11-blade scalpel to empty the contents inside. By creating an upward exit to reduce pressure directing sideways and downwards, it minimizes dermal damage even when clearing out the same volume.

Please also remember the stages where you must not pop them

Do not try to 'squeeze' hard nodules without a head or painful, large cysts by any method. The contents are too deep, so no matter what exit you try to create, pressure will push sideways and downwards. For this stage, you should start with intralesional steroid injections to calm the inflammation first. We will cover this in detail in the next post of the series.

Here is a summary table of the appropriate treatment for each stage.

Whether or not to pop acne is not a question of 'should I or shouldn't I', but rather a matter of the stage and method. For pustules with a visible head, extract them hygienically at the right time. For nodules and cysts, leave them untouched and seek medical care. Simply making this distinction will significantly lower the risk of forming permanent scars.

Frequently Asked Questions

Q. Is it really better to pop pustules?

Yes, but only if it is done 'hygienically at a clinic'. For superficial pustules with a yellow head, releasing the pressure speeds up recovery and reduces scar risk. However, squeezing with fingernails or fingers at home can tear the epidermis and pore walls, which actually leads to worse scarring. If you feel they need extraction, please visit us for professional care rather than attempting it yourself.

Q. Are there any situations where I can pop them at home?

We do not recommend self-drainage. Trying to squeeze them yourself tears the epidermis and the area around the pore, which often leaves scars. Rather than trying to figure out 'how to squeeze them well,' coming to the clinic quickly without touching them is the real key to minimizing scars. As a temporary measure, cover the area with a clean acne patch to reduce irritation and visit us as soon as possible.

Q. How many days does it take to calm down after clinical drainage?

For superficial pustules, redness and volume usually go down within 24 to 48 hours. Marks (PIH/PIE) may remain in the same spot for a month or two, but they rarely turn into permanent scars. For nodules and cysts, drainage alone is often not enough, so we combine it with intralesional acne injections.

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