Instruments Used in Office Acne Treatments

A viewer wrote in that he’s been to a dermatologist’s office for acne treatments several times but, whenever the nurse is cleaning out his pimples, he’s too scared to watch what she’s doing, so he closes his eyes and he asked could I demonstrate what types of instruments we use in the office to clean out acne pimples and blackheads and whiteheads, so that’s what we’re going to do today. When patients come in with active acne, they can have either non-inflammatory lesions, which are blackheads and whiteheads which we just push out, or inflamed lesions like pus pimples and cysts, which we usually have to make a little opening in before we can push the pus out. So let me show you how we do that. Of course, we start by taking some alcohol, we open the alcohol pad and, with an alcohol pad like this, we just wipe the skin to make sure that everything is as sterile as it can be. If we’re just talking about a blackhead or a whitehead, we use something called a comedone expresser, and this has a smooth, metal, curved surface with a tiny hole in it and, if that tiny hole is placed over the opening of the whitehead or blackhead, and I push down, the smooth metal painlessly pushes around the opening and pushes the oil clog out of the blackhead or whitehead and it pops out. Again, if it’s a pus pimple which doesn’t have an opening to the surface or a cyst under the skin which doesn’t have an opening, then I have to make an opening. So, of course, I have sterilized the skin with alcohol and I take a needle, and this is the same type of needle that we use when we do a blood test. This is called a #21 gauge needle. It has a tip which is very small at the edge and we use this to just very gently break the pus pimple or cyst. A tiny bit of discomfort but nothing bad. Then over the opening I’ve created, I again use my comedone extractor, and I place the instrument so the opening of the extractor is right over the opening that I made with the needle. Then I push down and the pus or the contents of the pus pimple or cyst comes out. If it’s a deep cyst or a very thick cyst, you can still feel a little bit of a bump in the skin. Sometimes then, we put a little injection of cortisone to shrink that cyst so it goes away much faster, and to do a cortisone injection, we take a very fine syringe with a tiny, tiny needle, and this is a #31 gauge needle, one of the smallest needles we use in regular medicine, and I take a little bottle of cortisone. If I pull back on the syringe, so I bring air into the syringe, and then I put the needle into the top of the bottle and I push that air into the bottle, turn it upside down and pull back, you can see the medicine coming into the syringe. We then put that tiny, tiny needle right into the cyst, put a little bit of medicine in, and that makes the cyst come down much faster and go away much sooner. And this basically is most of the instruments that we use when we’re taking care of patients’ acne, and this is very, very important in helping improve the acne by cleaning the pus out and cleaning the contents out, the pimples go away much faster.