Once upon a time the appearance of a pimple meant to die a little death.
Then we got older and more pressing life problems forced blemishes to make room. We gained perspective, but never forgot the lesson learned at age 13: Zits are created far from equal.
Regular zits can still be knocked out with weapons from an arsenal of benzoil peroxide, a salicylic acid toner, maybe a tube of Australian tea-tree extract for the green at heart. But the cystic zit!
The cystic zit.
The king of blackheads, the emperor of white heads and lord of all red bumps is evil incarnate. If in doubt recall the 1989 classic "How to Get Ahead in Advertising" -- the film about the murderous boil that sprouts on the neck of a young executive.
And as in the movie, a cystic zit can throw an otherwise rational adult into a rage.
And in our rage and pain we do exactly what dermatologic surgeon Min-Wei Christine Lee, director of the East Bay Laser and Skin Care Center in Walnut Creek, Calif., says not to. We attack the growth with fingernails and sewing kit needles, we bloody bathroom tissues, we burn the wound with pure alcohol and pronounce victory.
Of course there will be a scar, but in the moment of triumph we don't care; we've released the pressure that makes the boil -- to use the British word, so much more mature-sounding than pimple! -- so sore to the touch and so difficult to stop touching.
Not surprisingly dermatologists disapprove of the above and have alternate suggestions. What follows is a summary of data, in Q & A form, shared with ABC by a panel of top skin experts who spoke to us by phone and e-mail.
Besides Lee, we have Dr. Sandra Read of Washington, D.C., a member of the board of directors of the American Academy of Dermatology; Dr. Theresa Pacheco, associate professor in the Department of Dermatology at the University of Colorado-Denver; Dr. Jeffrey M. Weinberg, director of the Clinical Research Center of the Department of Dermatology at St. Luke's-Roosevelt Hospital Center in New York; and Dr. Richard Granstein, chairman of the Department of Dermatology at Cornell University.
Q: What is cystic acne? A: Acne starts with a clogged follicle that becomes infected. That's a white or black head. Sometimes inflammation occurs and it becomes rounder and redder. A cyst is what may happen if left untreated. They can grow several centimeters in diameter, and are often painful to the touch.
Q: What causes the infection? Dirt? A: Acne has many causes, and the cause will differ from person to person. Dirt is not one of them, however, so scrubbing your skin with a pumice stone will only bring you more pain. The main causes stem from hormones, which is why people typically notice outbreaks during puberty, periods, and pregnancy.
That said, if a patient noticed that she breaks out after eating a certain food, Lee would tell her to avoid that food, which may serve as a hormonal trigger. Still, she says, researchers have not yet discovered a "direct and universal correlation between any one food and acne."
Q: But what about the purported link between milk and cystic acne?
A: Says Pacheco: "A recent study, based on a survey of 47,335 women, did find a positive epidemiological association between acne and consumption of partially skimmed milk."
The researchers hypothesize that the association may be caused by hormones such as several sex hormones and bioactive molecules.