Why Do I Get Pimples On My Cheeks

Overview

If you suffer from acne, you are not alone. Acne is one of the most common skin disorders, affecting about 85% of adults.¹

Acne vulgaris is a disease that leads to skin lesions and, there are different types of acne depending on the severity of the condition:⁶

1. Blackheads: open pores in the skin
2. Whiteheads: closed pores
3. Papules: red, small, and tender bumps
4. Pimples (pustules): papules with pus
5. Nodular acne: solid, large, and painful lesions under the skin
6. Cystic acne: painful pus-filled lesions under the skin

How is acne formed?

Acne appears as a result of hair follicles (which are small tube-shaped cavities on the surface of the skin and from which the hair grows) clogging with oil (sebum) produced by sebaceous glands in addition to the accumulation of dead skin producing a perfect environment for bacteria to grow to a higher level than normal causing inflammation of the skin and acne formation.²

The bacteria that plays a role in acne formation is P acne (Propionibacterium acnes) also called C acne (Cutibacterium acnes), it is a type of bacteria that normally lives on the skin and when excess oil is produced, this bacteria thrives, and reproduces leading to inflammation and acne formation.² 

Who is affected by acne?

Acne is the most prevalent skin condition affecting all ages. Acne peaks in adolescence and early adulthood, but it is reported that 25% of women and 12% of men above 40 have acne. Acne is one of the most common reasons adult women visit the dermatology clinic.²

Causes of pimples in the cheeks

As acne is very common, we have to know what causes it. Despite the fact that acne is multifactorial, and it is difficult to figure out the exact cause of its appearance, However, there are some predisposing factors causing the formation of cheek acne:

• Genetics:

Acne may be common in some families, where people with a family history of acne are more likely to develop acne. 

• Poor skincare routine:

Using harsh chemicals can cause irritation of the skin. On the other hand, bacteria and oil will build up and accumulate, leading to acne, if the skin is not washed enough. 

• Poor skin care products:

Skincare products, especially oil-based make-up cosmetics, moisturizers, and sunscreens, may block hair follicles and lead to the accumulation of oil and bacteria, leading to acne formation. In addition, applying oily hair products such as Pomade may cause acne.⁴

• The phone is a source of bacteria:

The phone collects bacteria, and that is problematic when we touch the phone and then touch our face or put the phone directly on our ear, causing the bacteria to spread on the face.  

• Dirty pillowcases and sheets:

Pillowcases and sheets collect bacteria, irritating the skin while sleeping.

• Hormonal changes:

Sebaceous glands that produce oil are stimulated by hormones called androgens to produce the oil. Hormones indicate why acne is so common in teenagers, where during puberty, the body increases the production of androgens that fluctuate and stimulate sebaceous glands, causing the production of excess oil where oily skin is a perfect environment for bacterial growth and acne formation.⁴ 

Some conditions such as pregnancy, menstrual cycle, and menopause cause hormonal changes and trigger acne.²

• Endocrine disorders:

Endocrine diseases such as congenital adrenal hyperplasia and polycystic ovary syndrome (PCOS), these disorders represent one of the causes of increased levels of androgens hormone, causing and exacerbating acne. 

• Stress:⁴

Although stress doesn't develop new acne, but it does worsen the existing ones and exacerbate acne severity. 

• Diet and acne relationship:

High glycemic diets play roles in the development and worsening of acne. It includes white bread and potatoes which cause blood sugar to rise quickly.⁵ In addition, the consumption of cow’s milk may also contribute to acne formation because it is being treated with growth hormones that trigger acne.²

According to face mapping which is a method in traditional Chinese medicine that originated 3000 years ago, the face reflects inner health status, and each facial area is connected to different organ systems. This method is not scientifically proven to be the cause behind the development of acne in some facial areas. 

Management and treatment for pimples in the cheeks

Acne diagnosis: 

Acne is diagnosed when dermatologists look at the skin to know the severity of acne and determine which treatment is the best. The severity of acne is categorized into: 

• Mild acne: blackheads, whiteheads, few papules, and pustules. 
• Moderate acne: more whiteheads and blackheads, with many papules and pustules. 
• Severe acne: lots of large, painful pimples, nodules, and cystic acne. That may develop scar acne. 

In women, acne may be due to hormonal imbalance, especially if associated with other symptoms like excessive hair and irregular periods. The most common cause of hormonal imbalance is PCOS, which is diagnosed through ultrasound scans and blood tests. 

Acne treatment:

The dermatologist prescribes treatment depending on the type of the acne, age, and severity. The treatment is used to control acne and avoid scarring. Acne medications act by decreasing sebum (oil) production and treating bacterial infection. Acne is treated using topical medications, oral medications, or therapies, and a combination of more than one method can be effective for better and faster results. 

The most common topical medications for acne treatment are: 

• Benzoyl peroxide:

It is an antiseptic that has an anti-inflammatory effect, decreasing the number of bacteria on the skin and helping in reducing blackheads and whiteheads. It is in the form of cream or gel that is applied twice daily after washing the face over a 6-week course to clear the acne.

A common side effect of benzoyl peroxide includes:

1. Redness and skin peeling
2. Dry skin
3. Itching and burning sensation
4. Sensitivity to sun so avoid sun exposure and wear sunscreen

• Topical retinoids:

Topical retinoids work by exfoliating and removing dead skin cells from the skin, preventing the build-up of dead cells in hair follicles. Tretinoin and adapalene are topical retinoids used to treat acne and applied once daily before bed.

Topical retinoids are contraindicated during pregnancy because they may cause birth defects. Mild irritation and skin stinging are common side effects of topical retinoids.

A 6-week course of treatment is required.

• Topical antibiotics: These antibiotics kill the bacteria in the skin to prevent infections and plug the hair follicles. A 6-to-8-week course treatment is recommended to avoid the risk of bacterial resistance. 
  • Side effects include
    • Minor skin irritation
    • Peeling of the skin
    • Burning sensation and redness of the skin

• Azelaic acid and salicylic acid 

Azelaic acid is a naturally occurring acid produced by yeast. It has antibacterial properties and can be used as an alternative treatment to benzoyl peroxide or topical retinoids which could potentially cause irritation or pain. 

Apply twice daily or once if the skin is sensitive.

Oral medications used for treating acne include: 

• Antibiotic tablets 

Antibiotics are used to reduce bacteria in case of moderate to severe acne. Antibiotics used are tetracycline (minocycline or doxycycline), which are contraindicated for pregnant and breastfeeding women or children under 8 years old. Macrolide (erythromycin or azithromycin) is an option for acne treatment for people who can’t take tetracycline. 

Short periods of antibiotics are used to prevent bacterial resistance. 

• Isotretinoin:⁷ Isotretinoin is an orally administered systemic retinoid (vitamin A), used for severe acne treatment.
  • Benefits of isotretinoin include:
    • Prevent follicle-clogging
    • Reduce bacterial amount on the skin
    • Affect sebaceous glands and normalize sebum production
  • Side effects of isotretinoin include: 
    • Dry lips and dry skin
    • Sun sensitivity
    • Dry mouth (xerostomia)

• Anti-androgen agents

Used for women if antibiotics aren’t helping, by blocking the effect of androgen hormones on sebaceous glands to prevent the production of excess oil. Adverse effects of anti-androgens are breast tenderness and painful periods. 

• Hormonal therapy 

It is a therapy that can be used in women with acne that flares up around periods or suffering from hormonal conditions such as PCOS. 

• Oral contraceptive pills:^8,9 Some contraceptives have FDA approval for acne therapy including Yaz, Ortho tri-cyclen, Beyaz, and Estrostep FE. It works by producing less oil, therefore less risk for acne formation. Common side effects of birth control pills: 
  • Mood changes
  • Nausea
  • Sore breasts
  • Blood spotting between periods and lighter periods

• Co-cyprindiol 

It is a hormonal treatment used for treating severe acne that doesn’t respond to antibiotics. Causes a reduction of sebum production and is used for 2 -6 months till noticing acne improvement. Co-cyprindiol has a small risk of causing breast cancer or blood clots; in addition, it is unsafe to use in cases of pregnancy and breastfeeding.       

Therapy is a beneficial option to treat acne, either alone or in combination with other methods: 

• Light therapy:

It is an acne treatment that uses light to kill certain bacteria on the skin.  

• Chemical peel:

Requires repeated application using chemical solutions such as retinoic acid, salicylic acid, and glycolic acid to treat mild acne. 

• Steroid injection:

Injecting steroids into cystic and nodular lesions provides a rapid improvement in the lesion and pain reduction. 

• Drainage and extraction:

Removing whiteheads, blackheads, or cysts using special tools by the doctor. Provides improvement in the appearance of the skin but may cause scarring. 

How can I prevent pimples on the cheeks?

How can acne affect a patient's life? 

Acne has a negative impact on the patient’s life, causing a reduction in the quality of life of patients. Despite its apparent cosmetic impact, its effects are deeper than the skin, it has an emotional and psychological burden on patients, leading to a lack of confidence, shame, anxiety, depression, feelings of insecurity, and bullying.³

We have provided some self-care remedies and methods to avoid acne formation: 

• Disinfect your phone before each use to prevent the transfer of bacteria to the face
• Don’t take the phone into the bathroom, which is considered the germiest place and leads to bacterial accumulation on the phone
• Wash hands frequently and avoid touching the face to prevent bacteria from transferring to the face and developing acne
• Wash sheets and pillowcases at least once a week to maintain healthy skin
• “Let food be thy medicine and medicine be thy food,” said Hippocrates, the founder of modern medicine. Nutrition affects skin health, so having a low glycemic diet, and eating more vegetables and fruits decrease the possibility of developing acne
• Omega 3 fatty acids have an anti-inflammatory effect and a positive impact in treating and preventing acne¹⁰
• Probiotics are beneficial and help keep skin healthy and clear¹⁰
• Only wash the face twice daily; excessive washing of the skin causes irritation
• Remove make-up completely before sleeping
• Avoid oil-based make-up, sunscreen, and skincare products. Use water-based, non-comedogenic products that don’t block the skin pores
• Don’t squeeze or pop acne to avoid permanent acne scarring
• Avoid harsh chemicals that cause skin irritation

FAQs

Are pimples in the cheeks common

Although, it is not common to have blackheads or whiteheads on the cheek, it is annoying and irritating that pimples, inflammatory papules, and nodular, and cystic acne are very common to develop on the cheek.¹¹

Is it safe to pop pimples on the cheeks

Popping, touching, or picking the pimple worsens the condition and increases the infection and inflammation. It also negatively impacts the natural healing process and increases the possibility of scarring and pain, so it is not recommended to pop the pimple.¹²

When should I see a doctor for the pimples on my cheeks

If self-care remedies don’t clear the acne, your GP may help by prescribing stronger medications and if the acne is severe or persists, seek medical treatment from a dermatologist to treat the acne and diagnose if there is an underlying cause that is responsible for acne vulgaris. 

Summary

Acne is a chronic disease and it is multifactorial in etiology where the major etiological factors include excess oil, bacteria, hormonal changes, and dietary products. Early treatment of acne is necessary to avoid the risk of acne scarring and negative psychological effects. Finally, always remember that prevention is better than cure, so paying attention to prevent acne formation plays a key role in healthy skin and therefore better psychological health.