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Whatever you do, don't pick at your skin.

Kelsey Haywood Lucas
Mar 17, 2021 @ 6:01 pm
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skin emergencies
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Maybe you tried to kill a pimple before a trip to Mexico and accidentally layered the wrong skincare products, causing a quarter-sized chemical burn right between your eyebrows. (This happened to me.) Or maybe, two days before your wedding, you used a new dry shampoo that incited a nasty case of contact dermatitis all over your forehead and hairline. (This also happened to me.) Or maybe you got eyelash extensions and your eyelid blew up to the size of a golf ball. (Hiiii, yep, still me.)

If you've ever found yourself in a similar situation, you know how scary and traumatic it can feel when something unexpected happens to your skin. But let's get one thing clear: There's nothing to be embarrassed about. These mishaps can happen to anyone—whether you're a civilian skincare user who just dabbles in the basics, or an experienced product enthusiast with a solid understanding of your skin's chemistry.

Just ask Kirbie Johnson, a veteran beauty journalist and co-host of the Gloss Angeles podcast. Johnson recently shared a cautionary tale about contact dermatitis: After accidentally using an expired cleansing balm (and not thoroughly removing it), she noticed a rash develop on her cheeks. Under the guidance of esthetician Renée Rouleau, she switched to a super gentle skincare routine while observing it closely and waiting for the rash to clear up. In her Instagram posts about the process, Johnson shared all the wisdom she picked up along the way and it made me feel a little less ashamed of all my own what-was-I-thinking skincare mistakes. 

"Everyone has a bad skin day or a bad skin month," Johnson told me. "And sometimes, a breakout isn't due to anything you did—bodies are intricate, and skin is weird in how some things that affect you may not affect other people, and vice versa." Plus, she points out that with so many products on the market, it's easy to cause a reaction from the wrong mix. (And speaking of products, Johnson loves the Tower 28 Beauty SOS Spray and Perricone MD Hypoallergenic CBD Sensitive Skin Therapy Nourishing & Moisturizer for calming inflammation when skin is upset.) "Just know everyone has different skin experiences and you shouldn't be hard on yourself if something happens," she says.

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So what should you do when something in your routine goes awry and you suddenly find yourself in need of a skintervention? I talked to Johnson, Rouleau, and straight-talk dermatologist Ranella Hirsch, M.D., F.A.A.D., to figure out exactly what you should (and shouldn't) do if you find yourself in the midst of a complexion crisis.

The golden rule of a skintervention

Every expert I spoke to enthusiastically agreed on the single most important first step in a skincare emergency: Take a step back and breathe. "It's skin—and skin has its own extremely powerful self-healing properties," says Dr. Hirsch. "The main thing is to stay calm while you figure out the right move." That means keeping hands (and fingers, tweezers, products, and everything else) off the problem—until you have a solid plan, of course. A mistake that Dr. Hirsch sees far too frequently? The self-inflicted worsening of a situation caused by rushing to respond. 

"I'll see a patient who gets completely horrified by a brand new pimple, for example, then goes to town squeezing it or thinks, 'Oh, I'll just treat this myself,'" says Dr. Hirsch. "Two heavy-duty hydroxy acids later, everything just looks worse—so it's important to realize that an expert can do way more to help if you don't go into attack mode right away."

If you've got a little time on your hands and don't believe your skin or your health is in danger, 48 hours can provide you with time to gain perspective while allowing your skin to calm from a specific trigger or irritant. But if your condition is worsening, or if you're hopping on a plane, walking down the aisle, or getting your new professional headshot taken in the next few days? Then it's time to call in a pro, pronto—and that's when it helps to have a standing relationship with a dermatologist, which will make it easier to snag an emergency appointment than cold-calling an office where you're not an established patient. (If you don't have a doc on speed dial yet, consider booking a derm for a routine skin check—they'll talk about any random issues you're having and screen moles for cancer, which is something you should ideally be doing anyway!)

Here's how to solve the most common skin emergencies.

Now that you're all calm and clear-headed, let's talk about the best ways to soothe your specific situation—or determine it's time to call a doctor.

1. How to heal an unidentified rash due to an exposure (aka contact dermatitis):

Pinpointing the cause of contact dermatitis isn't always easy, especially since so many variables can set off a reaction (jewelry, fragrance, hair dye, preservatives, and essential oils—just to name a few). When my hairline broke out in red inflammation a few days before my wedding, my dermatologist suspected the new dry shampoo I had started using. Meanwhile, Johnson's dermatitis was pinpointed to a cleansing balm past its expiration date.

When to see a doctor:

Some contained mild bumps, similar to the flare-up Johnson experienced, are usually okay to observe at home while you wait for improvement—as long as you understand what caused the rash and it doesn't worsen. (Be sure to wash the area right away with mild soap and cool water to remove any traces of the offending product.) But if your rash is painful, gets worse, accompanied by hives or fever, keeps you from sleeping, spreads, seems infected, or is covering more of your body than the area of contact? Call a dermatologist.

How to care for it yourself:

If you're playing the waiting game, keep your routine simple: Stick with just a gentle cleanser and light moisturizer until things clear up. "Reneé [Rouleau] was super clear with me," says Johnson. "No aggressive scrubs, no exfoliating devices, no retinol, no vitamin C, no acids." You'll also want to remove the suspected trigger from your routine, of course, and if you're feeling itchy, an anti-itch cream kept in the fridge works wonders.

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Prevent it in the future:

Prevention is almost impossible, unfortunately, as you likely won't know whether a substance will cause dermatitis until you're exposed to it. However, it's always smart to introduce new skincare products slowly (meaning one at a time, with at least a few days in between), be mindful of expiration dates on your products, and pay attention to ingredient lists (in case you notice a common denominator connected to irritation).  

2. A truly terrible sunburn

skin health sunburn signs
Credit: Getty Images

On beach days, I reapply my SPF every two hours, wear huge hats, sit in the shade, and somehow still get sunburned sometimes—it just happens. Or perhaps you're like a friend of mine, who was using a body oil containing bergamot when she spent time in the sun (not knowing, of course, that it causes photosensitivity—and ended up with a mark that lasted months). Here's what to do when the burn is bad

When to see a doctor:

"If your burn is beyond first degree—meaning if there's a significant amount of blistering—or if you're experiencing fever, chills, nausea, or other systemic symptoms, it's time to see a doctor," says Dr. Hirsch. In some cases, they may suggest a medication. The appropriate treatment plan will depend on your unique circumstances, which is why it's important that you see a doc and don't try to DIY this one.

How to care for it yourself:

For a standard first-degree situation, Dr. Hirsch says to start by cooling things off ASAP: Soak in cool, room-temperature water or apply a cool compress—just be sure not to use ice. (She also recommends a bath using one part milk to one part water, as the milk proteins will "soothe and take the angry heat away.") Top the burn with petroleum jelly (no ointment, toothpaste, butter, or antibiotics, please!) and cover with a non-stick sterile bandage. 

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While you patiently wait for the healing process to progress, be sure to sip plenty of water (it'll keep your body temp down and hydrate internally, says Rouleau) and snack on hydrating fruits like watermelon. If you're uncomfortable, consider popping an OTC pain medication (like acetaminophen or ibuprofen) to reduce inflammation and help with the pain. You can also apply natural aloe vera—keep it chilled in the fridge—every three hours. 

And if you see blisters or peeling skin? Do. Not. Touch. "That dead skin covering the area you want to peel is a biological wound barrier," says Dr. Hirsch. "It's serving a vital function as a bandage protecting the healing site underneath from becoming dried out or getting infected." 

Prevent it in the future:

Try to figure out what went wrong, and don't make the same mistake twice. Did you forget to reapply? Miss a few spots? Use expired SFP? Dr. Hirsch recommends protecting your skin from the sun by seeking shade, wearing protective clothing and wearing a broad-spectrum sunscreen with SPF 30 or higher. Another biggie? Be sure to apply SPF at least 15 minutes prior to heading outside. "A common mistake is that people don't apply until they get set up at the beach—and in that time, they have enough exposure to burn," says Dr. Hirsch. 

3. A chemical burn 

True story: A friend in college came home after a night at the bar and wiped her entire face with what she *thought* was her makeup remover. It was actually 100% acetone nail polish remover, and the results on her sensitive skin were not pretty. Whether you find yourself in an accident like this one, or simply layer the wrong active ingredients in your skincare routine, these types of mild "chemical burns" are scary—but understandably common.

When to see a doctor:

You'll need to follow your gut here—how bad is the burn? "I prefer people call their doctor for specific advice in these types of injuries," says Dr. Hirsch. "You certainly hurt your [skin] barrier, but the treatment plan will depend on the severity." When I accidentally layered the wrong acne treatments trying to zap a zit before vacation, the resulting chemical burn (right between my eyebrows!) required a prescription steroid from my dermatologist—and if I hadn't treated it properly before the trip, I could have risked doing much more major damage by spending time in the sun.

How to care for it yourself:

If the reaction is mild and you feel comfortable treating at home, Dr. Hirsch says the first step is to stop using all products except for an extremely gentle cleanser and moisturizer without active ingredients. "Continue until all the symptoms are completely gone, and then add another week for good measure," she says.

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Prevent it in the future:

When trying new products, start slowly. "As a rule, it's best to introduce only one active at a time and make sure the skin is totally acclimated to it before introducing another," says Dr. Hirsch. "That will also allow you to identify exactly which product or ingredient is causing the problem." It's also smart to run a quick Google search when you plan on pairing up active ingredients to check for any well-known interactions.

4. A severe blemish 

skin purging
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Whether you're dealing with persistent acne or the occasional flare-up, blemishes are basically unavoidable. But if you're experiencing a truly terrible zit—large, painful, aggravated—at a particularly inconvenient time, there are steps you can take to significantly improve it.

When to see a doctor:

Even the most severe cysts will usually go away on their own—as long as you have a little time and patience to spare. "But if you have a special event and need it to go away faster, you could be a candidate for getting a cortisone injection," says Rouleau. Administered directly into the zit, this single shot of diluted corticosteroid should reduce inflammation and swelling significantly, and can even decrease the risk of scarring. This might seem like magic—for many, the pimple will improve substantially within a day, says Dr. Hirsch—but be sure you talk to your doc about the risks, too. (You should only turn to cortisone shots in an emergency situation, as they're not intended for use as a regular or recurring treatment.)

How to care for it yourself:

OK, willing to wait it out a bit? "If you have a cyst, the infection will not come up to the surface. It will stay deep within the skin until the body eventually re-absorbs it," explains Rouleau. Picking it, Rouleau reminds us, will just disrupt the skin's surface and result in an oozing, bleeding, messy scab that's far more noticeable than a closed, undisturbed bump.

While less is truly more helpful in this situation, there are still several options for expediting the healing process: Rouleau recommends applying ice for five minutes (do it every three hours to reduce redness and swelling), dabbing on a non-drying spot treatment and consider investing in a high frequency device to "zap" the zit and help it go down faster. 

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Prevent it in the future:

If anyone knew a surefire solution for preventing pimples, the acne treatment market wouldn't be on track to becoming a 7.19 billion dollar industry—so for now, you'll have to rely on trial and error to find the product and lifestyle choices that make a difference for your skin's unique needs. "If you get a lot of cysts in the chin and jawline area, you might consider talking to your dermatologist or OB-GYN," says Dr. Hirsch. "It's very difficult to resolve cystic acne without medical intervention." 

5. A cold sore or blister

skin emergency cold sore treatment
Credit: Getty Images

There's absolutely no medical research to back this up, but I'm pretty sure there's a law of skin chemistry that states cold sores will *only* crop up at the most inconvenient times. 

When to see a doctor:

If cold sores are a recurring problem, talk to your doctor about medications that can prevent future outbreaks from occurring. "It's critical you begin the medication as soon as you feel the tingle, before you even see the cold sore," says Dr. Hirsch. If you can't get to a doctor's office, try Wisp—it's a budget-friendly and discreet telehealth service that can provide treatment and prescriptions for issues like cold sores, urinary tract infections, yeast infections, contraception, and more.

How to care for it yourself:

There are plenty of OTC meds (Abreva is one of the most popular options) and holistic remedies (I personally swear by a drop of lavender essential oil to help zap the blister) to choose from. You can cover and treat with a specialty cold sore patch, and be sure to keep lips hydrated with a nourishing balm that contains lysine, which may reduce the severity and duration of outbreaks. 

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Prevent it in the future:

Cold sores are caused by a virus that lays dormant in the nerve, says Dr. Hirsch—so they're best prevented with a medical intervention. (Keeping an Rx handy will make your life *way* easier when you feel an outbreak coming on). Triggers of cold sores can include external factors (like sun or wind exposure) or internal factors (like stress or a weakened immune system). If you get recurring outbreaks, that's one more great reason to meditate, fill up on vitamin C-rich foods, and wear SPF every single day. 

6. Post-treatment scary skin (redness, dryness, flakiness!) 

If you've ever gotten a skincare treatment like microdermabrasion, microneedling, or a chemical peel, you know that those initial results are jarring. (When I walked out of my first microneedling session and saw my inflamed face, I was wracked with worry that my skin would never recover—but sure enough, four days later, I had never looked more glowy.)

When to see a doctor:

After any dermatologic treatment, your practitioner should provide you with a custom plan to follow, including signs to give them a call. 

How to care for it yourself:

Luckily, you don't have to DIY this time: Just follow the exact instructions you received after your treatment. You'll likely see one of Rouleau's tried-and-true recommendations for respecting your skin and giving it time to recover: Please, whatever you do, don't pick the skin. "The whole purpose of a chemical peel, for example, is to 'burn' off the dry, damaged surface cell layers and reveal younger-looking, healthy new cells," says Rouleau. "But to do this, the skin has to shed. That's the part that people dislike the most. Be warned that picking off dry, flaky skin when it's not ready to come off can result in scarring and unnecessary redness. It's really important to be patient and let it run its course." Also remember that applying SPF to the face and neck is as important as ever. "A peel exposes vulnerable immature cells, so you must ensure these cells aren't damaged by UV rays," she says. Check with your practitioner to see when it's OK to start wearing it after your treatment—and avoid the sun until you can cover up safely.

7. Anything eye-related 

eyelash-extensions.jpg
Credit: Getty Images

Here's a fun fact about eyelash extensions: The more frequently you fill them, the more likely you are to develop an allergic reaction to the adhesive used to attach them. I was not aware of this, which explains my shock when—after a year of getting the occasional set of extensions—my eyelids puffed up to epic proportions after a routine fill. 

When to see a doctor:

As a general rule, if there's something up with your eye, you'll want to call a professional pronto. "I'm a big 'call eye doc' fan in any scenario because things can turn more aggressive shockingly fast," says Dr. Hirsch.

How to care for it yourself:

None. Don't even try. Call a doctor! It's almost impossible for you to tell what's causing an eye concern on your own. Is that sudden redness an allergic reaction to your new eyeliner...or a case of conjunctivitis? You can't be sure—and eye concerns require wildly different courses of treatment.