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As far as pimples go, those deep, cystic acne flare-ups are probably the most traumatic. Aside from how much surface area those suckers tend to cover, the pain they cause makes them impossible to ignore. Press on one and it reverberates throughout your entire face. (That's not an exaggeration.)
While pimples come in many shapes, sizes, and forms, cystic acne is considered to be the most severe type of acne, according to board-certified dermatologist Joshua Zeichner, the director of cosmetic and clinical research at Mount Sinai Medical Center in New York City. It's characterized by the development of "tender, inflammatory nodules underneath the skin." Ouch.
Symptoms, treatment options, and personal experiences for various physical, mental, and health conditions and concerns. Moreover, when it comes to treating these bad boys at home, your typical acne skin-care routine might not cut it. "Usually, people run to their dermatologist's office for a quick cortisone injection to dry up those monsters within hours," says Rachel Nazarian, a board- certified dermatologist at Schweiger Dermatology Group in New York City. But what if you don't have the time (or the money) to pop into your dermatologist's office the moment you feel one coming on? Here are the next- best, at-home cystic acne treatments, and advice from top dermatologists for getting rid of those under-the-surface cysts ASAP.
Whatever you do, don't try to pop it.
We know you've heard it before, but we'll say it again: As satisfying as you think it might feel, do not try to pop your pimples — especially if they are cystic. "The hardest thing for me to communicate with my patients is that often, around age 20, women experience a major change in their acne," New York City board-certified dermatologist Scott Dunbar has told Honayst. "No longer are the zits the juicy whiteheads that explode with a satisfying pop. By the mid-20s and 30s, acne is made of deep pockets of white blood cells, and these can't be popped."
Maryland-based board-certified dermatologist Ife Rodney says they not only can't be popped, but that an attempt to can cause damage. "Unlike pustules — little pus-filled pimples — and blackheads, under-the-skin pimples usually do not contain a core of dead skin or pus," she tells Honayst. "When you try to squeeze a cystic pimple, the result is trauma and more inflammation, leading to scarring and skin discoloration."
When you feel it coming on, ice it like a sprained ankle to reduce swelling.
Whether the cystic acne is on your forehead or on your nose, the type of pimples we're talking about here are rooted deep beneath the skin, so you will usually be able to feel it starting to form. When you do, don't panic. Instead, grab an ice cube and apply it to the area for several seconds.
"Applying an ice cube directly to your pimple will constrict the small blood vessels that are feeding the cyst and will immediately decrease the redness and size," Nazarian says.
Zeichner echoes the advice: "Ice-cold temperatures help constrict blood vessels, so wrap an ice cube in a paper towel and hold it against the bump to reduce pimple redness and bring down the swelling a bit," he says. He recommends icing three times an hour in 10-minute intervals (10 minutes on, 10 minutes off). You want to do this after you wash your face since washing after icing would warm the skin right back up.
This trick is especially helpful if you aren't able to follow the next steps right away and you need something that will calm the oncoming redness and swelling before you cover it up with concealer and get on with your day.
Use a two- or three-pronged ingredient approach.
"The best way to treat acne is to use different ingredients that work differently and complement each other," Zeichner says. "That's why I typically advise my patients to use both salicylic acid and benzoyl peroxide." To prevent irritation when using the latter, make sure you prime the skin with a light moisturizer first, he says, then spot-treat the cyst with a super-thin layer of the lowest percentage of benzoyl peroxide.
To maximize the efficacy of both of these active ingredients for cystic acne removal, Zeichner recommends a salicylic acid cleanser, followed by an oil-free moisturizer, topped off with a benzoyl peroxide spot treatment.
Start with a cleanser that contains salicylic acid.
"Think of your cleanser not as a true wash, but rather as a short-contact therapy," Zeichner suggests. For this reason, he typically recommends that patients with cystic acne use cleansers that contain high concentrations of salicylic acid, a beta hydroxy acid (BHA) that helps shrink cystic pimples by removing excess oil, sloughing off dead skin cells, and drying them out. Typically, salicylic acid concentrations range between 0.5 to two percent, and if you're prone to cystic acne, Zeichner recommends looking for a cleanser that leans toward a higher concentration. A couple of great 1.5- to 2-percent salicylic acid-based cleansers include La Roche-Posay Effaclar Medicated Acne Face Wash and Murad Clarifying Cleanser.
Murad Clarifying Cleanser
If your skin is both acne-prone and sensitive, higher concentrations of salicylic acid could be overdrying. In that case, cleansers that contain lower concentrations (0.5 to one percent) of the ingredient include Aveeno's Clear Complexion Foaming Cleanser and the Burt's Bees Natural Acne Solutions Purifying Gel Cleanser.
Burt's Bees Natural Acne Solutions Purifying Gel Cleanser
Zeichner says to apply the cleanser and let it sit while you sing the alphabet before rinsing it off. "The cleanser needs enough contact time with the skin for the active ingredients to exert their effects."
Follow up with an oil-free moisturizer.
Even if you're prone to cystic acne, you should still use a facial moisturizer regularly in order to maintain a healthy skin barrier.
"Patients who are prone to cystic breakouts should use oil-free, noncomedogenic moisturizers to hydrate their skin," Rodney says. However, she notes that noncomedogenic products won’t necessarily treat your breakouts — they just won’t contribute to the problem. That said, choosing a moisturizer that contains ceramides, niacinamide, or hyaluronic acid can be especially helpful. "These ingredients help to reduce redness and inflammation and restore the skin’s protective barrier. This is important because many acne-fighting active ingredients tend to be drying and irritating to the skin."
Dr. Dennis Gross Stress Repair Face Cream is a noncomedogenic moisturizer that contains all three. Use it after washing with a salicylic-acid cleanser.
Finish with a medicated spot treatment to kill the bacteria.
Benzoyl peroxide works by lowering levels of acne-causing bacteria on the skin, thereby reducing inflammation, which is why Zeichner recommends using the ingredient as a spot treatment. Skin-care products come in 2.5, 5, and up to 10 percent concentrations of benzoyl peroxide, but you don't necessarily have to max out on it. "Studies have shown that even low concentrations of benzoyl peroxide are as effective as higher concentrations, but are associated with less dryness of the skin," he says.
Zeichner recommends looking for leave-on acne spot treatments with 2.5 percent benzoyl peroxide, such as Neutrogena Rapid Clear Stubborn Acne Daily Leave-On Mask or Paula's Choice Clear Daily Skin Clearing Treatment.
For painful cystic acne, top it off with a hydrocortisone cream cocktail to reduce redness and inflammation.
Applying an over-the-counter, one-percent hydrocortisone cream, which contains a low dose of topical steroids, can help reduce redness and calm inflammation. Try Aveeno's 1% Hydrocortisone Anti-Itch Cream or Cortizone 10 Maximum Strength Cream.
Cortizone-10 Max Strength
For the peskiest of big pimples, like cystic acne on the chin, combine a hydrocortisone cocktail as a leave-on spot treatment. Zeichner recommends a hydrocortisone cream to reduce inflammation, a two percent salicylic acid product to dry out excess oil (we like The Ordinary's Salicylic Acid 2% Masque), and then benzoyl peroxide to kill acne-causing bacteria. "Put a drop of all three in the palm of your hand, mix them together, then apply."
The Ordinary Salicylic Acid 2% Masque
For those with skin that's not sensitive or doesn't get easily dried out, another combo option is to swap in a sulfur-spiked treatment in place of the salicylic acid. "The combination of these three over-the-counter products — a sulfur-containing mask (try Sunday Riley's Saturn Sulfur Acne Treatment Mask), a benzoyl-peroxide cream (we love Clearasil's Daily Clear Acne Treatment Cream), and a mild cortisone salve — usually proves very effective when mixed and applied two to three times a day over the cyst for seven to 10 days," says board-certified dermatologist Leyda Bowes, the medical director at Bowes Aesthetics in Miami.