We've all woken up to a major zit and prayed it would disappear—but there's one type of painful pimple that can last for weeks: cystic acne.
"This particular [type of acne] leaves scars and needs to be treated correctly," says Dr. Elizabeth Tanzi, board-certified dermatologist based in Washingto D.C. "Most people tend to treat cysts as they would a standard blemish, which will only serve to further irritate the already-sensitive skin," she notes.
If you can't treat cystic pimples like a regular pimple, what do you do?! How do you get rid of cystic acne? Don't worry: there are plenty of ways to clear up those angry bumps. We chatted with leading doctors and skincare experts to get their best advice for dealing with cystic acne. Read on to learn about what cystic acne is, how it's different from regular zits, what causes it, and—most importantly—what cystic acne treatments are available.
What is cystic acne?
"Cystic acne is one of the more severe forms of acne," explains Dr. Laurel Geraghty, board-certified, Stanford-trained dermatologist based in Medford, Oregon. "Deep, red, tender pus bumps or nodules can form on the skin. They often have a hard time draining or healing, and can often leave dark marks and scars that can persist after they’ve resolved. That’s why it’s important to treat cystic acne—because a deep, cystic pimple may last a couple of weeks, but a scar could last forever. And the good news is that effective cystic acne treatments do exist."
What causes cystic acne?
As with anything acne-related, there's no easy way to pinpoint one specific cause. You may notice cysts popping up during that time of the month. "Cystic acne can be triggered by the surge of hormones associated with your period," says celebrity skin care expert and esthetician Renée Rouleau. Essentially, when your body's hormone levels shift, it sends oil-producing glands into overdrive. "An oil gland itself can become engorged or swollen because it's filled with hardened excess oil," Renée adds. Acne cysts are most likely to affect your chin and jawline since this area has a large number of oil glands—which means a higher probability of breakouts and clogged pores.
There's also a chance that your diet could be to blame. Common dietary causes of cystic pimples include too much dairy, caffeine or sugar. A diet that ranks high on the glycemic index scale is likely to blame for your underground blemishes, says Carl Thornfeldt, M.D., an Idaho-based dermatologist and founder of Epionce. "Studies have shown that a high-glycemic diet can activate acne because sugars are so inflammatory."
How to Get Rid of Cystic Acne: Treatments and Tips
This is one step you're probably already practicing, but we've got to include it: wash your face! "It is important to cleanse the skin—gently—once or twice a day, to help remove any makeup, sunscreen, oil, or bacteria that could contribute to breakouts," says Dr. Geraghty. "For anyone with pimples or cystic nodules, it’s important not to rub or scrub too hard when you’re cleansing – this can scratch or break the skin’s barrier and can actually contribute to scarring."
Here are the mild, non-irritating cleansers that Dr. Geraghty recommends to her acne-prone patients:
- Cetaphil Cleanser
- La Roche-Posay Toleriane Purifying Foaming Cleanser
- Bioderma Sebium Purifying Cleansing Foaming Gel
- CeraVe Hydrating Facial Cleanser
"Sunscreen is critical for anyone prone to breakouts. Dark or pink spots that form after a blemish can take a really long time to heal," says Dr. Geraghty. "I recommend an oil-free, noncomedogenic moisturizer spiked with SPF every morning to help the complexion look more clear and even."
Here are some sunscreen choices that Dr. Geraghty gives her stamp of approval to:
- Elta MD UV Clear
- La Roche-Posay Anthelios Clear Skin
- Olay Sun Facial Sunscreen + Shine Control
- Cetaphil Pro Oily Skin Oil Absorbing Moisturizer with Sunscreen
- Neutrogena Clear Face Oil-Free Sunscreen
Moisturizing is another key way to protect and smooth your skin, and heal acne marks. Choose a moisturizer that's labeled "noncomedogenic," which means it won't clog your pores (yay!). "Soothing moisturizer ingredients include ceramides, dimethicone, and glycerin. And if you see any product that contains coconut oil, put it away, or save it for areas that don’t tend to have acne, like the hands, feet, or legs. Coconut oil is known to clog pores and worsen acne," says Dr. Geraghty.
"For my teenage patients, I don’t typically recommend a specific diet to treat acne, and I definitely don’t recommend that any young, growing person restrict or eliminate any specific foods on account of his or her complexion. Diet is a less important factor in breakouts compared to our age, genetics, and hormones. The harsh reality is that you can have a perfect diet and still breakout. Meanwhile, some lucky people can have a terrible diet, yet are somehow spared of acne. Mother Nature is not always fair, but that’s where a board-certified dermatologist comes in – she can help you clear your skin, no matter what," says Dr. Geraghty.
"All of that said: There is some evidence that skim milk products (including whey protein, which is derived from skim milk) could worsen acne. That’s why, for anyone prone to breakouts, I recommend 2% or higher dairy products. A high glycemic index diet can also worsen acne. That’s an unbalanced diet filled with mostly processed, sugary, and carbohydrate-heavy foods—like mac and cheese from a box, white bread and bagels, white rice, and simple pastas. Our skin is happier and calmer if we eat a variety of foods, with lean proteins, whole grains, lots of vegetables and fruit, and occasional sweets and treats."
Benzoyl peroxide and salicylic acid are miracle ingredients, and you can find them in many over-the-counter products. "I recommend a benzoyl peroxide product used over blemish-prone areas once or twice a day. These come as creams, gels or washes. This antibiotic works locally on the skin to help clear acne, but has the potential to cause redness, irritation, and rash, the peroxide could bleach your pillow or your favorite t-shirt," says Dr. Geraghty. "Salicylic acid products often help reduce blemishes, as well, and might be a little less irritating than benzoyl peroxide.
"I recommend a thin layer of topical adapelene gel (found in La Roche-Posay Effaclar Adapalene Gel or Differin Gel) to the facial skin at bedtime. This can help to prevent and treat small bumps, little whiteheads and blackheads. Mixing benzoyl peroxide gel with adapalene at bedtime is a good combination treatment to help not only with breakouts, but with the dark marks and scars pimples can leave behind," says Dr. Geraghty.
Resist the urge to touch any bumps! "Everyone thinks that if they have any kind of a pimple, they should pop it," says Joanna Vargas, celebrity facialist and founder of Joanna Vargas Salons and Skincare Collection. "But you need to leave cysts alone because all that aggression only makes it worse."
Cyst-like breakouts actually damage healthy tissue, so picking only exacerbates the skin and inhibits its self-healing abilities. In fact, breaking open the cyst by trying to pop it will just spread the infection to your surrounding skin, which can cause more breakouts. On top of that, you're more likely to develop scars if you try to pop cystic acne because it's so deep down in your skin.
If you’re a glass-half-full kind of person, acne isn’t the worst thing ever—it’s an awesome reason to treat yourself to a pricey spa treatment! Regular facials keep pores as clean as possible. “The catalyst for acne is blocked and clogged pores, composed of oil and dead skin cells,” explains Dr. Howard Sobel, a board- certified dermatologic surgeon based in Manhattan. “Regular facials clear the pores, making acne less likely.”
Do whatever you can to reduce stress because it is definitely related to breakouts. Dr. Geraghty explains: "Acne flare-ups are very closely linked to stress. Doesn’t everyone have a story about a pimple arising when they were worried or anxious, cramming for an exam, or going through a hard time? Probably most of us can think of many times like this, because the connection is just so real. A lot of that has to do with stress hormones that flare in our body when we’re worried or anxious and contribute to breakouts."
"Any activity that helps to reduce stress level and promote feelings of well- being is an important thing to do. That could be something simple: Calling or texting a friend, reading a good book, listening to music, exercising, or going for a walk. Whatever your forms of stress relief may be, it’s important to pursue them every day—not just for your skin, but for overall health and well- being," she continues.
Getting enough sleep is part of stress management. "When we don’t get enough sleep, our minds and bodies are placed under extra stress, and this can manifest as more breakouts, or more severe breakouts," says Dr. Geraghty.
"If you have a hard time tolerating drugstore products, or if they’re just not enough to control your blemishes, please know they are only the starting point. A dermatologist can tailor a prescription regimen for you with far stronger and more effective therapies. And if you’re racking up a lot of dark marks or scars, don’t wait for an appointment. If you get one new scar a month for 2 years, that’s about 25 scars on your face that you could have avoided! I want everyone to know that acne can be cleared or greatly improved with the right therapy, and no one’s confidence should take a hit because of it," says Dr. Geraghty.
According to Dr. Geraghty, one of the most effective prescription cystic acne treatments available is a pill called isotretinoin (a medicine that many people call Accutane, though this specific brand is no longer made).
"This is a safe and highly effective medicine that comes from vitamin A. It’s a tightly regulated medicine, because females who take it could have birth defects if they become pregnant while taking it. There are a lot of possible side effects to know about, which is why you should see a board-certified dermatologist, who can discuss this option with you. The majority of people who get through a six-month (or so) course of treatment with isotretinoin never break out in the same way again. Their skin remains clear, or nearly clear, for the rest of their lives. I love that investing those several months with a medicine can make a difference forever (unlike, say, antibiotic pills, which might help while you take them… but then acne comes right back once you stop). I took isotretinoin when I was a teenager, and it saved me from a lot of scarring. Nearly 100% of my patients who take it are thrilled with their results," says Geraghty.
"Other treatment options exist, as well. These include oral antibiotics (something doctors and all of us are moving away from now, due to antibacterial resistance and other concerns), birth control pills (some are FDA approved for the treatment of acne in females), and spironolactone (a medicine that can help a lot with hormonal acne). Chemical peels with salicylic or glycolic acid could help a bit. So could some laser and light therapies, including intense pulsed light—though insurance often won’t cover these," adds Dr. Geraghty.