How to Treat Stubborn Cystic Acne, According to Dermatologists

By Claudia Shannon / Research Scientist / Honayst

Life is filled with ironies. Take this one as an example. As a teenager, I would get the occasional pimple, if that. Nothing major. Now that I'm in my twenties, however, I break out all the time. I honestly feel like my hormones think that I'm ten years younger than I actually am. Those painful, hard cysts on my chin that won't come to a head and fester on your face, like some sort of soul- sucking, life-ruining face crater? They are the worst. But luckily for me, and by extension you, I was able to speak with celebrity esthetician Renee Rouleau about why my skin has decided to go a lil' crazy on me.

"Cystic acne which usually occurs in the chin and jaw areas is the most common place to get acne — especially in adults," she says. "The reason for this is often due to the hormonal shifts and imbalances in the body. Hormones stimulate oil production, which leads to the growth of bacteria getting trapped in the pore." Rouleau adds that in addition to hormonal reasons, cystic acne breakouts might also indicate that you are getting more dairy than your body can tolerate (more on that later).

How do you know if you're dealing with cystic acne, in particular? "This type of breakout usually stays under your skin — no matter what method you employ, cysts will never rise to the surface of the skin," she says. So what are some small changes that we can make? We asked Rouleau and top dermatologists how to deal with stubborn chin breakouts that just won't quit.

1. Stop touching your face and chin.

You probably already know the importance of cleansing your skin at night to remove acne-causing bacteria that may have manifested itself during the day, but you may not realize that minimizing the number of times you touch your face on a daily basis is also crucial. As Rouleau explained to me, because all blemishes are related to bacteria getting trapped in a pore, we should prevent unnecessary bacteria from making its way onto our chin by avoiding resting our heads on our hands or mindlessly picking at our skin while deep in thought.

Also important? Don't pick your face, says Ranella Hirsch, M.D., a Boston-based dermatologist. "In many cases, picking is what takes a sterile wound without bacteria and introduces a portal for bacteria to enter," she explains. "This is often the infection we see after picking — so please don't."

3. Try stress-busting activities — and get more sleep.

Not only can stress lead to exhaustion and increase feelings of anxiety, but it may be playing a role in your breakouts, says Debra Jaliman, M.D., an NYC-based dermatologist and assistant professor of dermatology Icahn School of Medicine at Mount Sinai,

"Stress causes your body to make hormones like cortisol, which prompts glands in your skin to make more oil," she explains. "Excess oil can lead to breakouts." That's why Dr. Jaliman recommends decreasing stress with meditation, exercise, and other lifestyle changes (like catching more zzzs) to not only make you feel more at ease but, perhaps, improve your skin.

4. Use a spot treatment formulated exclusively for stubborn cysts.

If you're looking for a spot treatment for your cysts, you might consider trying the much-lauded Renée Rouleau Anti-Cyst Treatment, which according to Rouleau, contains "a purified form of lactic acid helps dissolve cells blocking the pore, as well as purifying within the pore to help prevent future breakouts." Bye-bye festering angry mountain on my face!

5. Exfoliate regularly.

If you're dealing with cystic acne, it's important to remove the dead, dry skin cell buildup by focusing on exfoliation, Rouleau says. The more you remove the surface dry cells, the less the oil will stay trapped and clogged under the skin, which should help make those clogged bumps start to disappear. Rouleau suggests chemical exfoliation with alpha-hydroxy acids (AHAs), like glycolic acid and lactic acid, and beta hydroxy acids (BHAs), like salicylic acid.

6. Break a sweat in a ponytail.

Hot yoga devotee? Dr. Hirsch recommends sweeping your hair up and off of your face before working out. When you're done, make sure you immediately cleanse your face with a product that contains salicylic acid 1% in order to offset acne-causing bacteria.

7. Drink hot lemon water first thing in the morning.

As soon as you wake up in the morning (and after you've hit snooze multiple times), Rouleau says you'll want to head to the kitchen and whip up some hot lemon water, her personal skin secret. Why? It could help flush out and purify the body internally, potentially reducing toxins and bacteria in the small intestine where the cycle of acne may begin for some people.

8. Try eliminating dairy from your diet.

Visit a dermatologist and you'll find it's not uncommon for a doc to make dietary recommendations in addition to topical solutions for breakouts, especially when it comes to dairy, says California-based dermatologist Caren Campbell, M.D.

In fact, a 2018 study showed intake of any dairy — including milk, yogurt, and cheese — "regardless of amount or frequency" was linked to higher odds for acne occurrences in individuals seven to 30 years old (when compared to individuals who did not consume dairy at all). Dr. Campbell says she also recommends patients avoid dairy-based powders, like whey protein, for these same reasons.

10. Avoid sugar.

Rouleau also noted, "If you are experiencing breakouts occurring on your cheek and cheekbone area, it may be due to excessive acidic foods in your diet like, tomatoes, pasta sauce, salsa, and citrus fruits/juices. If you get breakouts in these areas, try cutting back and your skin may clear up."

11. Try drinking spearmint tea.

Dr. Campbell recommends consuming three cups of spearmint tea, iced or hot. But take note: "Since this influences hormones, it's important not to do this while pregnant," she says.

12. Try taking oral probiotics.

For that reason, Rouleau says oral probiotics may regulate the imbalance of bacteria and reduce oil levels to treat acne. She says you can find supplements in health food stores, or just make probiotics a part of your everyday diet by eating yogurt with live active cultures (assuming dairy isn’t your cause of breakouts), miso soup, and sauerkraut. Rouleau noted: "It's important to chat with your doc to find out if this is right for you."

13. Consult with your dermatologist and/or ob-gyn.

When in doubt, consult a healthcare expert. In addition to your dermatologist, Rouleau says you may want to touch base with your ob-gyn. "A gynecologist may be most beneficial since they have a better understanding of hormonal fluctuations," she says. "They will most likely have your hormone levels checked via a blood test and prescribe oral medications such as birth control pills (or switch your current dosage) or spironolactone, a popular drug that can work well for balancing hormones." Rouleau added: "Some doctors take more of a natural approach and may suggest vitamin supplements or have other dietary recommendations."

And remember — it's important to be realistic about your skin. Making some of these changes may prove to be beneficial in the long run, but they might take time to noticeably change or affect the condition of your skin. That means a little patience and diligence may be necessary (but will very well be worth it).