Typically, salicylic acid concentrations range between 0.5 to 2 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.
If your skin is both acne-prone and sensitive, higher concentrations of salicylic acid could be over-drying. In this case, some cleanser options that contain lower concentrations (0.5 to 1 percent) of the ingredient include the Aveeno Clear Complexion Foaming Cleanser and Burt’s Bees Natural Acne Solutions Purifying Gel Cleanser.
Whichever cleanser you choose, “apply it to the skin and let it sit while you sing the alphabet, then rinse off,” says Zeichner. “The cleanser needs enough contact time with the skin for the active ingredients to exert their effects.”
5. 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. After you’ve rinsed off your salicylic-based face wash, follow up with an oil-free moisturizer such as Clinique’s Dramatically Different Moisturizing Gel, Neutrogena’s Oil-Free Moisturizer, and the Caudalie Vinosource Moisturizing Sorbet.
6. Finish with a medicated spot treatment.
Benzoyl peroxide works by lowering levels of acne-causing bacteria on the skin, thereby reducing inflammation, which is why Zeichner recommends utilizing the ingredient as a spot treatment. Skin-care products come in 2.5, 5 , and up to 10 percent concentrations of benzoyl peroxide, however, “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 that are formulated with 2.5 percent of the active ingredient, such as Neutrogena’s Rapid Clear Stubborn Acne Daily Leave-On Mask or Paula’s Choice Clear Daily Skin Clearing Treatment.
7. For really painful and/or red cysts, top it all off with a hydrocortisone cream cocktail.
Applying an over-the-counter 1 percent hydrocortisone cream, which contains a low dose of topical steroids, onto the affected area can help reduce redness and calm inflammation. Try Aveeno’s 1% Hydrocortisone Anti-Itch Cream or Cortizone 10 Maximum Strength Cream.
For the peskiest of cysts, combine your own hydrocortisone cocktail to apply as a leave-on spot treatment. Zeichner recommends a hydrocortisone cream to reduce inflammation, a 2 percent salicylic acid product to dry out excess oil (we like The Ordinary’s Salicylic Acid 2% Solution), 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.”
For those with skin that’s not sensitive or that 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 Saturn Sulfur Acne Treatment Mask), a benzoyl peroxide cream (try Clearasil 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 Leyda Bowes, the medical director at Bowes Aesthetics in Miami.
8. When all else fails, color-correct the cyst away.
When your cystic acne persists, despite your very best efforts, “use makeup with a slight green tint to help mask redness and blend your pimple into your natural skin tone,” Nazarian recommends. Try or Urban Decay’s Naked Skin Color Correcting Fluid. To use, apply a thin layer over the cyst before reaching for your concealer, then applying your foundation over top.
More on acne treatments:
- 4 Steps for Getting Rid of Cystic Acne, Fast
- The 14 Best Acne Spot Treatments That Get Rid of Pimples Fast
- The Ultimate Guide to Getting Rid of Acne
Now, see how acne treatments have evolved within the last 100 years:
You can follow Allure on Instagram and Twitter, or subscribe to our newsletter to stay up to date on all things beauty.
Nothing can ruin my week like a cystic pimple. It’s round, it’s red, it’s bulging, and no amount of concealer or prayer will kill it. You know it’s different from a regular pimple when inflammation is forming beneath the surface, says dermatologist Dr. Rachel Nazarian of Schweiger Dermatology Group. “Most cystic lesions begin below the skin when the oil glands and skin cells are ‘clogged’ and create irritation and inflammation—often in conjunction with surface bacteria,” she explains.
In my experience, a cystic zit can last for up to two weeks. Questions cycle through my mind: Do I need to go to the dermatologist’s office? Will it scar? Do spot treatments really work? What caused it in the first place?
It’s important to know that acne is a complex disease that can be affected by an infinite combination of internal (genetic predisposition, hormone concentrations) and external (diet, stress) factors. Stress, in particular, is one major catalyst to take a closer look at according to dermatologist Dr. Melissa Kanchanapoomi Levin, founder of Entiére Dermatology.
“Stress is an ever constant presence in modern life. While stress does not cause acne, it can exacerbate or worsen it,” she says. Previous studies have found that chronic stress can induce a rise in cortisol and androgens which increase oil production, leading to clogged pores and overgrowth of a bacteria called Propionibacterium acnes. She continues, “Overgrowth of the bacteria increases inflammation under the skin, resulting in cystic acne.”
Levin adds that newer studies have shown even deeper links between acne and stress, where ” not only because of the systemic rise in cortisol and androgen but also locally secreted neurotransmitters, neuropeptides, and hormones in the skin itself which leads to a triggering and worsening of the stress and acne cycle.”
Translation: Being more chill will only be beneficial for your skin in the long run. Meditate. Exercise. KonMari your whole life until everything “sparks joy.” And, as you work on big-picture lifestyle changes, try these dermatologists’ more tangible steps to take the minute you feel a cystic pimple coming.
- Do you need to treat a cystic pimple differently vs other pimples?
- What immediate action should you take when you feel a cystic pimple coming?
- What action should you take if the cystic pimple has already risen to the surface?
- When is it the right time to visit the dermatologist to treat a cyst?
- How do I avoid the cystic pimple from scarring once it dies down?
- What Is Cystic Acne and How Can You Get Rid Of It?
- What Is Cystic Acne?
- What Does Cystic Acne Look Like?
- What Are Some Cystic Acne Causes?
- What Is the Best Cystic Acne Treatment?
- Pimple popping: Why only a dermatologist should do it
- Everything You Need to Know About Treating Cystic Acne
- What is cystic acne?
- What causes cystic acne?
- Does diet trigger cystic acne?
- When do most people get cystic acne and how long does it last?
- How to treat cystic acne
- Caring for acne-prone skin
- The future of cystic acne treatments
- Getting rid of cystic acne scars
- Everything you need to know about cystic acne
- Why Your Hormones Might Be Taking Out Their Rage on Your Face
- So what is nodulocystic acne, anyway?
- Who is most likely to get cystic or nodular acne?
- Here’s the deal with cystic and nodular acne treatment.
- How Is It Treated?
Do you need to treat a cystic pimple differently vs other pimples?
“Yes. Absolutely,” Nazarian insists. “These lesions have a higher risk of scarring the skin- they should not be pressed or squeezed as this increases the chances of scars or mark formation.”
Levin adds that those who experience cystic acne should really be regularly seeing a dermatologist who can prescribe topical and oral medications. If you’re taking matters into your own hands, she says Differin is her top over the counter pick. “It contains the retinoid adapalene and there is no irritation. I also like the Differin Daily Deep Cleanser which contains five percent benzoyl peroxide,” she says. “Benzoyl peroxide effectively treats inflammatory acne because it reduces a few factors that cause acne—oil production and the P.Acnes bacteria.”
Differin Daily Deep Cleanser Differin amazon.com $10.44
What immediate action should you take when you feel a cystic pimple coming?
First thing’s first—do not pick. “Picking can worsen scarring and discoloration,” Levin says. Meanwhile, Nazarian suggests immediately applying a spot treatment, but making sure it is actually meant for spot application. “Traditional acne medications are not meant to be applied directly to one acne spot, and are usually too drying when a large amount is placed on a small pimple. Most of the time this leads to a “halo of irritation” around the original pimple—which can sometimes be worse than the pimple itself!” Nazarian says. One product she suggests is Proactiv’s Skin Purifying Mask, which can be dabbed on pimples and left overnight. “It contains antibacterial sulfur and can break down blackheads with continued use,” she says.
Skin Purifying Mask Proactiv sephora.com $38.00
What action should you take if the cystic pimple has already risen to the surface?
“I recommend applying a specialized hydrocolloid acne patch called ZitSticka which is a 24 freeze-dried microdarts bandage that self dissolves over two hours to deliver acne-fighting ingredients.” It contains oligopeptide-76, a new anti-inflammatory ingredient that’s like a gentler benzoyl peroxide without irritation, salicylic acid, niacinamide (which helps with anti-redness) and moisturizing hyaluronic acid.
Nazarian says it’s best to see your dermatologist as soon as you feel a zit brewing beneath your skin, but if it’s already too late a spot treatment could help here too. Look out for anti-inflammatory ingredients and ones that break down skin cells, like Neutrogena’s rapid clear spot treatment. “I also like to use a small amount of over-the-counter hydrocortisone one percent cream to the pimple. It’s even better if you leave the cream in the fridge because the cool temperature shrinks down the pimple and diminishes redness,” she shares.
KILLA™ KIT zitsticka.com $29.00
When is it the right time to visit the dermatologist to treat a cyst?
“Immediately! Cystic pimples respond very well to injections when done early,” Nazarian suggests. “If you can see the small bump forming, or the area feels tender, call your derm!” The injections, administered directly into the cyst, contain a dilute corticosteroid. Levin also suggests seeing a derm for an injection if your cyst is painful. “Cortisone is an anti-inflammatory that shrinks the swollen wall of the cyst,” she explains. “Cortisone shots don’t work for the pus-filled pimples and are often reserved for cystic blemishes.”
While they are not long-term solutions, an injection will make the cyst go away within one to two days—or quicker. “Even after the pimple goes away, the little marks may be scar tissue which will still respond to the injection,” Nazarian adds.
How do I avoid the cystic pimple from scarring once it dies down?
“Be diligent about daily sunscreen to encourage rapid fading of dark spots,” Nazarian suggests, adding that you should use a minimum of broad spectrum SPF 30 every day. “Additionally, I would suggest really sticking to a topical nightly regimen of a retinoid, which can stimulate collagen and improve scars over time.” Nazarian suggests an adapalene gel, which you can use three nights a week to start along with a good moisturizer with it.
Kristina Rodulfo Beauty Director Kristina Rodulfo is the Beauty Director of Women’s Health—she oversees beauty coverage across print and digital and is an expert in product testing, identifying trends, and exploring the intersections of beauty, wellness, and culture.
What Is Cystic Acne and How Can You Get Rid Of It?
Getty Images/Salvatore Virzi/EyeEm
Let’s be real, there’s no good kind of pimple. But if you’re looking at breakouts on a scale ranging from bad to worse, then cystic acne falls on the way, way ‘worse’ end for sure.
“Cystic acne creates the most frustrating type of inflammatory blemishes because they last the longest and can cause long-term scarring,” says Austin-based celebrity aesthetician and skin expert Renée Rouleau, founder of Renée Rouleau Skincare. They can also be painful.
Here’s the lowdown on cystic acne, including what you need to know—and do—to deal with it.
What Is Cystic Acne?
“Acne presents itself in a variety of shapes and sizes,” says Tara Rao, M.D., practicing at Schweiger Dermatology Group in New York City. Mild acne—your run-of-the-mill whiteheads, blackheads, and smaller pimples—is usually described as comedonal acne. When those pimples become large and sore and are deeper in the skin, you’re probably looking at cystic acne, she says.
What Does Cystic Acne Look Like?
Where the blemishes lay in your skin is the biggest indicator of cystic acne. If your pimples are on the surface of your skin, i.e. things you could (but shouldn’t) squeeze, you’re dealing with comedonal acne. On the flip side, “cysts form deep underneath the skin and never come to the surface,” explains Rouleau, adding that they’re also hard and painful.
Talk about adding insult to injury. Cystic acne often crops up along the chin and jawline, notes Rouelau (more on why in a minute).
What Are Some Cystic Acne Causes?
Like with other acne, you can blame clogged pores (usually with oil and dead skin) and the bacteria (in this case p.acnes) that feeds off this gunk.
With cystic acne, bacteria causes inflammation and swelling deep in the pores. Whether or not you end up having it largely boils down to genetics and luck of the draw, though good ol’ hormones also play a major role.
“Cysts are typically triggered by a surge of hormones, which is why they commonly occur around a woman’s menstrual cycle,” says Rouleau. “During this time, the skin’s oil glands become hypersensitive to the hormone surge and react by overproducing sebum.” Mid-cycle, there’s also a dip in estrogen and spike in testosterone, which triggers sebum production. (Related: 6 Surprising Things Making Your Acne Flare Up)
All of this ultimately leads to those engorged, swollen, hard blemishes under the skin. And hormonal acne—also often referred to as adult acne—often pops up around the chin and jawline.
Another possible trigger: dairy. According to Rouelau, cystic acne might be a sign that you’re consuming more dairy than your body can tolerate. (FYI, there have been several studies showing a correlation between acne and dairy. Recently, a 2018 study published in Nutrients found that the intake of milk, yogurt, and cheese all upped the likelihood of acne in people from age seven to 30.) The exact connection is still unclear, but the general consensus is that it once again goes back to hormones and that the hormone levels in milk stimulate excess sebum production. (Related: 10 Surprising Foods That Cause Acne)
What Is the Best Cystic Acne Treatment?
Now’s really the time to call in the big guns (read: skin docs) since most of the common OTC acne treatments won’t be able to reach blemishes buried deep in the skin. “Cystic acne is best addressed by a dermatologist who can suggest topical medicines, oral medicines, and sometimes cortisone injections,” says Dr. Tao. (Topical and oral antibiotics are commonly prescribed, as is spironolactone, an oral drug that addresses the hormonal component.)
Above all, adopt a 100 percent hands-off policy: “Don’t pick at cysts,” says Rouleau. “They’re not meant to come to the surface and doing so can cause scarring or lingering redness that lasts for weeks.” Keeping your hands away from your face will also be helpful in mitigating the spread of bacteria (and FYI, all blemishes are related to bacteria in your pores).
What you can do is up your prevention game. Rouleau suggests cutting out dairy for three weeks to see if that’s the culprit. (Related: Following a Dairy-Free, Raw Vegan Diet Helped My Horrible Acne)
As far as topicals go, be wary with standard spot treatments—most dry out the surface of the skin, further trapping the bacteria that’s buried deep underneath causing the pimple, she says. Benzoyl-peroxide is one good ingredient to look for since it both kills the acne-causing bacteria and has anti-inflammatory benefits. The caveat: Look for it in a lower concentration (2.5 percent), since studies shows that it’s as effective as higher percentages, but less drying. Find it in Neutrogena On-The-Spot Acne Spot Treatment (Buy It, $6, amazon.com). Rouleau also recommends calming, anti-bacterial masks to ward off breakouts without causing any further irritation or stress to your complexion. Try: Renée Rouleau Rapid Response Detox Masque (Buy It, $54, reneerouleau.com).
- By Melanie Rud
Of all the types of acne, cystic acne and nodules are by far the most severe. Contrary to other types of acne, such as hormonal acne or whiteheads, cystic acne is painful to the touch and is rooted deep in the skin. “It occurs when sebaceous material clogs the pores and causes bumpy texture, inflammation, and infection under the skin,” explains Lara Devgan, MD, a board-certified plastic surgeon and Chief Medical Officer at RealSelf .
Unfortunately, cystic acne can expand to the body and can persist as adult acne. These lesions can linger under the surface of the skin for weeks, or even months, and may leave deep acne scars as in the aftermath, explains Dendy Engelman, MD, a New York City-based dermatologist.
Genetics are largely to blame (ugh), but your diet and lifestyle also affect your skin’s condition. “Food that’s high in fat and unhealthy oils can trigger inflammation in your skin, which can lead to clogged pores,”explains Dr. Engelman. However, Dr. Devgan dispels the misconception that it is caused by chocolate, nuts, greasy food, or bad hygiene. That being said, there are ways to mitigate your acne-triggering DNA with the help of proper preventative care and treatments.
What is the best treatment for cystic acne?
Oftentimes, a combination of topical treatments, prescribed medication, and over-the-counter products render the best results. “The typical rule of thumb according to dermatologists is if a drugstore treatment hasn’t cleared up acne after two weeks,” recommends Dr. Engelman.
Dermatologist treatments: As far as in-office treatments go, “intense Pulsed Light treatments can be used to kill the bacteria that causes acne and quickly clear the skin,” says Dr. Devgan. “Topical products, chemical peels and intralesional steroids can sometimes assist in clearing active cystic acne, and ablative resurfacing lasers and microneedling can be helpful with scarring once the cystic acne has cleared.”
Melissa Kanchanapoomi Levin, MD, a New York City-based dermatologist also recommends getting a diluted corticosteroid injected directly into the cyst for a quick-fix (it will start to minimize in six hours). “Cortisone is an anti-inflammatory that shrinks the swollen wall of the cyst,” she explains.
Medication: Apart from the minimally invasive procedures above, a dermatologist can also work with you to find medications that will help treatment in the long-run. “Nodular acne often requires treatment with systemic medications such as oral antibiotics, and hormonal medications (oral contraceptives, spironolactone),” says Valerie Harvey, MD, a dermatologist based in Virginia. “Isotretinoin, a derivative of vitamin A, is also very effective.”
What products can you buy to prevent and treat cystic acne?
The responsibility to clear cystic acne also lays in the upkeep of professional treatment, and there are many over-the-counter products available on the market to keep acne under control. “Relevant products ingredients include benzoyl peroxide, salicyclic acid, glycolic and alpha-hydroxy acids, and gentle cleansers,” shares Dr. Devgan. Another tried-and-true ingredient to seek is a retinoid, which de-clogs pores by normalizing skin cell turnover and acts an a powerful anti-inflammatory.
We know that navigating the countless acne-treating products on the market and treatments offered by professionals can be overwhelming, and since cystic acne is so severe it often requires a combination of treatments and systemic therapy to help eliminate current lesions and prevent future ones from forming. That’s why we rounded up the best products to treat and eliminate cystic acne.
Pimple popping: Why only a dermatologist should do it
Too often, people worsen their acne by squeezing pimples and other acne blemishes. If you have a pimple that you’re about to pop, stop! You’ll want to read this first.
Do-it-yourself pimple popping can backfire
Squeezing pimples and other acne blemishes may seem so simple that anyone can do it, but there is an art to doing it right. You need proper technique to avoid:
Permanent acne scars
More noticeable acne
More painful acne
These unwanted side effects are likely when you pop pimples at home. If you push some of the contents inside the pimple deeper into the skin, which often happens, you increase inflammation. This can lead to more-noticeable acne. Some people develop acne scars and pain.
When you pop pimples yourself, you also run the risk of getting an infection from the bacteria on your hands.
Dermatologists know how to remove acne safely
Dermatologists use a few different techniques to physically get rid of acne. One is called acne extraction, which involves using sterile instruments to get rid of blackheads and whiteheads.
Acne extraction is usually offered when other acne treatment fails to clear the skin. it’s rarely a first choice because it takes time and can be expensive.
When performed by a dermatologist, acne extraction is a safe way to get rid of blackheads and whiteheads.
Another technique that dermatologists use allows them to get rid of a deep, painful acne cyst or nodule. To do this, a dermatologist will inject the blemish with a corticosteroid. This speeds healing and reduces the risk of scarring.
An injection is fine for treating one especially painful acne nodule or cyst. It cannot be used to treat several acne blemishes. If you receive too much corticosteroid, it can cause unwanted side effects.
Only a doctor should inject a corticosteroid.
To remove a large pimple or painful acne cyst or nodule, your dermatologist may also use a procedure called incision and drainage. It involves using a sterile needle or surgical blade to open the blemish and then removing what’s inside.
Because dermatologists use proper technique, this procedure can help drain a pimple, cyst, or nodule.
What to expect from acne removal procedures
During acne extraction, a dermatologist uses sterilized equipment to clean out your pores. You may need to have your skin exfoliated first.
Blackheads and whiteheads can return, so you’ll need to follow a skin-care plan to prevent new blemishes.
A corticosteroid injection will flatten most acne nodules or cysts within 48 to 72 hours.
The key to clearing a pimple with incision and drainage is to do this at the right time.
Three things that can improve acne clearing
These techniques aren’t necessary for every blemish. Acne often clears with acne medicine and the right skin care.
While you’re waiting for your skin to clear, it can be tempting to pop a large pimple or squeeze out a blackhead. That can delay clearing.
Here are 3 things you can do that will help you see clearer skin more quickly.
Keep your hands away from your face.
Touching, picking, and popping can worsen acne.
Relieve pain with ice.
Some acne can be painful, especially nodules and cysts. Ice reduces the inflammation.
Treat your acne.
Many people can clear their acne with treatment that they can buy online or at a drugstore. Treatment takes time to work. If you don’t see results in 4 to 6 weeks, a dermatologist can help you clear your skin.
Patience today, clearer skin tomorrow
While you may still be tempted to pop that pimple, you now know the benefits of using a different approach. And that can lead to clearer skin.
Fulton JE, Acne Rx: What acne really is and how to eliminate its devastating effects! Self-published; 2001.
Zaenglein AL, Pathy AL, et al. “Guidelines of care for the management of acne vulgaris.” J Am Acad Dermatol. 2016;74:945-73.
Everything You Need to Know About Treating Cystic Acne
It’s one of the most eye-poppingly common woes of young adulthood: Eight in ten people between the ages of 11 and 30 get acne, according to the National Institutes of Health. But it only takes a quick survey of the average school gym class to note that not everyone is affected by the same type. When you imagine red, swollen, painful pimples, you’re thinking about cystic acne—the kind that also leaves scars. While the causes behind cystic acne are still not entirely understood, and researchers are always looking for new and improved ways to treat it, there is still a lot you can do to effectively tame it and keep it from leaving a lasting mark.
What is cystic acne?
Cystic acne is an inflammatory type of acne that causes bumps deep under the skin that are usually tender, red, and painful. “Often they come up in big crops and wax and wane over time,” says Laura Ferris, a dermatologist and an associate professor of dermatology at the University of Pittsburgh. Cystic acne most commonly appears on the face, Ferris says, but it’s also found on the back, chest, upper arms, and shoulders. It’s different from other, more superficial types of types of acne, like blackheads and whiteheads, because it’s deeper down in your skin.
“Because of the depth and the amount of inflammation, cystic acne is the one that causes scarring,” says Bruce Robinson, a New York City-based dermatologist and clinical instructor of dermatology at Lenox Hill Hospital.
What causes cystic acne?
Oil glands that keep your skin moist are attached to your pores, which is where hair grows and dead skin cells are eliminated. All types of acne pop up when your pores get plugged with oil and dead skin. With cystic acne, bacteria trapped deep in your pores cause inflammation—i.e., redness, swelling, and pain.
There are lots of different factors that increase the risk of cystic acne. “For some people it’s genetic, for others it’s hormonal, and some people are just acne-prone,” says Nada Elbuluk, an associate professor of dermatology at the University of Southern California Keck School of Medicine.
Because cystic acne is linked to testosterone, men tend to be slightly more susceptible. For women, acne can get worse around menstrual cycles.
Does diet trigger cystic acne?
A lot of studies have tried to look at diet and acne, Ferris says, but the jury is still out. One study linked acne to skim milk, while others have tied it to eating too many sugary foods. Robinson says some people do find they get more cystic acne when they eat gluten or dairy, although they’re not necessarily gluten- or dairy-intolerant. Ultimately, experts say diet has nothing to do with acne for the vast majority of people.
In the meantime, it’s always a safe bet to cut back on sugary foods and eat a well-rounded diet—without going overboard. “There’s no evidence that elimination diets work for acne,” Ferris says.
When do most people get cystic acne and how long does it last?
Cystic acne is strongly linked to hormones; an estimated 85 percent of the time it hits around hormone-heavy puberty and tends to stick around until your 20s. “But I certainly see women and men in their 40s who have cystic acne, even for the first time,” Ferris says. In fact, a growing number of women in their 30s, 40s and 50s are getting acne, according to the AAD.
In women, hormonal changes that happen during pregnancy can trigger cystic acne later in life. PCOS, a hormonal imbalance where the body makes more testosterone-like hormones behind cystic acne, is another common cause. Because fat cells can convert female hormones into weak male hormones, Robinson notes, obesity—which is also linked to PCOS—ups the odds of cystic acne. Even menopause rarely causes cystic acne due to hormonal fluctuations. “It’s a big trigger for some women. That’s usually when you’ll see another peak,” says Robinson. Hormonal-linked acne usually appears around the jawline and the mouth, he adds.
More from Tonic:
If you get cystic acne for the first time in your 30s or 40s, your doctor will usually work with a gynecologist or endocrinologist to test for hormonal imbalances and work together to treat it. “There are even more rare syndromes that can be associated with acne, so if someone suddenly got bad acne later in life we look for another underlying cause,” Ferris says.
How to treat cystic acne
Although it’s worth testing OTC treatments like benzoyl peroxide or salicylic acid at home, if you have severe acne you’re better off seeing a dermatologist to minimize breakouts and scarring, Robinson says. The treatment your doctor will pick depends on the cause behind your breakouts, the severity, whether there’s scarring and if you’ve been on other treatments that failed in past.
While creams and washes are sometimes enough for surface acne like whiteheads, blackheads, and pustules, you’ll usually need to pop a pill to treat cystic acne, Elbuluk says. Your doctor may start you off with oral antibiotics for three to six months, although if flare-ups happen around your menstrual cycle, Robinson says he sometimes prescribes it for regular brief periods around your period.
Antibiotics work by killing the bacteria and calming the inflammation that contribute to acne, Elbuluk says. Problem is, they also come with loads of not-so-nice side effects: Antibiotics can cause abdominal pain, diarrhea, and nausea, and some make your skin more prone to sunburn, Ferris says. Relying on them for long periods of time can affect the balance of good bacteria in your gut and skin. And they can contribute to antibiotic resistance, where they become less effective against more serious bacterial infections. That’s a problem, Ferris says, since some of the drugs doctors prescribe for acne are also used to treat Lyme disease and MRSA.
Here’s the other issue: As soon as you go off of antibiotics, acne tends to roar right back. “Acne isn’t a short-term problem,” Ferris says. That’s why doctors will usually try an antibiotic cream or other surface treatment like Retin A, a vitamin A cream that increases the rate your body sheds dead skin cells to prevent clogging, Elbuluk says. “I’ll often mix and match, depending on the patient’s sensitivity and the types of acne they have.”
If you’re a woman and your acne is likely hormone-related, your dermatologist may refer you to an OB/GYN for a birth control prescription to help regulate your hormones, a few of which are FDA-approved to treat acne. Your OB or dermatologist might also suggest spironolactone, another type of hormonal treatment for women only that reduces testosterone levels to reduce oil production and cut back on acne, Ferris says.
Doctors agree, however, that by far the best cystic acne treatment is isotretinoin (i.e. Accutane), an oral form of vitamin A that targets all the sources of cystic acne by killing acne-causing bacteria, unclogging pores and cutting back on excess oil and inflammation. It’s the only medicine that permanently stops cystic acne instead of just treating it while you’re using it, Robinson says. “It permanently shrinks oil glands so your skin will never be as oily as it used to be. It also changes the way your skin cells mature, so your pores don’t get blocked. It can even help improve scarring, he says. You’ll need to go on just one round that lasts four to six months, which clears up acne for 85 percent of people, Elbuluk says.
While isotretinoin is safe—the most common side effect is dryness of skin and peeling of lips—it can cause serious birth defects, so your doctor will only prescribe it if you’re on birth control and using a second form of protection to avoid getting pregnant. The good news is, if you are hoping for a mini-me any time in the future, it’s perfectly safe to get pregnant as soon as one month after coming off Accutane, Ferris says.
If all else fails—or if you’re just really against using antibiotics or Accutane—your dermatologist may try photodynamic therapy, the most effective laser treatment for severe acne, Elbuluk says. After applying a special prescription medication to your skin and letting it sit for up to three hours, he or she will shine a special light that activates and kills acne-causing bacteria.
While there is no way to prevent cystic acne, getting treated ASAP is important to prevent scarring. “That’s one of the reasons why if someone does have fairly severe acne, most of us will push to move on to Accutane or topical creams like Retin A,” Ferris says.
Caring for acne-prone skin
Day in and out, doctors recommend using a gentle cleanser (like Cetaphyl or Purpose) and lukewarm water morning and night. If you have oilier skin, your doc might suggest a more drying soap (like Ivory or Dial), Robinson says. Use a moisturizer with sunscreen every morning, and skip harsh scrubs, astringents and toners, which cause more dryness, redness, and inflammation.
The future of cystic acne treatments
You’ve probably heard a lot about your microbiome, the mix of bacteria in your body that impacts your metabolism, immune system, and gut health. Turns out, variations in your personal mix of bacteria may even impact the likelihood of getting cystic acne.
Research last year found that people who suffer from acne have more of one of two versions of a type of bacteria, propionibacterium acnes (P. acnes), on their skin that’s more likely to cause breakouts. Although the research is preliminary, it could eventually lead to treatments like bacteriophages and probiotics that only target that particular strain of bacteria that causes acne or boost good-for-your-skin strains.
“This study showed that the P acnes in patients with acne is different than the P acnes in patients without acne,” Ferris says. “Therapy that could target the pathogenic strain of P acnes could be a new approach to treating acne.”
Robinson adds, “As medicine advances, we seek to better target causative agents like P. acnes and not perturb the normal flora of the skin and gut.”
Getting rid of cystic acne scars
If you do end up with cystic acne scars, lots of treatments can help reduce or eliminate them, including chemical peels, laser resurfacing, and micro needling, Elbuluk says. Most people need around four laser treatments or four to six peels to clear up cystic acne scars, depending on how severe they are. Robinson says these treatments cause way less injury to the skin than older options like microdermabrasion and can work wonders to heal cystic acne scars within weeks of treatment up to decades later.
For more severe cystic acne scars that are deeply tethered down, another more invasive procedure known as subcision involves using a needle to physically loosen them and allow the skin to better pop out, Robinson says. A doctor may even surgically remove scar tissue and sew the skin back together, he adds. Just keep in mind all of these treatments can come with a pretty price tag, since they’re usually not covered by insurance, Ferris says.
Sign up for our newsletter to get the best of Tonic delivered to your inbox.
Everything you need to know about cystic acne
Benzoyl peroxide is available directly from pharmacies over the counter in a number of formulations that may be applied to the skin. It has been a mainstay in the treatment of acne for over 50 years, and works by killing bacteria, particularly Propionibacterium acnes (P. acnes). Some benzoyl peroxide treatments are also available to purchase online.
It also breaks up comedones. These include whiteheads and blackheads.
Water-based and alcohol-based formulations of benzoyl peroxide are available, and the most appropriate form depends on skin type. Alcohol-based preparations have a drying effect, making these more suitable for people with oily skin.
Benzoyl peroxide products, which include cleansing liquids and bars, lotions, creams, and gels, are used once or twice a day. The most common side-effect is skin irritation. Allergies do not commonly occur.
Drug treatment with isotretinoin
Isotretinoin is a prescription drug for the treatment of cystic acne, sold under a number of brand names in the United States, including Absorica, Amnesteem, Claravis, Myorisan, and Sotret.
Isotretinoin is a very effective treatment, but it has significant side effects and is dangerous to an unborn child. It is usually taken at a dosage of 1 milligram (mg) for every kilogram of body weight once daily for 16 to 20 weeks.
For cases of moderate acne, isotretinoin is not recommended until standard treatment with oral antibiotics has been tried and found to be ineffective. Isotretinoin is, however, recommended as a first-line treatment for severe acne.
Potential adverse effects associated with the use of isotretinoin include:
- eye and genital dryness
- chapped lips
- joint pains
- liver damage
- elevated lipid levels
Isotretinoin is a teratogenic drug. This means that taking it during pregnancy at any dose, even for a short time, can lead to congenital deformities.
Isotretinoin may also lead to the loss of the pregnancy or premature birth and can cause the death of the newborn infant.
Women who can become pregnant are, therefore, required to use two methods of contraception for 1 month before, during, and at least a month after treatment with isotretinoin.
Testing for pregnancy is also required before starting isotretinoin and then every month until 1 month after stopping the drug.
The conditions for being prescribed the drug include producing two negative pregnancy tests.
Injecting a corticosteroid medication called triamcinolone directly into a cyst can help reduce inflammation and prevent scarring. This treatment is carried out by a dermatologist.
There may be short-lived localized side effects after the injection.
Dermatologists may also offer incision and drainage of certain large cysts, but it is strongly recommended that people do not attempt this themselves as it will likely worsen the skin problem and could cause serious scarring and deeper infection.
Birth control pills
Long-term treatment of acne in women can involve the birth control pill, which suppresses sebum production. Where appropriate, an oral medication containing estrogen and progesterone may be used for 6 months or more.
A drug called spironolactone may also be prescribed with the pill. This is a synthetic steroid that inhibits androgens.
Why Your Hormones Might Be Taking Out Their Rage on Your Face
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 I mean you, I was able to speak with celebrity esthetician Renee Rouleau about why my skin has decided to go a lil’ crazy on me.
Firstly, I wanted to know what exactly was causing me to break out to such an extent on my chin. According to Rouleau, there are two possibilities: hormones and dairy. “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. 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.”
Good to know. You know what else was good to know? Finding out that consuming too much dairy foods can contribute to the experience of cystic acne— and these breakouts might indicate that you are getting more dairy than your body can tolerate.
So what are some small changes that we can make? This is what Renee Rouleau had to say.
Try eliminating dairy from your diet.
Rouleau explained to me why that might be necessary too, saying, “The hypothesis is that since the majority of milk in the U.S. comes from pregnant cows (and some cows are given growth hormones), the hormone levels in milk may play a role in excess sebum production, which promotes acne. Since sebum production is influenced by androgens and hormonal mediators, (such as insulin-like growth factors found in milk and other animal products), the consumption of milk, cheese, and yogurt may become factors that influence endogenous hormones and mimic the hormones that trigger oil production in the skin to ignite the acne process.” And that could mean more painful, stubborn pimples that won’t budge from your chin.
Keep your hands off your chin
This seemed easy enough, right? Rouleau explained to me that because all blemishes are related to bacteria getting trapped in a pore, we should prevent unnecessary bacteria from making its way onto our chin—AKA don’t rest your head on your hands or mindlessly pick at your skin while deep in thought. And of course, cleanse your skin at night to remove acne causing bacteria that may have manifested itself during the day.
Keep Your Cell Phone Clean
Another small simple change that can make a world of a difference. Like touching your face, cell phones are not the cause of acne, but they can potentially make acne worse due to the presence of bacteria on your mobile device. Be sure to wipe down your phone daily to avoid unnecessary bacteria from getting onto your skin.
And what if your acne isn’t on your chin? Well, rest assured I asked Rouleau about that, too!
Avoiding certain foods in your diet.
Sugary carbohydrates may have an effect in causing acne. 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!”
RELATED: How to Add Glow to Every Part of Your Face Without Looking Shiny
Exfoliate your skin.
It is important to remove the dead, dry skin cell buildup by focusing on exfoliation. 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.
Use a spot treatment formulated exclusively for stubborn cysts.
And if you’re gonna use one for your cysts, you might consider trying the much lauded Renée Rouleau Anti-Cyst Treatment because it works like a charm. Roulea explains that it contains, “a purified form of lactic acid helps dissolve cells blocking the pore, as well as purifying within the pore and will also help prevent future breakouts.” Bye-bye festering angry mountain on my face!
I didn’t leave it there, though, because I do suspect that my acne might the result of a hormonal imbalance. So what’s a girl to do if it seems that her hormones really are to blame?
Take Vitamin B6 daily one week prior to your cycle.
This supplement could help ease PMS symptoms by improving metabolic function and hormone metabolism. In addition, vitamin B6 can help the body manufacture neurotransmitters, such as serotonin, which aids in the body’s ability to cope with stress. Obviously, it’s important to talk to your doctor to find out if this is right for you. Rouleau explains, “I have some clients who feel this works well for preventing their monthly breakouts, but every person’s body chemistry is different so you’ll just have to experiment.”
She continued saying, “The best way to determine if your acne cysts are directly related to your intake of dairy is to completely cut cheese, yogurt, ice cream, and milk out of your diet for at least three weeks. If you don’t develop any new cysts and you normally would have by now, then this might solve your problem! It doesn’t mean that you cannot eat any dairy at all. Slowly introduce dairy back into your diet, and the point you start breaking out again is your body’s tolerance level.” Good to know.
Try taking oral probiotics.
Rouleau explained to me that our digestion can be affected by stress, which shifts our inner microbial systems leading to inflammation. This, in turn, changes the type and number of bacteria that live in the gut to unhealthy bacteria. “Eventually the gut lining becomes leaky and toxins are released into the bloodstream causing inflammation throughout the body,” Rouleau continued, “which can result in a flare up of breakouts due to the shift in gut bacteria, and subsequent inflammation. Oral probiotics may regulate the imbalance of bacteria and reduce oil levels to treat acne. You can find them in health food stores as well as get your daily serving of probiotics from eating yogurt with live active cultures (assuming dairy isn’t your cause of breakouts), miso soup, and sauerkraut.” Again, it’s important to chat with your doc to find out if this is right for you.
VIDEO: Dr. Pimple Popper Breaks Down Everything You Need to Know About Acne
Drink hot lemon water first thing in the morning before you eat or drink anything else.
This is Renee Rouleau’s personal secret! Squeeze fresh lemon into a mug full of hot water and drink it when you wake up. If you don’t have a fresh lemon handy, you can pour in lemon juice. Use enough so that the water tastes very lemon-y. Why do all of this? 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.
RELATED: Khloe K.’s Favorite Cheat Food Is Probably Your Favorite Cheat Food
A week prior to your cycle, tweak your skin-care routine
Add in a few products such as a cleanser and moisturizer that are focused on keeping acne-causing breakouts from appearing. Switch to products that use the ingredient salicylic acid that can penetrate into the pore lining to keep pores clear like BHA Clarifying Serum, AHA/BHA Cleansing Gel, and Skin Clarifying Gel. (Note: the Skin Clarifying Gel has a gel consistency so you can use a thin coat under your regular moisturizer to keep the skin free of bacteria.)
Consult with your doctor.
When in doubt, consult a doctor. Your lady doctor, is your medical BFF. “A gynecologist may be most beneficial since they work more closely with women and have a better understanding of hormonal fluctuations. They will most likely have your hormone levels checked via a blood test and prescribe oral medications such as birth control pills (or switching your current dosage) or spironolactone, a popular drug that can work well for balancing hormones. Some doctors take more of a natural approach and may suggest vitamin supplements or have other dietary recommendations.”
Now that we have all of those amazing tips, we can employ them and see what happens. And remember — it’s important to be realistic, these changes might take time to noticeably change or affect the condition of your skin, but the patience and diligence may very well be worth it!
Not everyone has experienced the pain of cystic acne, but if you do suffer from the skin condition, you know how rough a breakout can be. Cystic acne is a specific type of acne that consists of painful underground pimples that can leave severe facial scarring if not treated correctly.
It sounds scary, but don’t worry, we’ve got all the deets on cystic acne causes, treatment, and prevention so, you can tackle breakouts like a pro. Whether you just have the occasional underground pimple, or you get clusters of them on the regs, this is going to be your cystic acne bible.
Cystic acne occurs when clogged pores filled with oil and dead skin rupture underneath the skin (hence the name: underground pimple), causing the inflammation to spill out into the surrounding tissue.
Your body forms a cyst around it to stop the inflammation from spreading further. This causes painful nodules that feel almost like a pebble under your skin, says Beverly Hills Dermatologist and Owner of Ava MD and Skin Five, Ava Shamban.
Since these pimples live underneath the skin’s surface they don’t form whiteheads or blackheads, so they’re difficult to pop. The effect is a face covered with red bumps, almost like cobblestones.
“Teens, in general tend to get cystic acne on their cheeks and on their temple, like right at the edge of the eyebrow,” Dr. Shamban says.
Unlike normal acne, cystic acne can be super painful because it’s 100% inflammatory, meaning they’re going to be red and irritated. That also means that, if left untreated, the underground pimples can cause pretty bad scarring.
margaret flatley margaret flatley Margaret Flatley
“Cystic acne is multifactorial,” says Dr. Shamban, s0, many different things can cause an outbreak, but most likely when you get an underground pimple, it has to do with these five causes:
Genetics: That’s right, just like anything, cystic acne can run in the family. So, if your mom or dad suffered when they were a teen, you might have some painful acne in your future as well. Usually, genetic cystic acne will first appear during puberty and last “anywhere from six to eight years,” says Dr. Shamban.
Hormones: Androgen hormones overstimulate the sebaceous (oil) glands, which makes your body produce so much oil that it gets stuck in your pores and traps bacteria. The bacteria multiplies, causing the inflammation that starts a cystic pimple.
Basically, when your hormones are raging, your cystic acne will get worse. Because of this, you’re more likely to experience a bad breakout during puberty, as well as a few days before each period.
Stress: When you’re under pressure and your stress level rises, your body responds by producing cortisol, another hormone that over stimulates your oil glands.
Processed Food: Yup, all those Pop-Tarts may be causing those bad breakouts. “The processed food we eat isn’t good for our skin microbiome,” says Dr. Shamban. And while, eating processed foods may not cause you to get cystic acne if you’re used to normal breakouts, it will probably make whatever breakouts you do get, a lot worse.
Lack of Sleep: Again, this will just make any acne you have worse, but when you don’t get enough sleep, your body raises your cortisone levels to compensate and this could lead to a breakout.
As stated above, cystic acne is multifactorial, “so it’s not just enough to change your cleanser and put on some gels,” says Dr. Shamban. You do, however, have a lot of options when in treating underground pimples when it comes to behavioral, over-the-counter, and prescription options.
Behavioral: A lot of the causes of cystic acne are behavioral, meaning you’re going to have to change some of your daily actions in order to prevent breakouts. Try eating healthier, getting more sleep, and reducing stress in your life. While a healthy diet won’t necessarily make your acne go away, fueling up on key vitamins and nutrients can help, as can avoiding processed foods and artificial sugar. Eat one serving daily of foods with vitamin B6 (one banana or a bowl of whole-grain cereal) to help even out hormone levels; and beta-carotene (two medium carrots) to give skin a smoother texture. This can be easier said than done (especially when it comes to reducing stress), but the effects on your skin will be worth it.
Over-the-Counter Options: Want to take a crack at treating your cystic acne yourself? Start with a salicylic acid, says Dr. Shamban. This anti-inflammatory will reduce the redness in regular pimples and underground pimples.
Oil-Free Acne Fighting Face Wash, Daily Cleanser with Salicylic Acid Neutrogena amazon.com $24.02 $18.90 (21% off)
You can also try a cleanser with a low concentration of benzoyl peroxide and a light moisturizer and sunscreen.
Humane Benzoyl Peroxide 10% Acne Treatment humane amazon.com $29.95 $21.95 (27% off) Ultra-Light Face Lotion/Face Moisturizer with Sunscreen CeraVe amazon.com $14.96
It’s important to remember that people with cystic acne tend to have more sensitive skin. So, “you have to treat the skin gently,” says Dr. Shamban. “It’s not about scrubbing it with brillo pads.”
Before you go to sleep try applying an adapalene gel, which can work on your skin as you catch up on those all important Zzzzs.
Differin Adapalene Gel Differin amazon.com $26.98
Finally, products like tea tree oil and aloe gel are good OTC options for reducing redness, according to Dr. Shamban.
Organic Tea Tree Oil Eve Hansen amazon.com $29.99 Organic Aloe Vera Gel NaturSense amazon.com $13.89
Dr. Shamban suggests trying the over-the-counter options for about two months. If they aren’t working, head to the dermatologist.
“If you’re upset about it, then get it taken care of sooner rather than later,” she says. “That’s the thing about skin problems, there are treatments that work.”
Go to the Dermatologist: Your doctor is trained to take care of your acne, so he or she will know what to do to help about the pain and breakouts. They may suggest OTC options that best fit your problem or them could give you some long-term treatments like Epiduo, Aczone, Retin-A or Accutane, a strong oral medication that decreases the amount of oil that your sebaceous glands produce.
A dermatologist might have some short term solutions as well. Meaning, if you get a bad underground pimple right before a big event, like prom or homecoming, don’t panic. See your doctor to have him or her inject the pimple with cortisone, a steroid that reduces inflammation under the skin and shrinks swelling around the infection. Within six hours, the pimple should be gone.
Don’t pick. Picking at zits not only can make them worse, but it can also lead to permanent scarring. If you’re dead set on it, click here for the right way to pop a pimple.
Kristin Koch Executive Director Kristin Koch is the Executive Director of Seventeen, overseeing the content and editorial operations for all of Seventeen’s digital and print efforts. Carolyn Twersky Assistant Editor Carolyn Twersky is an assistant editor for Seventeen covering celebrities, entertainment, politics, fashion, beauty, and health.
You’ve probably experienced a few different types of acne since your teenage years, from annoying blackheads to juicy papules. But if you’ve ever developed one of those large, deep, painful red pimples that doesn’t go away, and sometimes never comes to a head, you know it’s a different beast altogether.
If you’ve been slathering your topical on an inflamed pimple for weeks to no avail, you might have what dermatologists call a cyst, nodule, or, more generally nodulo-cystic acne. These bumps run deeper under the skin than your classic cystic pimple, and thus come with a higher risk for scarring. (That’s why cystic acne treatment is a little more complicated than other acne treatments.) Here’s what you need to know to identify, treat, and ideally even prevent those big, annoying bumps.
So what is nodulocystic acne, anyway?
“Cysts and nodules are large, deep, and painful bumps, filled initially with blood, then with pus,” Dendy Engelman, M.D., a board-certified dermatologic surgeon at Medical Dermatology and Cosmetic Surgery in New York City, tells SELF. Delightful, right? You might not even be able to pop it should you want to. “These bumps can linger under the surface for weeks or even months and can eventually harden,” Dr. Engelman says.
To break it down further, this form of acne is composed of two parts. Technically, nodular refers to bumps over one centimeter in diameter, and cystic refers to a lesion that’s under the skin and lined by a hair follicle, Hooman Khorasani, M.D., chief of dermatologic and cosmetic surgery at Mount Sinai Health System, tells SELF.
“These are different than typical acne, which are white or black comedones,” Dr. Khorasani says. “They are larger, deeper bumps under the skin.”
Cysts and nodules can occur on their own or together, but they are caused by different circumstances. “A nodule is when a pore ruptures under the skin, resulting in a large, raised bump,” Dr. Engelman says. On the other hand, “a cyst happens when a pore is clogged with oil, dead skin cells, or bacteria. The pore ruptures under the skin, causing the inflammation to spill out into the surrounding tissue,” she explains. “The difference here is that the body forms a cyst around it to stop the inflammation from spreading.” Plus that makes them super painful.
And because cysts and nodules form so deep in the skin, they are more likely to result in a scar than other types of acne, Dr. Khorasani says.
Who is most likely to get cystic or nodular acne?
Some people are more prone to nodulocystic acne. “Acne-related cysts and nodules are usually due to chronic inflammation of the hair follicle and sweat gland,” Sruthi Renati, M.D., a dermatologist at Michigan Medicine, tells SELF. “Multiple factors can influence this form of acne, including increased oil production by the sweat glands, proliferation of acne-causing bacteria on the skin, or hormones.”
Unfortunately a lot of the predisposition for cysts and nodules is simply genetic, Dr. Engelman says. Your skin’s tendency toward oil production, for instance, is not something you can control. There’s also the influence of stress: “These bumps are often caused when there is a hormonal imbalance or during periods of stress, when your body responds by producing more cortisol,” Dr. Engelman says. “Both hormones overstimulate the sebaceous oil glands, making your body produce more oil that gets stuck in your pores, thus trapping bacteria.”
If you’ve had several large inflamed bumps recently, talk to your doctor about whether hormones might be playing a role in your acne. They might recommend trying a form of hormonal birth control to manage those fluctuations and prevent this type of acne. And although you can’t necessarily control every stressful situation in your life or your body’s reaction to them, you can develop some stress management and self-care strategies to make things a little less disruptive.
Here’s the deal with cystic and nodular acne treatment.
“If a drugstore treatment hasn’t cleared up acne after two weeks, then you need to see a dermatologist for a prescription treatment,” Dr. Engelman explains. And of course if you have any pimple that doesn’t heal after a few weeks or months, it’s important to get it checked out because that could be a sign of skin cancer, Dr. Renati says.
How Is It Treated?
Over-the-counter medicines that work on milder acne often have little effect on cystic acne. A dermatologist will likely recommend one or more of the following:
- Oral antibiotics help control bacteria and lower inflammation. Sometimes your acne may not respond to antibiotics, though. Or you may find they don’t work as well after a few years.
- Birth-control pills help some women by regulating their hormones.
- Prescription-strength creams, lotions, or gels with retinoid, a form of vitamin A, can help unplug your pores and help antibiotics do their job.
- Isotretinoin (formally known as Accutane but now available as the brands Claravis, Sotret, Myorisan, Amnesteem, and Absorica) attacks all causes of acne. The recommended dosage for most of these medications is to take a pill once or twice daily for about 5 months. For most people, this clears the skin completely and permanently. If it recurs, you can repeat the treatment. Women should avoid becoming pregnant while taking this drug.
- Spironolactone is a medication that helps you get rid of unneeded water, but also is effective for cystic acne in women.
Injections of steroids into individual cysts can be performed at your doctor’s office.
See More: Birth Control for Acne