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When it comes to fighting acne, waging a war against the cystic variety is one of the most difficult. The reason? Unlike breakouts that form on the surface which are easier to manage and treat, cystic acne is usually more painful, has a higher risk of scarring, and often requires prescription medication, which makes finding an effective OTC or topical solve difficult, if not altogether impossible. Don't worry, though—there are some products and antidotes that might help. To figure out which ones are the best of the best, we asked dermatologists to recommend the ones that really work.
Keep reading for our expert-approved rundown of the best treatments for cystic acne.
"I specifically like this cleanser from PCA Skin as an OTC option for treating cystic acne," says Omer Ibrahim, MD, of Chicago Cosmetic Surgery and Dermatology. "It is gentler than many benzoyl peroxide products and also contains gluconolactone, a polyhydroxy acid that has been shown to support the benefits of BPO as well as reduce inflammation."
Ibrahim also recommends this MVP acne gel from PCA that contains 2% salicylic acid.
"As they mostly occur in the chin and jaw areas, it is important to remember that cysts are like submarines; they are meant to stay under the skin," celebrity esthetician Renée Rouleau explains.
"No matter what method you employ, the infection from a cyst won't rise to the surface of the skin, even though you can feel a painful bump underneath. Your best bet is to treat the symptoms of the cyst with something like my Anti Bump Solution, which can help calm the infection from within while also preventing future ones."
Okay, okay. While Riverdale star Lili Reinhart isn't an esthetician or dermatologist, she has been very open about her ongoing struggle with cystic acne on social media. So when she took to Instagram a few months back to share this cult-favorite (and affordable!) mask as one of the best OTC treatment options for her cystic breakouts, we took note.
"Although research is still ongoing, probiotics might be an effective option for some as far as OTC cystic acne treatments," says Jennifer Herrmann, MD, FAAD, of Moy Fincher Chipps Facial Plastics and Dermatology. "The skin is populated with millions of symbiotic organisms, and we think that a disruption of this native microbiome might predispose or lead some to inflammatory skin conditions. Although we don’t know all the precise friendly players that make up healthy, acne-free skin, adding back in friendly bacteria might help reverse some of these conditions."
For the record, Team Byrdie is obsessed with the probiotic-infused skincare line Tula, and this threesome provides a few all-star product picks we've personally vetted as far as our breakout banishment goes.
With salicylic acid at the forefront (which helps remove excess oil and exfoliate dead cells from the surface of the skin to keep pores clear), Joshua Zeichner, MD, recommends this budget-friendly drugstore find which he says can help dry out an inflamed pimple.
Benzoyl peroxide is an organic acid in the peroxide family that has been used to treat acne because of its keratolytic, moderate comedolytic, and antibacterial properties, which include the reduction of P. acnes and Staph. aureus on the skin.
"Benzoyl peroxide is perhaps the most effective treatment we have to treat acne," Zeichner explains. "It lowers levels of acne-causing bacteria in the skin, reduces inflammation, and can even help re-open blocked pores." He likes this formula from Neutrogena, which contains maximum-strength levels of the ingredient. Just tread carefully, as he says too much will dry out the skin—not the goal here.
Hydrocortisone is a corticosteroid, a medicine that reduces inflammation. It's a common anti-inflammatory treatment for skin conditions such as eczema or psoriasis and is available both over-the-counter and as a prescription.
"If you develop an individual painful pimple or cyst, you can combine benzoyl peroxide along with salicylic acid and over-the-counter 1% hydrocortisone cream to directly treat the cyst," advises Zeichner.
He suggests mixing three ingredients together in your hand before applying (versus layering one on top of another) and says you can use the Clean & Clear and the Neutrogena products mentioned above in addition to this hydrocortisone cream from drugstore-favorite CeraVe.
As for long-term preventative measures, Zeichner suggests investing in a high-quality retinoid, which is favorable to spot-treat after you've already broken out. "Rather than just spot-treating, the goal is to prevent the development of cystic acne from the get-go," he shares. "Treating your entire face with a topical retinoid can help keep pores clear. I like Differin Gel, which, while available OTC, contains a prescription-strength retinoid."
If you have very oily skin and cleansing doesn't feel like it does enough to keep grease and debris at bay, that's when Zeichner recommends reaching for a toner—just make sure it's gentle, alcohol-free, and preferably spiked with witch hazel. "Witch hazel is a natural ingredient that helps remove excess oil from the skin while maintaining a healthy skin pH," he clarifies.
"Sulfur has long been used in medicine for its anti-inflammatory and antimicrobial properties," adds Zeichner. "This formula from Mario Badescu is a gentle option that can help calm inflamed pimples."
Expert Tips for Treating Cystic Acne
Once you've loaded your cystic acne product arsenal, consider these additional tips from our team of skin experts.
Start on the Inside
"Honestly, there aren't a lot of beneficial OTC cystic acne topical treatments," Breana Wheeler, MSN, NP, at Facile Dermatology + Boutique explains. "Cysts are deeper and [can] indicate a systemic issue. I think diet, sleep, and stress are the best places to start when addressing cystic acne."
Of course, it's imperative to visit a board-certified dermatologist to discuss the best treatment options for you and your skin, especially if you haven't found luck with topicals or after adjusting various lifestyle factors.
Seek a Dermatologist's Input
According to Mount Sinai Hospital Director of Cosmetic and Clinical Research Joshua Zeichner, MD, topical ingredients may not be able to penetrate as deep as they need to go in order to treat a cyst. As a result, your dermatologist may have to prescribe an oral medication to help treat cystic acne from the inside out. Or if it's a true cyst, Wheeler says your derm may suggest a cortisone injection, which will be the most effective way to reduce swelling, inflammation, and the likelihood of scarring later on.
What to Embrace
Ice: Although it can be tempting to pick or prod cysts, Jennifer Herrmann, MD, FAAD, of Moy Fincher Chipps Facial Plastics and Dermatology warns that manipulation of any kind may cause cysts to rupture underneath the skin, which will only provoke more inflammation and scarring. That said, if cystic acne is painful, she suggests reaching for an ice pack to engage your temperature nerves while directing signals away from the pain pathway.
A homemade aspirin mask: Herrmann suggests another soothing antidote if you're suffering from painful or inflamed cystic acne. Crushing up aspirin and mixing in some water until you form a paste can provide some relief. "Because aspirin has direct anti-inflammatory effects, this remedy can help decrease redness better than other drying agents," she tells us.
Strategic ingredients: According to Zeichner, witch hazel, sulfur, salicylic acid, benzoyl peroxide, retinol, and 1% hydrocortisone cream are good places to start when scanning potential skincare (many of which are featured in the product picks above).
A prescription option: Though not always the most popular (or first) option, a prescription might be necessary in order to treat cases of cystic acne. "Your dermatologist can talk to you about medications by mouth for a long-term solution if over-the-counter products are not helping," confirms Zeichner. "Oral antibiotics help reduce levels of acne-causing bacteria and can also calm skin inflammation. Additionally, hormonal therapy like birth control or Spironolactone can help regulate simulation of oil glands."
What to Avoid
Drying out your face: According to Wheeler, avoid any excessive use of drying OTC treatments (even some of the ones we listed above). Being overzealous with heavy hitters like benzoyl peroxide and sulfur will overly dry the surface of the cyst, which may potentially make it look worse or delay healing. "If you suffer from acne, especially cystic acne, my one recommendation to avoid is overly stripping your skin of oil," Zeichner adds. "We want to treat the acne, but we also want to protect the skin's barrier. Drying up the skin can lead to irritation and inflammation which can make the cystic acne worse."
Don't itch or pick: Not only will itching and picking make your cystic acne worse, but Wheeler also warns the habit will definitely lead to scarring.
Don't load up on inflammatory foods: "Minimizing dairy is one way to decrease the overall hormone load, which could help ease your cystic acne," explains Herrmann. "Dairy, even if it's organic, contains hormones, which may lead to oil overproduction. And sugar, or foods with a high glycemic index (sweets, white bread, white rice, sodas), stimulate insulin production, which can also stimulate oil production and increase skin cell proliferation that clogs pores."