Your Complete, Dermatologist-Approved Guide to Treating Cystic Acne

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Cystic acne: Maybe you’ve heard of it—or, better (er, worse) yet, maybe you’ve come face to face with it yourself. The below-the-surface breakouts are renowned for being so deep that they’re virtually impossible to pop. Instead, these breakouts leave us with dull, pulsing sensations that are rather hard to ignore (despite being hard to reach)—especially when they’re paired with a bright red facade.  

Since ignoring cystic breakouts is too much of a task, we decided to chat with a couple of the industry’s leading dermatologists about how to approach these pesky pimples head-on. Below, they share what cystic acne is, what causes it, and—what we’ve all been waiting for—the best cystic acne treatments. In other words, get ready to kick your breakouts to the curb with this complexion-saving guide. Ahead, dermatologists share exactly how to spot, prevent, and treat cystic acne.

What Is Cystic Acne?

Cystic acne is considered the most severe form of acne, and is marked by painful, pulsing breakouts that occur deep beneath the skin.

If you’ve ever experienced deep, painful bumps that won’t pop as much as you may squeeze them (which, BTW, you should never do, but hey, we’ve all been there), then there’s a good chance that you’ve encountered cystic acne. According to NYC-based board-certified dermatologist Dr. Dendy Engelman, cystic bumps are first filled with blood, then with pus, which is why they often appear redder and don’t feature a noticeable white head. 

“It is the most severe type of acne—cystic breakouts often throb and are painful to the touch—and it occurs deep within the skin,” Dr. Engelman says. Only a dermatologist can accurately diagnose you with cystic acne, but the #cysticacne hashtag on Instagram has 50k+ posts to help you gauge whether or not your acne is cystic.

Causes and Prevention of Cystic Acne

  • Clogged pores: Since cystic acne occurs when pores get clogged with dead skin cells, excess sebum, and p. Acnes bacteria, it’s essential to wash and exfoliate your face regularly. While you can wash your face twice daily, it’s best to exfoliate just once, or even once every other day if you have a more reactive skin type.
  • Hormones: Have you ever noticed cystic bumps popping up around the time of your period? Ding, ding, ding —there’s a reason why. According to recent research, while many things can play into the formation of acne, all acne is hormonally mediated. Though, the authors of the article point out that it’s more accurate to call hormonal breakouts “cyclical” or “pre-menstrual” breakouts, as it’s the hormones during these time-frames that often lead to adult breakouts.
  • Lifestyle: Everything from smoking and drinking to stress and your work environment can meddle with your hormones and lead to deep cystic breakouts. Causes can be fairly subjective, though, so just because you and your BFF are stressed doesn’t necessarily mean that both of you will breakout. Regardless, a great way to ensure your lifestyle doesn’t negatively impact your complexion is to focus on stress-management, not smoking, drinking less, and ensure your diet is balanced. Speaking of…
salad with avocado and olive oil
Getty/Claudia Totir
  • Diet: According to Engelman, food contains nutrients that we need to fight and kill bad bacteria. “Without them, the skin feels threatened and becomes inflamed,” she explains, noting that opting for foods high in fat and unhealthy oils can trigger inflammation in your skin, which can lead to clogged pores. As such, it’s best to eat a clean diet with few processed fatty foods when attempting to stop cystic breakouts in their tracks.
  • Genetics: Recent studies have found that there’s a link between acne and genetics, though more studies need to be conducted to determine conclusively whether genetics guarantee cystic breakouts. Nevertheless, it is still a possibility that Engelman says to be aware of. After all, even if you’re aware of all the causes and ways to prevent breakouts, if it’s in your genetics, you may still experience the painful bumps.

Treatments For Cystic Acne

  • Gentle cleanser: Oftentimes people with acne think that they need a heavy-duty cleanser or scrub to cut through the gunk that’s clogging their pores. The reality is, however, that a gentle cleanser is the better bet. “We don’t need to be applying scrubs or tools on our face that will breakdown the skin barrier,” Engelman says. “Cystic acne is too deep within the skin to be buffed or scrubbed away. Instead, use a cleanser that contains salicylic acid or benzoyl peroxide.”
  • If you're unsure where to start, you can't go wrong with CeraVe's Acne-Foaming Cream Cleanser ($15), which is formulated with benzoyl peroxide and ceramides to hydrate and treat acne-prone skin from the outside in.
  • Spot treatments: These targeted treatments (like Proactiv’s Emergency Blemish Relief, $20) deliver a powerful punch of active ingredients (typically salicylic acid or benzoyl peroxide), which effectively begins to diminish the blemish on the spot. “One thing to emphasize about spot treatments is that you’re treating acne after it’s already reared its ugly head, not preventing pimples from forming: so in essence, you’re always playing catch up with your skin,” Engelman explains. “I recommend using a spot treatment as needed but always using an ongoing regimen.”
  • Prescriptions: According to Engelman, The typical rule of thumb according to dermatologists is that if a drugstore treatment hasn’t cleared up acne after two weeks, then you need to see the dermatologist for a prescription treatment. Cystic acne does involve dermatological intervention. If you are experiencing the symptoms described, then it is time to see your dermatologist.”
  • Retinoids: Retinoids are the umbrella under which retinol and Retin-A exist. While you can start your with an OTC retinol treatment and see how that affects your breakouts, Engelman says that you might be better off with a prescription-strength topical retinol treatment. “They work to control cell turnover, allowing older, clogged cells to shed and normalizing the turnover rate for new cells to prevent them from clogging, targeting acne before it begins,” she explains.
  • Oral antibiotics: “Oral antibiotics work to kill Propionibacterium acnes (the causative pathogen in acne),” Engleman explains, noting that some antibiotics (like those in the tetracycline family) are also anti-inflammatory, which helps improve acne. McLean, VA-based and board-certified dermatologist Dr. Lily Talakoub tacks onto this, noting that, “Cystic acne is very, very difficult to treat with over-the-counter medications. Because the acne starts from multiple layers beneath the surface of the skin, topical medications (even prescription ones) often cannot help it. Oral medications are often needed.”

The Takeaway

When on a quest to get rid of or prevent cystic acne from forming, there are a few ingredients and processes you should steer clear of. “Exfoliation is not always your friend,” Engelman emphasizes. “Since cystic acne happens underneath the skin’s surface, it is likely that you will be drying out the surrounding skin area before it gets to the cyst, thereby irritating the surrounding area and exacerbating the infection.” Instead, she recommends applying a fast-absorbing serum followed by an occlusive balm to help force the acne-fighting product into the pore. 

What’s more, don’t forget to moisturize! Many people believe the acne is the cause of overly-oily, hydrated skin, but oftentimes skin only looks oily because it has a compromised skin barrier and it’s over-producing oil in an attempt to actually stay hydrated. “We need to strengthen this barrier in order to keep bacteria out and prevent more breakouts,” Engelman says. “Hyaluronic acid does wonders for hydrating skin and improving texture. Even though it is an acid, it does not exfoliate but rather locks in water.”

Last but not least, whatever you do, no matter how tempted you may be, do not pick a cystic zit. While whiteheads and blackheads can often be extracted with the utmost care (though, it’s still best to leave it to a derm or esthetician to do so), squeezing a cystic zit can lead to more inflammation, bleeding, and even scarring.

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