Breakouts that form deep under the skin may be less visible compared to blackheads or your standard angry pimple, but they’re certainly not easier to deal with. Often, they're far more painful. These spots are known as cystic acne, or "blind pimples," and they can stay under the skin and be seriously tricky to get rid of.
Cystic acne is an inflamed, nodular type of acne that may leave scars. It's often shiny on the surface, tender to touch, and has a hot, throbbing sensation.
"The main difference between cystic acne and the common pimple is that cystic acne forms well below the surface of the skin and produces what is called a nodule, which is the bumpy, hard, tender cyst that is the hallmark of this type of acne,” says Kerry Benjamin, founder of LA-based brand StackedSkincare. "[It] is the most severe, painful form of inflammatory acne. It develops into large, firm, red blemishes that usually have no visible ‘head’ on the surface of the skin.”
Meet the Expert
So what makes cystic acne such a nightmare? It’s all to do with how deeply it forms below the skin's upper layer, says Benjamin. “Like milder forms of inflammatory acne, cystic acne consists of oils, fluids, and white blood cells. Because they form so deep below the surface of the skin, however, the likelihood of damage and scarring, even if left alone, is much higher. The reason for this is that the pressure from such deep inflammation causes the entire follicle to collapse, trapping the base of the hair follicle under the skin and causing infection.”
How do you deal with these breakouts? Keep scrolling to find out.
Consult an Expert
So onto the reason we’re all here: What’s the best way to deal with spots that refuse to rear their head? “If you’re suffering from cystic acne, you should see a skincare professional for treatments at least once a month, to deep-clean the pores and help alleviate some of the painful inflammation,” advises Benjamin.
Exfoliate Regularly – But Don't Scrub!
When it comes to at-home treatments, the key is all in gentle exfoliation—look to skin-refining acids rather than grainy scrubs, which can aggravate—and giving your skin the clean, healthy environment it needs to heal. According to dermatologist David Lortscer, "There are some good over-the-counter ingredients that help fight acne, including benzoyl peroxide, BHA (salicylic acid), and AHA (glycolic acid, lactic acid or similar)."
Look for products like the above solution by The Ordinary that contain these ingredients, but don't overdo it. Lortscher recommends you "start with one ingredient, and add another only after you know that your skin is tolerating the first without dryness or irritation." When it comes to skin-clearing exfoliation, few do it better than salicylic acid. Dab this on spots to give clogged pores a deep clean.
Invest in a Breakout-Fighting Tool
If topical skincare isn't enough and regular dermatology visits are out of the question, consider investing a bit more money in an at-home treatment. Benjamin recommends StackedSkincare's High Frequency Tool, "which uses a small electrical current to kill acne-causing bacteria and inflammation instantly."
Zap skin bacteria that can trigger breakouts with this handy tool. The small electrical current works to oxygenate skin and kill off harmful bacteria while reducing inflammation at the same time.
Try an Anti-Inflammatory Diet
Benjamin recommends adjusting your diet if you frequently experience cystic breakouts, specifically by trying an anti-inflammatory diet rich in healthy fats and greens. "Stay away from dairy and processed foods, too, as an anti-inflammatory diet can help ease some of the redness and pain associated with cystic blemishes."
Lortscher also suggests cutting back on sugars and simple carbohydrates, which can trigger acne flair-ups in some people. "Our guide to acne-causing foods talks about how making dietary adjustments may help you achieve clearer skin."
Leave It Alone
Also crucial, don’t squeeze or pick at your skin. “The contents of the cyst will most likely rupture under your skin, spreading the infection, and likely inflaming it even more,” warns Benjamin. Popping your pimples can also lead to scarring in the longer term, according to Lortscher.
Find a Your Ideal Spot Treatment
Antibacterial and exfoliating topical creams and gels could be just what your breakout needs to kill the underlying bacteria/sweep out pore-clogging debris. Not sure which ingredient to use? Let these OTC products for cystic acne be your guide (and, if you're able, speak with a dermatologist to identify your best treatment plan).
It's important to note that spot treatments might not always be the ticket to relief from cystic breakouts. According to Lortscher, "Once a cyst has developed, it's on 'autopilot,' so topical medications can’t magically eradicate the developed cyst—although, a spot treatment dabbed on with a Q-tip is fine to use if you’d like." He likes Mario Badescu Drying Lotion ($17)
Pop on an Acne Sticker
Acne stickers—also known as hydrocolloid bandages—are another option approved by Lortscher. "You can cover the lesions with a hydrocolloid dressing overnight (or for 24-48 hours!) to help draw out the contents and to speed healing. A hydrocolloid bandage worn for as long as possible will help to prevent you from touching as well!"
Go the Prescription Route
If OTC remedies like bandages and spot treatments aren't doing the trick or your acne is highly persistent, you may need to see a doctor for prescription skincare. Some options outlined by Lortscher include antibiotics for severe inflammation, Spironolactone, and Isotretinoin (aka, Accutane).
Lortscher's brand, Curology, is an easy way to access prescription skincare with the guidance of a dermatologist from the comfort of your own home. "Our formulas come packed with active ingredients like azelaic acid, clindamycin, niacinamide, tretinoin, and zinc pyrithione that target acne. After a quick skin quiz and a few selfies, your skin will be evaluated by a licensed medical provider. If medically indicated, you’ll get a prescription formula customized to your unique skin and delivered to your door starting at $19.95/month."
That being said, acneic skin can be super sensitive, which is why you should pay close attention to ingredients and make sure you're not overdoing it. Stripping the skin of oil can actually make matters worse, so you'll want to apply acne-fighting ingredients just a few days a week at first to ease into treatment.
Canadian Medical Association Journal. “Management of Acne.” April 19, 2011. E430-E435. Doi:10.1503/cmaj.090374