If you've got acne under the skin, don't despair. Sure, these large, firm, red blemishes (also known as "blind pimples" or cystic acne) can stay under the skin and be tricky to get rid of, but that's where we come in. Unlike your common pimple which forms on the surface of the skin, cystic acne forms well below the surface of the skin and produces nodules. In order to effectively get rid of "blind pimples" you need to try treatments that specifically address this type of acne. We consulted dermatologists Dendy Engelman and David Lortscher to find out more.
Meet the Expert
- Dr. Dendy Engelman is a board-certified cosmetic dermatologist and Mohs surgeon based in New York City.
- Dr. David Lortscher is a board-certified dermatologist and the CEO of Curology.
Reduce Inflammation With a Cold Compress
Since cystic breakouts are extremely uncomfortable, Engelman suggests applying ice compresses to help reduce inflammation and discomfort. "If you already have a cystic pimple, you can try to minimize its swelling and discomfort by applying benzoyl peroxide and hydrocortisone cream. Cleanse the area with Humphrey's Clarifying Cleansing Pads and apply benzoyl peroxide, followed by the cream once everything has dried," she instructs.
Try an Anti-Inflammatory Diet
Engelman recommends adjusting your diet if you frequently experience cystic breakouts. "Your diet can definitely exacerbate cystic acne. Cystic acne is a severe form of acne, and your diet coincides directly with the health of your skin, hair, and body in general," she tells us. "A diet consisting of processed foods, dairy, and saturated fats is more likely to exacerbate cystic breakouts as opposed to foods that are rich in omega-3 fatty acids, and low-glycemic foods to reduce inflammation and balance hormones."
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."
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, aggravating scrubs—and giving your skin the clean, healthy environment it needs to heal. According to 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 those 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. We recommend StackedSkincare's High Frequency Tool, which uses a small electrical current to zap acne-causing bacteria while also reducing inflammation.
Don't Squeeze or Pick Your Breakouts
Also crucial is don’t squeeze or pick at your skin. "Picking a cystic pimple is actually almost impossible to do, as it is so deep-rooted in the tissue of the skin that it does not attach to the skin’s surface," says Engelman. "By trying to pop the cyst, you will only be increasing discomfort and inflammation."
Popping your pimples can also lead to scarring in the longer term, adds Lortscher. Engelman agrees: "Touching or manipulating your cystic pimple can lead to infection and severe scarring, as you are literally pushing the inflammation out towards the surface of your skin."
Don't Waste Your Money on Spot Treatments
Because spot treatments target surface-level breakouts, 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."
Use Acne Patches to Avoid Contamination
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!"
Use Retinoid Products
Retinoids like tretinoin might be principally known for reducing the appearance of fine lines and wrinkles, but they can also be used on those with acne-prone skin. "Retinoid products are a great option for increasing and regulating skin cell production to help shed older, dead skin cells and reduce the build-up of oils and bacteria," says Engelman.
When it comes to at-home treatments, Engelman tells us her recommendations are meant to prevent future cystic acne breakouts and/ or to alleviate symptoms from current ones. "No home remedies will make a cystic pimple go away, as they are extremely deep in the tissue of the skin," she confirms.
"If you choose to use a Retinoid, ensure you start with a low concentration and use it sparsely, as these products can dry out the skin if used too frequently," instructs Engelman. If improvements from Retinoid products are not seen within four to six weeks of application, seek treatment from a dermatologist."
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.
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. "In-office treatments for cystic acne are usually much quicker to deliver results through penetrating deep into the tissue," says Engelman.
Some options outlined by Lortscher include antibiotics for severe inflammation. "Antibiotics help to prevent the bacteria that exacerbate inflammation of the cystic breakout," notes Engelman. Lortscher also recommends Spironolactone and Isotretinoin (aka, Accutane). "Accutane is a great option for general acne, but can help with cystic acne too," adds Engelman.
Try Blue LED Masks
Light-emitting diode (LED) therapy, especially blue light, may help to combat acne under the skin by eliminating P. acnes (a.k.a. acne-causing bacteria), reducing inflammation, and regulating sebum production. Consider combining this treatment with a topical cream which will be able to penetrate deeper into the skin post-treatment. And while there are LED systems you can try out at home, you might find an in-office treatment by a professional more effective.
Consider a Cortisone Shot
While it shouldn't be the first treatment you try, you might want to talk with your derm about getting a cortisone shot if you need a quick blind pimple fix. "Cortisone injections, which contain small amounts of steroids, deliver great results and help to reduce the pimples’ size and appearance in just a few days," says Engelman. "You should be aware, though, that cortisone shots can thin the skin in the affected area after multiple injections, so this is usually a last-resort option," she adds.
"As cystic acne is rooted deep in the tissue of the skin, it has no connection to the surface of the skin, making it basically impossible to remove cystic acne with topical treatments alone," explains Engelman. "Seeing a dermatologist to come up with a treatment plan is extremely beneficial, as they can help to monitor your treatments, and provide you with medications that cannot be obtained at your local drugstore. Dermatologists can also come up with personalized treatment plans dedicated to your exact skin type to ensure you reap the most benefits."