To get rid of cystic acne (for example cystic acne on forehead) is probably the most physically and emotionally draining endeavor. Aside from how much area they tend to cover, these suckers are hard to ignore because they hurt. When you press on one, it makes your whole face shake.
What is cystic acne?
Dermatologist Joshua Zeichner, M.D., the director of cosmetic and clinical research at Mount Sinai Medical Center in New York City and a board-certified dermatologist, says that cystic acne is the most severe type of acne. It is marked by the formation of “tender, inflamed nodules” under the skin.
Cystic acne usually appears on the chin, but it can also show up in other places on the face or even on the arms or back. It usually comes back in the same place, so if you don’t get it treated, your first chin cyst probably won’t be the last.
What causes cystic acne?
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Sheila Farhang, M.D., is a board-certified dermatologist in Tucson. She says that food triggers, stress, and hormones are often to blame for cystic acne. It’s unlikely that diet is the only reason for acne as bad as cystic acne, but Dr. Zeichner says that some foods “have been linked to making acne worse.” Some of these foods are skim milk, whey protein, vitamin B12 supplements, and sugary foods.
Changing things about your life, like what you eat and how much stress you have, can help clear up your skin. “The same hormones that help our bodies deal with stress also make our oil glands work too hard,” says Dr. Zeichner, which can lead to breakouts.
Androgen hormones like testosterone also make the oil glands work harder. “Because hormone levels rise and fall during a woman’s period, acne may get worse around that time,” he says.
How To Get Rid Of cystic acne?
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It is difficult to get rid of cystic acne, and dermatologists typically recommend a combination of oral and topical prescriptions, as well as lifestyle changes such as stress reduction, which we wish came in pill form. See a dermatologist right away because your usual acne skin care routine might not work for cystic acne if you try to treat it at home.
Rachel Nazarian, M.D., a board-certified dermatologist in New York City, says, “Usually, people run to their dermatologist’s office for a quick cortisone injection to dry up those monsters within hours.” But not everyone has the time or money to go to a dermatologist as soon as they feel a pimple coming on. Also, getting injections whenever you feel like it won’t help treat or get rid of cystic acne in the long run.
In her practice, Dr. Farhang starts treatment with topical prescriptions and talks with patients about making changes to their lifestyles. If needed, she then moves on to oral medications. “Topical treatments could include a combination of benzoyl peroxide and/or prescription antibiotic cream if there are multiple whiteheads in the morning, along with prescription dapsone (Aczone) cream if the target area is less oily and has more adult inflammatory lesions, like hormonal cysts along the jawline,” she says. In the evening, she often gives a retinoid to help increase cell turnover, which helps reduce acne and get rid of any hyperpigmentation from previous breakouts.
Dr. Zeichner says that the best way to get rid of cystic acne with over-the-counter medicines is to use “different ingredients that work in different ways and help each other.” He suggests using salicylic acid and benzoyl peroxide, which he says are the two most important ingredients. If you use the second one, he says, make sure to use a light moisturizer on your skin first, and then put a very thin layer of the lowest percentage of benzoyl peroxide on the cyst to treat it.
If your acne doesn’t get better after three months or if it leaves permanent scars, your dermatologist may prescribe spironolactone, an oral medication for adults with acne that helps “block the excess hormones that [increase oiliness] and cause cystic acne,” according to Dr. Farhang.
Which products help treat cystic acne?
1. Start with a oil-free cleanser
Dr. Zeichner says, “Don’t think of your cleanser as a real wash, but rather as a short-contact therapy.” Because of this, he usually tells people with cystic acne to use cleansers with a lot of salicylic acid. Salicylic acid is a beta-hydroxy acid (BHA) that helps cystic pimples shrink by getting rid of excess oil, sloughing off dead skin cells, and drying them out.
The amount of salicylic acid in a cleanser is usually between 0.5 and 2%. If you tend to get cystic acne, Dr. Zeichner suggests looking for a cleanser with a higher concentration. La Roche-Posay Effaclar Medicated Acne Face Wash and Murad Clarifying Cleanser are two great cleansers that have between 1.5 and 2% salicylic acid.
If you get acne and have sensitive skin, salicylic acid in higher concentrations could make your skin too dry. In that case, the Aveeno Clear Complexion Foaming Cleanser and the Burt’s Bees Natural Acne Solutions Purifying Gel Cleanser are two cleansers with lower concentrations (0.5 to 1 percent) of the ingredient.
Dr. Zeichner says to put on the cleanser and let it sit while you sing the alphabet before rinsing it off. “The cleanser has to stay on the skin long enough for the active ingredients to do their jobs.”
2. Follow up with an oil-free moisturizer
Even if you have cystic acne, you should still use a moisturizer on your face every day to keep your skin barrier healthy. Ife Rodney, M.D., a board-certified dermatologist in Maryland, says, “Patients who are prone to cystic breakouts should use oil-free, noncomedogenic moisturizers to keep their skin hydrated.”
She does say, though, that noncomedogenic products won’t necessarily get rid of cystic acne; they just won’t make it worse. So, it can be especially helpful to choose a moisturizer with ceramides, niacinamide, or hyaluronic acid.
“These ingredients help to reduce redness and swelling and repair the protective barrier of the skin.” This is important because many ingredients that help get rid of cystic acne tend to dry out and irritate the skin.” All three are in the Dr. Dennis Gross Stress Repair Face Cream, which is a moisturizer that doesn’t cause acne and doesn’t clog pores. Use it after washing with a cleanser that has salicylic acid in it.
3. Finish with a medicated spot treatment
Dr. Zeichner recommends using benzoyl peroxide as a spot treatment because it reduces the amount of acne-causing bacteria on the skin. There are skin care products with 2.5, 5, and even 10 percent benzoyl peroxide, but you don’t have to use the most. “Studies have shown that even low concentrations of benzoyl peroxide are just as effective as higher concentrations, but they cause the skin to dry out less,” he says.
Dr. Zeichner says to look for leave-on acne spot treatments with 2.5 percent benzoyl peroxide, like Neutrogena Rapid Clear Stubborn Acne Daily Leave-On Mask or Paula’s Choice Clear Daily Skin Clearing Treatment.
4. Use mixture of hydrocortisone cream
Applying 1% hydrocortisone cream, which is available over-the-counter and has a small amount of topical steroids, can help reduce redness and calm inflammation. Try Cortizone 10 Maximum Strength Cream or Aveeno’s 1% Hydrocortisone Anti-Itch Cream.
As a leave-on spot treatment for the most stubborn big pimples, like cystic acne on the chin, you can mix a hydrocortisone cocktail. Dr. Zeichner suggests using 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% Masque), and then benzoyl peroxide to kill acne-causing bacteria. Put a drop of all three in the palm of your hand, mix them together, and then use them, “he says.”
If your skin isn’t sensitive or doesn’t dry out easily, you could swap out the salicylic acid for a treatment with sulfur. The combination of these three over-the-counter products—a sulfur-containing mask (try Sunday Riley’s Saturn Sulfur Acne Treatment Mask), a benzoyl-peroxide cream (we love Clearasil’s Daily Clear Acne Treatment Cream), and a mild cortisone salve—usually works well when applied to the cyst two to three times a day for seven to 10 days,” says board-certified dermatologist Leyda Bowes, M.D.,
5. When all else fails, color-correct the cyst
Dr. Nazarian recommends using makeup with a slight green tint to hide redness and help your pimple blend in with your natural skin tone if your cystic acne persists despite your best efforts.Try Cover FX Correct Click Color Corrector and put a thin layer over the cyst before you use concealer and foundation.
Does cystic acne go away on its own?
Cystic acne may go away on its own, but dermatologists don’t want their patients to wait until their skin clears up on its own. “I don’t think you should wait until it goes away on its own, especially since cystic acne can leave severe and permanent scars,” says Dr. Farhang.
Scarring from acne can be harder and costlier to try to get rid of cystic acne itself. It’s better not to scar in the first place than to have to treat a scar later. So, if you feel bumps under your skin, try to get to your doctor right away.