Cystic Acne | Dermatologist-Approved Guide to Treating

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.

1. Cystic Acne

2. Cystic Acne Dermatologist-
Approved Guide to Treating
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

3. 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,

4. 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.

5. What Is Cystic Acne?
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

6. 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,”
Engelman says. Only a dermatologist can
accurately diagnose you with cystic acne, but
the #cysticacne hashtag on Instagram has 96k+

7. posts to help you gauge whether or not your
acne is cystic.

8. Causes and Prevention of Cystic Acne

9.  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 your face regularly.
 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 research, while many
things can play into the formation of acne,

10. 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

11. 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.

12.  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

13. when attempting to stop cystic breakouts in
their tracks.
 Genetics: Some studies have found that
there’s a link between acne and genetics,
though more research need to be conducted
to determine conclusively whether genetics
guarantee cystic breakouts.4 Nevertheless, it
is still a possibility that Engelman says to be
aware of. After all, even if you’re aware of all

14. the causes and ways to prevent breakouts, if
it’s in your genetics, you may still experience
the painful bumps.

15. What are the signs and symptoms of
cystic acne?
Cystic acne feels like a lump deep within your
skin, unlike other forms of acne, which tend to
feel like they’re only on the skin surface. It
appears on the face and neck, as well as the
back, chest, and arms.

Symptoms of cystic acne include:

16.  Large red cysts filled with pus
 Pain around the cysts
 Dark scars or “pits” in the skin
 Large oozing abscesses
The large abscesses are formed when
individual cysts merge. These generally don’t
look good, resulting in self-esteem issues.

17. Treatments For Cystic Acne

18. Gentle cleanser: Often people with acne think
they need a strong cleanser or exfoliant to cut
through the gunk that clogs their pores. But
the truth is, a gentle cleanser is your best bet.
“We don't need to put scrubs or tools on our
faces that will break down the skin barrier,”
says Engelman. “Cystic acne is too deep within
the skin to be buffed out or scrubbed. Instead,
use a cleanser containing salicylic acid or
benzoyl peroxide.

19. If you're not sure where to start, you can't go
wrong with Revamin Acne Cream, which aims
to hydrate and treat acne-prone skin from the
outside in.
Topical treatments: These targeted treatments
such as: Nonacne provide a powerful
combination of active ingredients, which
promise to start reducing the blemish
immediately. "The one thing to stress about

20. spot treatments is that you're treating acne
after it's already reared its ugly head, and
you're not preventing pimples from forming:
So in essence, you're always playing catch-up
with your skin," Engelman explains. “I
recommend using topical treatment as needed
but always with a continuous regimen”.
Prescriptions: According to Engelman, “The
rule of thumb according to dermatologists is

21. that if a drugstore treatment doesn't clear up
your acne after two weeks, you need to see a
dermatologist for a prescription treatment.
Cystic acne does not involve skin involvement.
If you are experiencing the symptoms
described, it is time to see your dermatologist.
Retinoids: Retinoids are the umbrella under
which retinol and Retin-A exist. Although you
can start with an over-the-counter retinol

22. treatment and see how it affects your
breakouts, Engelman says you may be better
off using a prescription-strength topical retinol
treatment. “They work to control cell turnover,
allowing old, clogged cells to get rid of and
normalizing the turnover of new cells to
prevent them from getting clogged, targeting
acne before it starts,” she explains.

23. Oral supplements: “Oral supplements work to
kill Propionibacterium acnes (the pathogen
that causes acne),” Engelman explains, noting
that some supplements like Zinamax
It is also anti-inflammatory, which helps
improve acne. McLean, Virginia-certified
dermatologist Dr. Lily Talakoub weighs in on
this, noting, “Cystic acne is difficult to treat
with over-the-counter medications. Because

24. acne starts in multiple layers beneath the
skin's surface, topical medications often don't
help. Oral medications are often needed.

25. What are the signs and symptoms of
cystic acne?

Cystic acne feels like a lump deep within your
skin, unlike other forms of acne, which tend to
feel like they’re only on the skin surface. It
appears on the face and neck, as well as the
back, chest, and arms.

26. Symptoms of cystic acne include:
 Large red cysts filled with pus
 Pain around the cysts
 Dark scars or “pits” in the skin
 Large oozing abscesses

The large abscesses are formed when
individual cysts merge. These generally don’t
look good, resulting in self-esteem issues.

27. How is cystic acne diagnosed?

A dermatologist will examine your skin to see if
your symptoms match those of cystic acne.
They will rule out any other skin conditions,
such as rosacea, which, unlike cystic acne,
cannot be cured.

28. How to treat cystic acne
Often the first treatment a doctor will
prescribe for cystic acne is a combination of an
oral antibiotic and a cream to apply to the
acne.

The antibiotic helps reduce the inflammation—
redness and swelling—while the medicine
unblocks pores and kills the bacteria in the

29. cysts. If this doesn’t work, other methods can
be tried.

Here are some medications your doctor may
use to treat cystic acne.

Topical retinoids

30. Topical retinoids are helpful acne treatments
as they can reduce inflammation and prevent
new cysts from forming.⁴ Topical treatment
alone is usually not enough to resolve the
cysts. However, topical retinoids can be used in
combination with other medications when
recommended by your doctor.

31. Here are the secrets to getting rid of
acne:

1. For the first secret method, click here
2. For the second secret method, click here
3. For the third secret method, click here

32. Isotretinoin
Oral isotretinoin, known as Accutane, can be
prescribed for cystic acne, usually for periods
of about 16 to 20 weeks. However, it can be
used for longer if recommended by a doctor or
dermatologist. This medication is effective in
reducing inflammation, killing bacteria,
unclogging pores, and removing excess oil to
clear acne.

33. Isotretinoin does have some negative side
effects, such as dry skin, nose bleeds, dry
mouth, and more sun-sensitive skin.
Isotretinoin cannot be taken when pregnant as
it is highly teratogenic, which means it can
cause severe birth defects and miscarriages.

34. If you can become pregnant, using two forms
of contraceptives to ensure you do not
conceive when on isotretinoin is
recommended. It is vital to discuss taking
isotretinoin with your doctor before deciding if
it is right for you.

35. Remember, you should only obtain isotretinoin
from your drugstore with a prescription from
your doctor. Never buy isotretinoin online. If
you do take isotretinoin, apply sunblock and
moisturizer daily to take care of your skin.

36. Spironolactone

Spironolactone is an oral medication, either in
tablet or liquid form, that is approved by the
U.S. Food and Drug Administration (FDA) for
treating many conditions, including heart
failure.

37. Although spironolactone is not approved for
acne treatment,⁷ it has been shown to reduce
androgen, lessening the production of oil in
the skin, helping to reduce cystic acne.
However, this medication can only be taken by
women, and not when pregnant.

38. Side effects of this medication include
headaches, irregular periods, breast
tenderness, and fatigue.

Birth control

Oral birth control can be an effective form of
acne treatment for those who have worsening
acne around menstruation. It reduces sebum

39. production by reducing the amount of
androgen circulating in the body.

Four birth control pills have been approved by
the FDA for the treatment of moderate acne
only, so they should be taken in combination
with antibiotics or spironolactone. Birth
control pills should only be used if the

40. contraceptive effects of the medication are
also wanted.

The approved birth control pills are:

 Yaz
 Ortho tri-cyclen
 Beyaz
 Estrostep FE

41. Corticosteroid injection

Injecting a corticosteroid into a cyst can help
reduce the cyst’s size and scarring, as well as
the associated pain. Triamcinolone acetonide
is the most common corticosteroid used for
cystic acne treatment.

42. Unfortunately, the treatment itself can be
quite painful and result in some redness. These
effects, as well as the cyst, should go away in
about 24 to 48 hours.

Incision and drainage

Large, painful cysts can be removed by making
an incision in the cyst and draining the pus

43. from it. This should only be done by a doctor
as there is a high risk of infection when done
incorrectly.

Natural treatments

Natural treatment options can help reduce
acne; however, they are unlikely to be
sufficient for clearing severe cystic acne.

44. Some natural options include:
 Zinc (oral) to reduce inflammation and
promotes wound healing
 Brewer’s yeast, specifically Hansen CBS
(oral)⁹
 Tea tree oil (topical) for its antiseptic
properties

45.  Bovine cartilage (topical) for promotion of
wound healing
 Lavender oil (topical) to kill bacteria and
reduce inflammation
 Peppermint oil (topical) for suppressing
the growth of P. acnes
 Chamomile oil (topical) to aid wound
healing and reduce skin redness

46. For treating cystic acne, these should be used
in addition to, not instead of, any other
treatment prescribed by a doctor. It is
important to tell your doctor if you intend to
try these options as sometimes interactions
can occur between medications, particularly
with zinc.

47. Procedural acne treatments

These treatments are performed in your
doctor’s office to help diminish and prevent
acne cysts and nodules. It’s best to avoid these
treatments in the summer months and to use a
strong SPF sunscreen afterward to prevent
damage to the newly exposed and very tender
skin layers.

48.  Salicylic acid peel: This liquid treatment is
applied to the skin to remove or exfoliate
the surface layers of the skin. Salicylic acid
breaks the bonds that hold the skin's cells
together, causing them to shed away or
peel. It also helps unclog pores and reduce
the amount of oil on the skin.

49.  Pyruvic acid peel: This liquid treatment is
applied to the skin to remove dead and
damaged skin cells. It also improves skin
brightness, fades discolored areas and
reduces excess oil in the skin.
 Photodynamic therapy: After applying a
topical photosensitizer, a medical light
source is focused on the skin to activate it.
Combined with the photosensitizer and the

50. presence of oxygen, the light helps destroy
acne cysts, nodules and bacteria. This
treatment also reduces the size and activity
of oil-producing glands on the skin.

51. Cosmetic acne treatments

These treatments help minimize scars left
behind by severe cystic acne breakouts.
 Dermabrasion: This procedure removes
acne scars and gives skin a smoother look.
During the process, your provider uses a
special surgical scraping tool to remove the
layers of skin that cover the collagen layer.

52.  Laser resurfacing: This procedure uses a
wand-like laser instrument to remove the
upper layers of skin from acne scarring. It is
sometimes referred to as laser peeling
because it removes old skin cells in order to
reveal new, more youthful-looking cells.
 Radiofrequency resurfacing: The
treatment uses tiny pins that safely deliver
energy through the skin's surface. This

53. creates tiny wounds that initiate a natural
healing process and accelerate the
formation of new, healthy tissue. The result
is an improved skin tone and texture and
smoothing of acne scars.

Here you will find the product you
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54. Summary
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,

55. 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 result of overly-
oily, hydrated skin, but oftentimes skin only

56. looks oily because it has a compromised skin
barrier and is over-producing oil in an attempt
to actually stay hydrated.5 “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”.

57. Cystic acne is a severe form of acne,
characterized by the presence of large pus-
filled cysts that feel painful and deep within
the skin. It is caused by the clogging of hair
follicles by dead skin cells and dried sebum,
which become infected by P. acnes.

Although there are many triggers for cystic
acne, the most common are hormonal

58. changes, such as those at puberty and
menstruation.

The best way to deal with cystic acne is to see
your doctor to discuss treatment, keep your
skin clean, and avoid picking at your pimples,
even though that can be difficult.

59. Remember that acne of any kind is not
uncommon. When it comes to cystic acne, you
don’t have to just live with it. There are many
treatments available for it, as well as for acne
scarring.

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

60. 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.

61. Sources:
 Acne | American Academy of Family Physicians
 Acne | MSD Manual Consumer Version
 Adult acne versus adolescent acne (2018
 Why topical retinoids are mainstay of therapy for acne (2017
 Isotretinoin: The Truth About Side Effects | American Academy of Dermatology
Association
 Is Any Acne Treatment Safe to Use During Pregnancy? | American Academy of
Dermatology Association
 Highlights of Prescribing Information | U.S. Food & Drug Administration
 Oral spironolactone in post-teenage female patients with Acne vulgaris (2012)
 Natural Acne Treatment: What’s Most Effective? | Mayo Clinic
 Lasers and Lights: How Well Do They Treat Acne? | American Academy of Dermatology
Association
 Microneedling for the treatment of scars: An update for clinicians (2020)
 Impact of sugar on the body, brain, and behavior (2018)