There are regular old breakouts, and then there is cystic acne. As anyone who has been on the receiving end of cystic acne knows, it can be a lot harder to deal with than your average pimple, and a whole lot more frustrating. While a pimple is caused by clogged pores, a cyst is an infection happening deep within your skin that causes a red, tender bump. It is more painful, it can’t be popped like a pimple, and it usually lasts a lot longer. Figuring out how to deal with cystic acne can be really tough, which is why I enlisted the help of Dr. Sonia Batra, a Los Angeles dermatologist who works closely with Proactiv, for some tips on how to get rid of it, how to prevent it, and how to deal when you’re struggling through it.
Because, believe me, I know the struggle all too well. I still experience small breakouts regularly, especially when I get my period, so when I noticed a large zit on my chin a few weeks ago, I wasn’t surprised. I was surprised, though, when I realized it wasn’t going away or getting better… in fact, it might have been getting worse? I blew it off when it went away, but the next month, it happened again – and the next month, I got two. Feeling totally lost, I booked an appointment with my own dermatologist, who happens to have quite a long wait list and gave me some time – two months from that day. In the meantime, I’ve been focusing on the advice from Dr. Batra, so I wanted to share it with you guys. Here are some tips on how to deal with cystic acne:
1. Know the causes.
Cystic acne isn’t the exact same thing as a pimple, so it’s important to know where it’s coming from before you can try to treat it. Dr. Batra says, “Cystic acne is the deeper, painful acne that is more inflammatory and can cause more destruction of collagen and scarring. It can be due to genetic predisposition, hormonal fluctuation, and perhaps more aggressive bacteria living in the pores.”
2. Work on reducing inflammation rather than trying to pop it.
When you first see a cyst pop up, you might feel the need to pop it, but this isn’t a great idea. Dr. Batra says, “Resist the urge to squeeze it! Squeezing a cyst can cause more inflammation and longer-term scarring, not to mention it is a good way to introduce more bacteria to the area. I usually tell my patients to apply a cold pack to reduce inflammation, a spot treatment such as salicylic acid 1 percent or 2 percent, and to reduce redness, Visine or over-the-counter hydrocortisone. I always recommend using a noncomedogenic sunscreen to prevent discoloration from cystic or inflammatory acne, especially in olive-toned or pigmented skin. Proactiv makes over the counter Mark Correcting Pads that can fade discoloration that results from cystic acne that has been picked.”
3. Consider seeing a dermatologist for a faster solution.
It’s common for anyone with cystic acne to head to their derm if they have a breakout. Dr. Batra explains what happens when you do that: “A cortisone shot at a dermatologist’s office can settle individual inflamed cysts. In terms of a preventive regimen, for cystic acne, a dermatologist might prescribe an oral contraceptive pill, hormone blocking pill (spironolactone), or antibiotic. In severe cases, isotretinoin (best known as Accutane) might be prescribed. Isotretinoin is a pill that shrinks the oil glands and often used to interrupt the inflammation and scarring. Though use of isotretinoin requires careful monitoring and can have side effects, it is still the most effective medication for severe cystic or scarring acne.”
4. Figure out if there is a pattern.
Figuring out when and why you’re getting cystic acne could be helpful in trying to treat and prevent it. I wondered if my cysts were from my period, so I asked Dr. Batra, who said, “Yes, cystic acne can be hormonal. It may be due to decreasing estrogen levels or androgen (male hormones such as testosterone and progesterone) dominance. It fluctuates with women’s cycles.”
5. Pay attention to how often it happens in one spot.
After getting my first cyst, I was alarmed to realize that the ones coming after it were all in the same exact spot. As it turns out, this isn’t exactly strange, but it does require different treatment. Dr. Batra explains: “If the cyst is in the same exact spot, it may be a cyst that has a true capsule and has come from a hair follicle. In this case, the cyst never completely resolves and can always be felt under the surface even if it isn’t inflamed. In that case, it could either be injected with cortisone to flatten it, and in more stubborn cases, will need to be cut out by a dermatologist.”
6. Know that it’s hard to get rid of.
Well, this is a bummer: cystic acne might not ever totally go away. Dr. Batra says, “While cystic acne can be controlled and prevented with oral contraceptive or hormone blocking pills, the only full cure is with isotretinoin (Accutane).”
7. Some products are better than others.
Just like anything else, there are some products that will work better than others. In the case of cystic acne, it’s important to have a routine to tackle it. Dr. Batra has some ideas, saying, “In general, a preventive acne regimen should include an over the counter exfoliant that contains salicylic acid, benzoyl peroxide, or glycolic acid. Retinoids also help with cell turnover. For cystic acne, I often recommend a prescription-strength pill, such as an oral contraceptive, hormone mediator, antibiotic or isotretinoin, depending on the severity of the acne.” I personally recommend using something like Proactiv, which is a great routine on its own. I also swear by Kate Somerville’s EradiKate Acne Treatment, which is a spot treatment made with AHAs and zinc oxide that genuinely works over night.
8. There are certain things you need to avoid if you’re getting cysts.
When you get a cyst, you will probably want to hide it with concealer and/or foundation. Unfortunately, this could be making things worse. Dr. Batra points out, “Heavy or occlusive products that are meant to camouflage the acne can clog pores and make acne worse. I recommend checking the label of any makeup or product for the face to see if it says it is ‘noncomedogenic’ or ‘nonacnegenic,’ which means it has been tested and does not clog pores.” Murad Acne Treatment Concealer has great reviews.
9. Certain “normal” behaviors will make things worse.
You might be tempted to do certain little things when you have a cyst, but you’re probably making the issue worse. Dr. Batra advises against “squeezing, picking, or attempting to pop or lance a cyst.” She isn’t a big fan of spot treatments, saying if they contain benzoyl peroxide or salicylic acid, they “can dry out skin, and make it irritated, red and flaky.” If you’re going to use a spot treatment anyway, she says, “a dab of non-comedogenic moisturizer will help decrease dry flaky skin or irritation if applied immediately after a spot treatment.”
10. Remember that cysts can last a loooong time.
When my cyst hadn’t gone away after a week, I started freaking out and assuming I had some sort of tumor that needed to be removed (don’t ask). But, apparently, this is normal. Dr. Batra says that “because cysts are deep seated and hormonal, they can often last weeks.” Fun! If yours isn’t going away, see a dermatologist about a cortisone shot. It might need to be drained.
11. Consider taking birth control pills.
You might not know this, but birth control pills do more than just prevent pregnancy. They are a really popular medication for treating acne – in fact, I was originally prescribed birth control pills for my breakouts rather than safe sex. And it’s good for cystic acne too. Dr. Batra says it’s great for “women with hormonal cystic acne” because “the outside source and regulated amount of hormones in a birth control pill can help.” Speak to a dermatologist and a gynecologist about this option.
Do you have cystic acne? How do you deal with it or make it go away? Share in the comments.