How to Treat Stubborn Cystic Acne, According to Derms

Let's face it: Cystic acne can be a real pain (literally). Not only do these suckers have a propensity for turning up at the worst possible moment, but they also stick around longer than your average whitehead. And if you feel like you always seem to get cystic zits in the same spot, you're not imagining things.

"Because they are caused by a structural change under the skin — a 'balloon' or an out-pouching that fills up with oil from your oil gland — cysts may come and go in the same location over years," says board-certified dermatologist Joshua Zeichner, M.D.

The good news? There are ways to deflate cystic pimples fast and even prevent them from forming in the first place. We tapped Dr. Zeichner and other skin care pros who gave us the lowdown on the dos and don'ts of managing these swollen red bumps. Keep scrolling for our expert-approved tips and treatment methods for how to get rid of cystic acne, stat.

What Is Cystic Acne?

Figuring out the type of acne you have is the first step to figuring out how to get rid of it. That's why it's important to understand what cystic acne is exactly and what sets it apart from your standard acne vulgaris (AV).

"Cystic acne is a severe form of acne, in which deep pimples form underneath the skin," Dr. Zeichner explains. "Cystic acne is different from regular acne because it is deeper, often tender nodules. The individual lesions are often bigger than regular acne bumps and persist for a longer duration before resolving," adds board-certified dermatologist Brian Hibler, M.D., of Schweiger Dermatology Group in New York City.

Cystic acne can occur in the same places as AV (think: face, chest, and back), confirms Dr. Hibler. The chin and jaw areas are especially susceptible, adds celebrity esthetician Renee Rouleau. "The reason for this is often due to the hormonal shifts and imbalances in the body. Hormones stimulate oil production, which leads to the growth of bacteria getting trapped in the pore," she explains.

All skin is prone to cystic acne and unfortunately, many of the causes — like age, stress, or genetics — are out of our control, says Shuting Hu, M.D., founder of Acaderma. For example, those who are experiencing hormonal changes (e.g. teenagers and women who are going through menopause) and/or have oily skin are more likely to experience it. Melanin-rich skin is also prone to acne due to the higher lipid content. "It gets easily inflamed and often produces excess melanin and sebum which can ultimately lead to cystic acne," says Dr. Hu.

How to Prevent Cystic Acne

Again, cystic breakouts can occur for a number of reasons, some of which are under our control and others, not so much (read: hormones and genetics). However, it's worth evaluating — and then properly adjusting — your lifestyle choices since they can manifest on your skin. Here's how:

1. Exfoliate regularly.

If you're dealing with cystic acne, it's important to remove the dead, dry skin cell buildup by focusing on exfoliation, Rouleau says. The more you remove the surface dry cells, the less the oil will stay trapped and clogged under the skin, which should help those bumps to disappear. Rouleau suggests chemical exfoliation with alpha-hydroxy acids (AHAs), like glycolic acid and lactic acid, and beta hydroxy acids (BHAs), like salicylic acid.

2. Don't overdo it with masks and deep treatments.

When you're dealing with acne, it can be easy to think the best course of action is the most heavy-duty treatment that will dry your acne up. But using deep treatments on a daily basis could lead to over-stripping the skin and actually cause you to produce even more oil and, therefore, more breakouts, says Debra Jaliman, M.D., an NYC-based dermatologist and assistant professor of dermatology at Icahn School of Medicine at Mount Sinai. "Take things down a notch by saving masks or deep skin treatments for a once-a-week treat," recommends Dr. Hirsch.

3. Avoid products that produce excess melanin and sebum.

For those with melanin-rich skin, avoid products that contain ingredients that can cause the skin to produce excess melanin and sebum. "Certain products can lead to inflammation and clogged pores, which make your skin more susceptible to developing cysts," says Dr. Hu. "Ingredients to avoid include mineral oil, paraffin, synthetic wax, and drying surfactants such as sodium laureth sulfate, and sodium lauryl sulfate."

4. Keep your skin hydrated and moisturized, especially during the winter.

If you are living in colder climates, cell turnover rate is slow, which means the skin dries out and accumulates more dead skin cells on the surface. These dead skin cells can clog pores, which can lead to inflammation and cystic acne. "When looking for a moisturizer that will truly nourish the skin, look for products containing humectants, emollients, and occlusives," says Dr. Hu. This will keep skin at optimal hydration and nurture your skin during harsher weather conditions."

How to Treat Cystic Acne

When dealing with a cystic flare-up, the key is to act fast. "Because of their depth, cystic acne lesions are more likely to result in inflammation in the dermis (lower layer of skin) which can lead to scarring and textural changes," says Dr. Hibler. "While cystic acne might eventually go away on its own, it is important to be aggressive and treat it as soon as it begins to prevent scarring," he stresses.

Also, avoid picking or popping cystic acne since doing so will only make the situation worse. It won't be very satisfying either! "These 'underground balloons' are not attached to the surface of the skin and cannot be popped the way that blackheads can be," comments Dr. Zeichner.

To combat cystic acne, try these expert-recommended treatment methods instead.

1. Apply a spot treatment

"I recommend combining different over-the-counter medications that complement each other to get to the root of what causes acne," says Dr. Zeichner. Dr. Hibler agrees with this approach: "Over-the-counter treatment options might include face washes containing benzoyl peroxide or salicylic acid and topical retinol products."

Apply a mixture of 2.5% benzoyl peroxide with 2% salicylic acid and 1% over-the-counter hydrocortisone ointment to your nodule. "Benzoyl peroxide kills acne-causing bacteria. Salicylic acid helps remove excess oil and dries out the pimple itself. Hydrocortisone cream helps reduce inflammation in general," explains Dr. Zeichner.

His product recommendations? Neutrogena On-the-Spot Acne Treatment, Clean and Clear Advantage Acne Spot Treatment, and Cortaid. You might also consider trying Renée Rouleau Anti-Cyst Treatment, which according to Rouleau, contains "a purified form of lactic acid that helps dissolve cells blocking the pore, as well as purifying within the pore to help prevent future breakouts." Bye-bye festering angry mountain on my face!

2. Apply a compress

Dr. Zeichner recommends a cold pack to constrict the blood vessels to reduce inflammation.

3. Whip up a DIY solution

If redness is a big concern, Vargas recommends applying yogurt or chamomile, two natural anti-inflammatory ingredients, on top of your zit.

When to See a Professional

If cystic acne is becoming a regular occurrence and preventative methods and treatments aren't clearing it up, visit your dermatologist for a professional consultation. "Anyone with cystic acne should see a dermatologist to design a tailored skin-care regimen," says Dr. Hibler.

In addition to your dermatologist, Rouleau suggests that you may want to touch base with your ob-gyn. "A gynecologist may be most beneficial since they have a better understanding of hormonal fluctuations," she says. "They will most likely have your hormone levels checked via a blood test and prescribe oral medications such as birth control pills (or switch your current dosage) or spironolactone, a popular drug that can work well for balancing hormones. Some doctors take more of a natural approach and may suggest vitamin supplements or have other dietary recommendations."

No matter what course of treatment and preventative methods you take to tackle your cystic acne, it's important to keep expectations in check. Making some of these changes may prove to be beneficial in the long run, but they might take time to noticeably change or affect the condition of your skin. That means a little patience and diligence may be necessary (but will very well be worth it).