How to Really Treat Cystic Acne, According to Dermatologists

Aesthetics Hub | 12 Mar 2019

My period is no joke. The day-long pre-game migraine and painkiller-proof cramps that I put up with every month aren't a good time, but they are nowhere near as annoying as the hormonal cystic acne I get around my mouth and jawline in the days leading up to my menstrual cycle. 


These zits are huge red bumps that itch, hurt, and take so long to clear up, that when the skin's finally clear, I'm just about due to start my cycle all over again. 

For anyone who has the pleasure of experiencing cystic breakouts like myself, it's a known fact that picking these pimples is the worst thing you can possibly do. Since these blemishes are deep under the skin, trying to pop them will just make them more inflamed, red, and can even cause them to spread, which means, yep, you'll get more zits. 

It turns out, though, that trying to pop a cystic pimple isn't the only mistake that many of us are making when we're trying to self-treat cystic acne. If it seems like none of the spot treatments you've been using are working, it's because they're not. 

"Over-the-counter medications do not work well at all," says Dr. Jeanine Downie, a Montclair, New Jersey-based dermatologist and founder of Image Dermatology. "If cystic acne is not treated properly, it can scar the skin permanently."  

The same goes for other skincare products targeted for acne-prone skin.

"Scrubbing and doing abrasive treatments with the hope they will get rid of the acne is only going to increase inflammation and make the acne more irritated," says Dr. Shari Sperling, a New Jersey-based board-certified dermatologist. This includes harsh scrubs and astringent-based toners.  

Dr. Ava Shamban, a Los Angeles-based dermatologist agrees. "While some creams and washes pads and peels are sometimes enough for surface acne [whiteheads, blackheads, and pustules], you’ll most likely need the big guns to treat cystic acne," she says. 

These "big guns" can only be prescribed by a dermatologist.

"That said, by far the best cystic acne treatment is isotretinoin (i.e. Accutane). Isotretinoin is an oral form of vitamin that is a multi-tasker, targeting all aspects of cystic acne," Dr. Shamban explains. "It will kill [acne-causing] bacteria, unclog pores and suppresses the production of excess sebum while fighting off inflammation. And it is the best and only medication that can actually help to shrink the oil-producing glands permanently, so it has the side effect of making skin and lips incredibly dry and sometimes flaky." 

Another oral prescription that your dermatologist may consider is spironolactione, a blood pressure medication that's becoming an increasingly popular treatment for hormonal acne because it blocks androgens (male hormones) from over-stimulating the oil glands. 

Alternatively, an in-office cortisone shot is a quick way to calm an inflamed cystic zit. It'll diffuse the bump and the redness surrounding it. 

As for what you can do at home, you've got a few options. Those pimple patches you've seen all over Instagram? They now come in microneedling form.

"There's now a new kind of pimple patches with 'microneedles' in them, which may also be a quicker fix," says Dr. Shamban. "Usually a bandage-like patch with a series of hundreds of microneedles, these teeny tiny pricks in the skin are able to drive and deliver acne-fighting active ingredients [before they dissolve] deep into the skin. This supports the dissolution of the acne more efficiently than any topical medicine, and when done with moisture-binding ingredients, the skin does not dehydrate during the process."

As far as topicals go, a hydrocortisone cream can reduce the appearance of angry red cystic pimples, but won't have any effect on the source of these blemishes. 

Whatever cystic acne treatment you do go with, all of the dermatologists I spoke to agree that you shouldn't skip your daily moisturizer.

"When we treat acne, it is important to respect the skin barrier," says Dr. Joshua Zeichner, a New York City-based dermatologist. "While many acne treatments can dry out a pimple, if they dry out the skin too much, it can lead to skin barrier disruption with irritation and inflammation. It is OK to apply a moisturizer to your face along with your acne treatment to help keep the skin well hydrated and in as good shape as possible."  


By Erin Lukas

This article first appear in InStyle.