If you’ve ever gotten cystic acne or an underground blind pimple, you’re probs very familiar with the feeling that is wanting to remove your own skin and borrow some from a baby (was that motivational? Inspirational? Worrisome? Sry—I’m breaking out right now, can’t help). Because cystic zits suck. They do. We all hate a pimple that throbs when you sleep and aches when you smile, then peaces out three months later, only to leave you with a red or brown splotch that takes half a year to fade.
And unlike every other form of acne, like blackheads, whiteheads, and little, squeezable-even-though-you-shouldn’t bumps, cystic acne can’t be treated with the same creams and serums in your medicine cabinet. Why? Because cystic acne is rooted deep within the skin tissue, with no direct connection to the surface. So all the spot treatments and cleansers in the world can’t penetrate far enough to treat the source of the inflammation. Fun! We’re having fun!
So what to do? Well, a lot of things. Really. As someone who only gets cystic acne when my skin does break out, I’ve basically become an unofficial (but, like, fully official) expert on all things cystic zits, from the at-home treatments to the prescription-treatments—and, yup, I’ve tried almost all of them. So whether you just woke up with a cystic pimple and you’re freaking out, or you’re just trying to prevent new ones from forming, keep reading to find out every possible way to treat your cystic breakouts, below. But first…
What causes cystic acne?
Ugh, bad luck? Just kidding. Maybe. “Fundamentally, everyone’s skin is the same—everyone has hormonal fluctuations, oil productions, and acne-causing bacteria in their skin that could cause a huge breakout at any time,” says Mona Gohara, MD, associate clinical professor at Yale School of Medicine. But, BUT! “The sebaceous glands in some people are just naturally more sensitive to these triggers, causing a larger and more frequent inflammatory response.”
And if you’re someone with cystic acne, here’s what that inflammatory response looks like: Your follicle gets pissed off and clogged, trapping the oil and bacteria deep within your pore and causing intense inflammation. That inflammation then ruptures the sides of the pore and leaks bacteria into the surrounding skin, resulting in a big-ass, super-painful cystic zit with no escape route. “Honestly, your risk of developing cystic acne only partially has to do with how you take care of your skin,” says Dr. Gohara. Translation: It’s not your fault.
How to get rid of cystic acne fast
K, first, make sure to temper your expectations. Though you’ve got a few at-home treatments that can help prevent cystic acne from forming (more on that later), there’s not much you can really do at home to get rid of the bump that just popped up. That being said, here are your best at-home cystic acne treatments that can help:
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Don’t try to pop it. Seriously
Cystic zits literally cannot be popped, since the problem is so deep within your skin. "Trying to manipulate or squeeze the cyst will only push the inflammation out further, leading to more severe scarring and possible infection," says Shari Marchbein, MD, a dermatologist in New York City. Even if it has the tiniest of whiteheads on top, don’t trust it—that sh*t is deep, and you’ll never get it out. You will always (always) make it worse.
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Ice it
Nah, it’s not a bunch of B.S.—ice really can help your cystic breakout…to some extent. "The reason a cystic pimple is painful is because of swelling and inflammation in the tissue," says Dr. Gohara. "Ice can help constrict your blood vessels and bring down the swelling a bit." Wrap an ice cube in a paper towel or napkin (no direct-to-skin contact) and hold it against your zit for one to two minutes max, giving your skin 30-minute breaks in between.
BUT WHAT ABOUT WARM COMPRESSES?! The thing mothers and Google have been telling us to put on our zits for decades?! Sry, but both derms gave me a “meh” response: "It’s not going to help heal your cystic zit faster, and I don't use them on myself when I get cystic breakouts either," says Dr. Marchbein. Dr. Gohara agrees, adding "heat can be really inflammatory, so I’d only apply a warm compress once or twice to relieve some pain if needed."
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Cocktail a spot treatment
K, don’t get too excited—no topical product will get rid of your cystic zit at home, aside from time (it’s free!). BUT, “a cocktail of benzoyl peroxide and one percent hydrocortisone cream can help flatten the zit faster,” says Dr. Gohara. Both are anti-inflammatories (yup, even benzoyl peroxide) that will help calm the bump, and “the less inflammation you have now, the less hyperpigmentation and scarring you’ll have when the zit heals,” she says. So once a day for one week, dab benzoyl peroxide on the cyst, let it dry, and then tap on a thin layer of hydrocortisone cream.
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Aaaaand that concludes all of your at-home fixes. I’m sorry. Your next step? The derm’s office, which brings us to:
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Get a cortisone injection
"A cortisone shot involves injecting a low-dose steroid directly into your zit to drastically decrease the pain and inflammation within a day," says Dr. Marchbein. "It’ll still take a few days for the cyst to resolve itself completely, and if it’s monstrous, you might want another injection a few weeks later." It sounds intense and painful, but as someone who has had a dozen zits injected in my life with zero issues, I can assure you it’s really, truly not a big deal—it takes about three seconds (I counted), and it’s usually covered by insurance, so it’s cheap.
The only potential side effect? Denting. Accidentally injecting too much cortisone can leave a slight depression where your zit used to be, but 1) it’s rare, especially if it’s being administered by a board-certified dermatologist—which, um, is the only person you should be allowed to do it, 2) your derm can fix it fast with a bit of saline solution, and 3) your body usually fills out the dent on its own after a few months anyway.
Regardless of which one you choose, START SLOW, or you’ll risk intense irritation, flakes, and worsened breakouts. Smooth a pea-sized dab over clean, dry skin one night a week for one week (followed by your moisturizer), then two nights a week for two weeks, then three nights a week for three weeks, and then every other night indefinitely. "If you’re six weeks into it and your cystic acne isn’t getting any better, go to the dermatologist," says Dr. Gohara. "It’s just not worth the scarring or inflammation when we can help you faster."
Either your derm will then prescribe you a prescription-strength retinoid, or they’ll potentially try…
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Antibiotics
Reminder: This isn’t an exact roadmap to your cystic-acne cure. Your dermatologist might try antibiotics right away, or never, or in conjunction with a retinoid, or with another oral medication. That’s why they’re doctors, and we are mere mortals. Still, "if topical treatments aren’t working, we might consider an oral antibiotic to kill off the bacteria that are involved in acne’s inflammatory process," says Dr. Gohara.
This isn’t a longterm cure, though—more like a quick-ish fix to calm your skin—and derms rarely leave patients on antibiotics for longer than three months. "But for some people, all it takes is a few months of an oral anti-inflammatory to get them over some hormonal surge or a weird skin period, and then they’re good," says Dr. Gohara. But if not, your derm might consider…
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Hormone regulators
We’re talkin’ oral birth control and spironolactone—two medications that "help regulate the hormonal surges that can create cystic acne," says Dr. Gohara. "We usually start to see great results after three cycles, or about three months." Dermatologists often prescribe both at once, and if you’re anything like the entire Cosmo staff (almost all of whom are on spironolactone because it really is that good), your cystic acne will then be fully gone or significantly reduced. But if not, there’s always…
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Accutane
Okay, really listen to this: Despite the swirling myths and stories, Accutane is not as dangerous as you’ve been led to believe. Yes, it’s definitely an intense medication—it requires monthly blood tests and birth-control monitoring, and the temporary side effects can range from dry lips to joint pain—but it truly is the closest thing to an acne cure that dermatologists have.
"Accutane permanently shrinks your oil glands so they can’t be hormonally stimulated as easily anymore," says Dr. Gohara. "It shuts down the party in your pores, so cysts have a hard time setting up shop." And you don’t need a face full of severe, cystic zits to be a candidate, either: "I have patients with pretty mild yet persistent acne, and because they’ve ‘failed’ everything else, I have them on Accutane," she says. "It’s effective, and it’s finite—you know in six months, your acne will be gone, and you can move on with your life."
The bottom line
You’ve got options. Really. Cystic acne can feel like the worst, most frustrating thing in the world, but there’s always one more thing you can try. "I think people try to manage their acne far too long at home until they feel a bit hopeless," says Dr. Marchbein. "But it doesn’t have to be—you just need to find a derm who loves treating acne and also trust the process."
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This article originally appeared on Cosmopolitan.com. Minor edits have been made by the Cosmo.ph editors.