Everyone’s had a cystic pimple at least once in their lives, believe it or not. And yes, that includes you—and me.
We’re acne bros.
Cystic acne often strikes when we least expect it and sometimes at the worst time possible; before a Tinder date, the day before a wedding you’re expected to attend, or the worst when I was younger—just before photo day at school.
At least when you’re younger, pimples are kind of a given so everyone’s had the struggle of coming to school puffy-faced and scabby after a whole night’s effort of trying to pop pimples.
(In fact, that’s the worst thing you could do for cystic acne removal!)
How to Tell If Your Acne Is Cystic
In case you’re sitting there thinking, “What even is cystic acne?” here’s a quick run-through.
Luckily, it's not something that you're going to confuse for fungal acne.
You’ll know that acne is cystic when it seems like it’s really deep under the skin. The clinical term you’ll hear doctors use is nodular acne.
Compared to regular breakouts (called pustules and papules) that have that tell-tale poppable head, cysts don’t come to the surface in the same way. They lurk under the skin, which is why cystic acne removal is so hard.
Cystic acne is normally also very swollen—it might almost look like a bug bite because it’s that inflamed.
(Image source: https://a-newyou.co.uk/)
The third way to tell if your acne is cystic is that you can feel it under your skin.
A cyst might throb or itch, very helpfully reminding you of its presence when you wish it would disappear.
It’s important to keep your hands off cystic acne, no matter how much it itches or throbs—easier said than done.
Cystic acne also has a bad habit of lingering for a long time—compared to blackheads that can be extracted and regular breakouts that eventually go away, cysts like to overstay their welcome.
However, that doesn’t mean that they’re impossible to get rid of!
There are multiple approaches to take when it comes to getting rid of infected cystic acne, once and for all.
What NOT to Do If You Have Cystic Acne
1. Never Try to Pop It
Without a doubt, this is the worst thing you can do for cystic acne. Like with most other pimples, attempting to pop zits is the best way to spread acne-causing bacteria on your face—as in, the exact opposite of what you’re trying to achieve. No thanks! While popping isn’t ‘as’ bad when it comes to smaller pimples, trying to pop a cystic pimple is almost like setting off a landmine underneath your skin.
First, a cystic zit is going to feel much, much more tender than a regular pimple, so you’ll be causing unnecessary pain—especially if the cyst is in a thin-skinned part of the face, like the temples. Secondly, when you pop a zit, you cause even more damage to that delicate facial tissue than there already is.
If this is you, STOP.
Popping cystic acne on face is what leads to scarring.
I know, it’s probably something you’ve heard over and over again about not squeezing pimples—but it’s a bigger issue than you think.
The thing about scarring is that it will usually end up lasting for much, much longer than any cyst will last for. Because the inflammation caused by cysts is so intense, they can permanently change how healthy tissue looks, long after they’ve healed.
So give your skin the best chance at healing normally—don’t pop anything!
There are four different types of acne scars that are linked to cystic acne: ice pick, rolling, boxcar, and keloid.
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Scars like this usually require clinical attention—it’s pretty much impossible for any over the counter topical treatments to address help with this level of scarring.
2. Steer Clear of Drawing Salves and DIY Recipes
Ooh, I don’t know where to start with this one. Drawing salves sound like a great way to treat cysts, right? They’re hailed as all-natural alternatives to traditional treatments. They used to be formulated (and perhaps some still are) with ichthyol, which is also sometimes called ichthammol. Drawing salves are supposedly recommended as a treatment for boils (which, as you can guess, are sort of like very large pimples that might pop up on other parts of the body).
The thing with using a drawing salve for cystic acne is that it has no scientifically proven ability to treat pimples. They appear in zero scientific journals about treating acne! The most popular drawing salve on Amazon, despite all the glowing reviews, is at the core a homeopathic product, meaning any active ingredients (including ichthyol) are diluted to very, very small amounts in the product’s formula. In other words, it's all bunk and lies.
Another popular DIY treatment for cystic acne is baking soda. While, yes, a paste of baking soda can help once in a while with itchy poison ivy or bug stings, it shouldn’t be relied on for regular use on the face. Baking soda is considered an alkaline substance; remember learning about the pH scale?
Baking soda has a pH of 8-9. The optimal pH of skin is around 4-6; see the problem here? Studies have consistently found that skin issues like acne were more common in people whose acid mantles were disrupted by higher pH products. So, while baking soda is great for temporary relief for itching on the body, if you want to give your skin the best chance of being acne-free, avoid using baking soda. Cystic acne doesn't need any more irritation!
Essential oils for cystic acne pop up a lot too—but are they that effective? A popular essential oil for skin is tea tree oil. Cystic acne should be no match for it, right? Well, tea tree oil is an essential oil, meaning it's an extremely concentrated oil. For safe use on skin, tea tree oil requires dilution or usage in a correctly formulated product before use to avoid irritation.
While putting pure tea tree oil right on a cyst sounds like a good idea, it’s likely to irritate the skin on top of the cyst and not make it down to the layers of skin where the problem truly lies.
It's also worth noting that tea tree oil is considered complementary medicine, meaning it’s suggested in addition to medical treatment—not in the place of. So essential oils + cystic acne is not going to be a miracle cure!
How to Treat Cystic Acne
If you have a one-off cyst that you want to disappear, there are a few things that you can do at home that won't require a trip to a dermatologist's office. Starting with a good skincare routine is the best start—ensuring that the skin on top of the cyst is clean goes a long way to creating an environment where the cyst can heal.
1. Ice It
I know—cysts can get uncomfortable, swollen, and red. In other words, they become very noticeable. However, just like with any other swelling from an injury, ice is the go-to treatment. Wrap a small piece of ice in a clean (and I can’t stress that enough!) face towel and ice the cyst a few times a day. Use a fresh towel every time, if you can! The ice helps ease any swelling and redness so the cyst is less noticeable—so it’s something you can do before heading out to minimize how the cyst looks. It also helps bring down any throbbing or itchiness, reducing the amount of torture that your cyst is throwing at you.
2. Hot Compresses
If you have the time, using hot compresses goes a long way to speeding up the cyst life cycle. Run a clean face cloth under some hot water (but not so hot that it will burn you!) and wring it out before gently pressing to your face. The aim here isn’t to squeeze the cyst, but to use the heat to improve blood flow and encourage healing. Like with icing, you can do this a few times a day—preferably on a day where you'll be home all day since the heat will probably make the area where the cyst is a little red.
3. Cortisone Shot for Cystic Acne
This is the option for when you have a cyst but you need it gone ASAP. As in, you have a cyst (that’s not paying any rent on your face, by the way) but your wedding day is tomorrow. You can only get this treatment at a dermatologists' office. This is the last resort if you have a one-off pimple—it shouldn't be used as a way to treat chronic cystic acne.
4. Cystic Acne Removal Surgery
If a cyst is getting too big or at risk of infection, a dermatologist may perform a removal surgery. They will make an incision at the site (after local anesthetic, don't worry) and drain the contents of the cyst. This is a controlled 'pop', except that the lack of pressure means that there's no unnecessary damage to the healthy skin around the cyst. In some cases, the 'sac' of the cyst will be removed to ensure that the cyst never grows back again.
Chronic cystic acne has internal causes, and can't be treated solely topically—if at all. For the long-term treatment of cystic acne, there are three options that you have from your dermatologists or other healthcare professional.
5. Oral Antibiotics
Because antibiotics target all types of bacteria, they can be effective at treating the bacteria that’s hanging out in any cysts and pimples. Certain types of antibiotics are preferred for their efficacy but lower risk of side effects, such as doxycycline. However, it’s not recommended to use antibiotics for a period longer than 12 weeks. The thing with antibiotics is that they don’t discriminate—they’ll kill all bacteria in the body, so while they’ll zap bacteria in cystic acne, they’ll get all the good bacteria in your gut too.
Oral antibiotics are usually prescribed alongside topical medication, such as retinoids. I know what you’re thinking—didn’t you say that topical meds won’t work against cystic acne? Well, using a combination of the two is the best way to reduce the likelihood of the cystic acne returning once antibiotics are stopped.
6. Hormonal Medication
There are two types of hormonal medication used to treat cystic acne! However, they can only be used by women because of the hormones that they affect. The first one is called spironolactone and has anti-androgenic and anti-sebogenesis abilities. This means that it a) reduces the levels of male hormones that cause acne and b) reduces the amount of sebum that skin produces.
Both of these combined work to reduce the likelihood of cystic acne occurring—yes! Spironolactone for cystic acne treatment is technically ‘off-label’, but it works incredibly well. It has very few side effects and can be taken for a long time to manage acne, unlike some of the other prescription options.
Hormonal birth control, specifically combined oral contraceptive pills are another option for women to manage their acne. Like spiro, they influence the levels of specific hormones in the body which influences whether or not acne appears.
Known to some as Accutane, isotretinoin is usually considered the last resort of all last resorts. If your acne is chronic and spread over a large area of your body, it's more likely that your derm will suggest you take isotretinoin. This is an intense medication that requires monthly blood tests, and in female patients' cases, it requires them to sign a form that states they're using two types of birth control.
However, it is the most effective method for cystic acne removal and it just works. People who do a course of isotretinoin often don't have to do it again.
Now that’s something that I wouldn’t mind!
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