As far as pimples go, those deep, cystic acne flare-ups are probably the most traumatic. Aside from how much surface area those suckers tend to cover, the pain they cause makes them impossible to ignore. Press on one, and it reverberates throughout your entire face (that's not an exaggeration). While pimples come in many different shapes, sizes and forms, cystic acne is considered to be "the most severe type of acne," says Joshua Zeichner, the director of cosmetic and clinical research at Mount Sinai Medical Center in New York City. It's characterized by the development of "tender, inflammatory nodules underneath the skin." Ouch.
Moreover, when it comes to treating these bad boys at home, your regular acne skin-care routine might not cut it. "Usually, people run to their dermatologist's office for a quick cortisone injection to dry up those monsters within hours," says Rachel Nazarian, a dermatologist at Schweiger Dermatology Group in New York City. But what if you don't have the time (or the money) to pop into your dermatologist's office the moment you feel one coming on? Here are the next-best, at-home treatments and advice recommended from top dermatologists for getting rid of those under-the-surface cysts ASAP.
1. Whatever you do, don't try to pop it.
We know you've heard it before, but we'll say it again: As satisfying as you think it might feel, do not try to pop your pimples — especially if they are cystic. "The hardest thing for me to communicate with my patients is that often, around age 20, women experience a major change in their acne," New York City dermatologist Scott Dunbar previously told Allure. "No longer are the zits the juicy whiteheads that explode with a satisfying pop. By the mid-20s and 30s, acne is made of deep pockets of white blood cells, and these can't be popped."
That being said, keep your hands off of your pimples, especially if they're of the cystic variety. Trying to pop them will not only be unsuccessful, it will also make them worse.
2. When you first feel it coming on, ice it like a sprained ankle.
The type of acne we're talking about here is rooted deep underneath the skin, so you will usually be able to feel it starting to form. When you do, don't panic: Grab an ice cube and apply it directly onto the area for several seconds. "Applying an ice cube directly to your pimple will constrict small blood vessels, feeding the cyst, and will immediately decrease redness and size," Nazarian says.
This trick is especially helpful if, say, you aren't able to follow the next steps right away and you need something that will calm the oncoming redness and swelling before you cover it up with concealer and get on with your day.
3. Use a two- or three-pronged ingredient approach.
"The best way to treat acne is to use different ingredients that work differently and complement each other," Zeichner says. "That's why I typically advise my patients to use both salicylic acid and benzoyl peroxide." To maximize the efficacy of both of these active ingredients in your own skin-care routine, Zeichner recommends a salicylic acid cleanser, followed by an oil-free moisturizer, then topped off with a benzoyl peroxide spot treatment. Below, you'll find our best recommendations for each step.
4. Start with the right cleanser.
"Think of your cleanser not as a true wash, but rather as a short contact therapy," Zeichner suggests. For this reason, he typically recommends that patients with cystic acne use cleansers that contain high concentrations of salicylic acid. If you're not familiar with the ingredient, salicylic acid is a beta hydroxy acid (BHAs) that helps remove excess oil, slough off dead skin cells, and dry out pimples.
Typically, salicylic acid concentrations range between 0.5 to 2 percent, and if you're prone to cystic acne, Zeichner recommends looking for a cleanser that leans toward a higher concentration. A couple of great 1.5 to 2 percent salicylic acid-based cleansers include La Roche-Posay Effaclar Medicated Acne Face Wash and Murad Clarifying Cleanser.
If your skin is both acne-prone and sensitive, higher concentrations of salicylic acid could be over-drying. In this case, some cleanser options that contain lower concentrations (0.5 to 1 percent) of the ingredient include the Aveeno Clear Complexion Foaming Cleanser and Burt's Bees Natural Acne Solutions Purifying Gel Cleanser.
Whichever cleanser you choose, "apply it to the skin and let it sit while you sing the alphabet, then rinse off," says Zeichner. "The cleanser needs enough contact time with the skin for the active ingredients to exert their effects."
5. Follow up with an oil-free moisturizer.
Even if you're prone to cystic acne, you should still use a facial moisturizer regularly in order to maintain a healthy skin barrier. After you've rinsed off your salicylic-based face wash, follow up with an oil-free moisturizer such as Clinique's Dramatically Different Moisturizing Gel, Neutrogena's Oil-Free Moisturizer, and the Caudalie Vinosource Moisturizing Sorbet.
6. Finish with a medicated spot treatment.
Benzoyl peroxide works by lowering levels of acne-causing bacteria on the skin, thereby reducing inflammation, which is why Zeichner recommends utilizing the ingredient as a spot treatment. Skin-care products come in 2.5, 5 ,and up to 10 percent concentrations of benzoyl peroxide, however, "studies have shown that even low concentrations of benzoyl peroxide are as effective as higher concentrations, but are associated with less dryness of the skin," he says.
Zeichner recommends looking for leave-on acne spot treatments that are formulated with 2.5 percent of the active ingredient, such as Neutrogena's Rapid Clear Stubborn Acne Daily Leave-On Mask or Paula's Choice Clear Daily Skin Clearing Treatment.
7. For really painful and/or red cysts, top it all off with a hydrocortisone cream cocktail.
Applying an over-the-counter 1 percent hydrocortisone cream, which contains a low dose of topical steroids, onto the affected area can help reduce redness and calm inflammation. Try Aveeno's 1% Hydrocortisone Anti-Itch Cream or Cortizone 10 Maximum Strength Cream.
For the peskiest of cysts, combine your own hydrocortisone cocktail to apply as a leave-on spot treatment. Zeichner recommends a hydrocortisone cream to reduce inflammation, a 2 percent salicylic acid product to dry out excess oil (we like The Ordinary's Salicylic Acid 2% Solution), and then benzoyl peroxide to kill acne-causing bacteria. "Put a drop of all three in the palm of your hand, mix them together, then apply."
For those with skin that's not sensitive or that doesn't get easily dried out, another combo option is to swap in a sulfur-spiked treatment in place of the salicylic acid. "The combination of these three over-the-counter products — a sulfur-containing mask (try Sunday Riley Saturn Sulfur Acne Treatment Mask), a benzoyl peroxide cream (try Clearasil Daily Clear Acne Treatment Cream), and a mild cortisone salve usually proves very effective when mixed and applied two to three times a day over the cyst for seven to 10 days," says Leyda Bowes, the medical director at Bowes Aesthetics in Miami.
8. When all else fails, color-correct the cyst away.
When your cystic acne persists, despite your very best efforts, "use makeup with a slight green tint to help mask redness and blend your pimple into your natural skin tone," Nazarian recommends. Try Cover FX's Correct Click Color Corrector or Urban Decay's Naked Skin Color Correcting Fluid. To use, apply a thin layer over the cyst before reaching for your concealer, then applying your foundation over top.
More on acne treatments:
- 4 Steps for Getting Rid of Cystic Acne, Fast
- The 14 Best Acne Spot Treatments That Get Rid of Pimples Fast
- The Ultimate Guide to Getting Rid of Acne
Now, see how acne treatments have evolved within the last 100 years: