How To Get Rid Of Cystic Acne, According To Top Derms

Photographed by Collins Nai.
Think back to middle school when year after year, person after person would tell us that we’d grow out of our acne. We get it: The adults in our lives wanted to be encouraging. So they threw out a glimmer of hope — an “it gets better” kind of thing that has us bamboozled all these years later. Because after countless cycles of hormonal acne, we’re here to say that it does not, in fact, always get better: A 2011 study showed that nearly half of women aged 20-29 has clinical acne. One of the most notorious types? The cystic variety, which can be brought on by monthly hormonal cycles — and can be way more intense to deal with than your average pimple.
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“Cysts are like balloons under the skin that are filled with oil, but have no place to go. As your oil glands make more oil, cysts become enlarged, the wall cracks, and inflammation develops,” explains Joshua Zeichner, MD, a New York-based dermatologist and Director of Cosmetic and Clinical Research in Dermatology at Mount Sinai Hospital. Unlike more surface-based pimples, he explains, cystic zits can’t be picked: “They have no connection to the surface of the skin so any attempt to pick them will cause more harm than good.”
Extractions are also out when it comes to cystic zits. S. Manjula Jegasothy, MD, a Miami-based dermatologist with a celebrity-rich clientele, notes that these suckers can start deep in the skin, at one-to-two millimeters beneath its surface. “They’re extremely difficult, if not impossible, to extract or ‘pop,’ even by a skin-care specialist or dermatologist,” she says. In short, these zits are deep-rooted and tough to fight, which is why our pros suggest booking an appointment with a derm as a first line of defense. Prescribed treatments like oral antibiotics, some types of birth control pills, Aldactone, (a pituitary hormonal oral medicine), and isotretinoin (what used to be known as Accutane) top Dr. Jegasothy’s list of prescribed treatments.
Though Accutane has proven controversial for some, Marina Peredo, MD, a New York-based dermatologist and associate clinical professor of Dermatology at Mount Sinai Hospital, also likes the medication to treat cystic acne. “For most patients, it's a cure and will prevent deep scar formation if started early in a course of a disease,” she says, noting that a proactive approach is key. “It is very important to start Accutane is soon as possible with severe cystic acne because prolonging the start of the treatment can cause deep scars, which are very hard to treat even with the most aggressive laser treatments later.”
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Dermatologists also use cortisone shots as a magic wand to instantly deflate cystic bumps, though Dr. Jegasothy notes that this methodology is falling out of favor. “They are known to occasionally cause indentations which may persist up to three months after the pimple has gone,” she warns. Instead of using steroid injections, she turns to combinations of oral antibiotics (typically used for two to four months), light chemical peels (to help control oil and reduce clogged pores), topical medications, probiotic cleansers (which can help balance skin), and lasers.
Bottom line? If you want to get serious about cystic acne treatment, there’s no getting around time-consuming derm visits and prescribed meds. But here’s the upshot: We can take action from our own bathrooms to help minimize cystic acne from forming and help control those mighty bumps in between doctor’s visits (or until we meet the deductible on our health insurance, anyway). Ahead, get pro advice on how to best tackle deep-rooted acne at home.
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This cream has a mixture of 5.5% benzoyl peroxide and LHA, a derivative of salicylic acid, to fight acne and exfoliate.

La Roche-Posay Effaclar Duo, $39.95, available at La Roche-Posay.
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Dr. Jegasothy likes probiotic cleansers for acneic patients, as they help keep the skin’s good bacteria balanced.This one uses probiotics and other plant-derived ingredients to help clear pores without drying out skin.

Nerd Skincare Clarifying Cleanser, $20, available at Nerd Skincare.
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Dr. Peredo notes that salicylic or glycolic acid peels can help keep breakouts in check. This gel-based peel not only contains skin-clearing glycolic acid and charcoal, it gently gathers gunk and dead skin cells into clumps as you exfoliate (something that’s mesmerizing to watch) and leaves skin super-soft.

Boscia Charcoal Deep-Pore Exfoliating Peel Gel, $34, available at Sephora.
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The star ingredient of this spot treatment is monolaurin, a coconut-derived antibacterial that not only helps address cystic zits, but also addresses acne that results from sweat. What’s more, it’s built to keep skin cooler, which helps prevent excessive sweating, which can create even more zits.

VMV Hypoallergenics id Monolaurin Gel, $30, available at VMV Hypoallergenics.
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Mario Badescu’s Drying Lotion is an effective acne spot treatment that's also cost effective. Because it has sulfur, it works to reduce oiliness and unblock pores. There's no need to rub or blend this stuff into your entire face, just use a cotton swab to dot it on any spots, hit the hay, and you'll see reduced pimple size by morning.

Mario Badescu Drying Lotion, $17, available at Bloomingdales.
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Keeping skin hydrated means preventing its own overproduction of pore-clogging oils. This moisturizer contains ingredients high in linoleic acid to help balance sebum and pH levels. It also boasts antibacterials and antifungals, and yes, ingredients to hydrate, too.

True Botanicals Pure Radiance Oil, $110, available at Barney’s New York.
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Yeah, we know it can feel kind of counterintuitive to put a face oil atop oily and acne-ridden skin. But this one, a dry oil made with 1.5% salicylic acid, tea tree, and chamomile, helps address congested skin while treating fine lines, dullness, and hyperpigmentation.

Sunday Riley U.F.O. Ultra Clarifying Face Oil, $80, available at Sephora.
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We use this vegan mask as an overnight spot treatment to help minimize oncoming acne. Dr. Peredo notes that algae can "have a tightening effect, which can help reduce the size [of cystic acne] slightly.” But don’t take that to mean the mask makes skin feel tight when used on the entire face; you'll feel soft and hydrated after rinsing.

Osea Red Algae Mask, $48, available at Osea Malibu.
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Benzoyl peroxide can help shrink cysts, Dr. Peredo notes. A whopping 4.5% benzoyl peroxide is used in this skin-clearing wash, a concentration that might normally irritate skin. But the ingredient is microencapsulated, which controls its release (to cut irritation) while allowing for better penetration.

Glytone Acne BPO Clearing Cleanser, $38, available at Glytone.
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When dealing with breakouts, it can often feel like skin never gets quite clean enough. But over-washing can strip skin of oils and send oil production into hyperdrive, creating even more zits. This cleansing duo is the perfect antidote. It includes a detoxifying cleansing oil and sea mud and charcoal cleansing bar that allows you to double cleanse and target blemishes without totally drying skin. (Plus, Marilyn Monroe used it, so there's that.)

Erno Laszlo Detoxifying Cleansing Set, $28, available at Nordstrom.
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Anyone lucky enough to have visited Kate Somerville’s LA clinic knows that she’s a wizard when it comes to clearing skin. (Required reading in the waiting room: an entire picture book of patients with and without acne, before and after treatment.) This newly-launched cleanser (inspired by the best-selling EradiKate Acne Treatment treatment) is one way to get Kate’s skin-clearing skills at home. It uses 3% sulfur, along with honey and rice bran extracts, to gently unclog pores.

Kate Somerville EradiKate Daily Foaming Cleanser, $38, available at Neiman Marcus.
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This wand doesn’t feel like it’s doing much when held to the face — there’s no painful zapping or stinging effect, just a warming sensation that feels like sitting outside on a nice day. But after three to four uses in a week, our monthly crop of cystic zits began to dwindle. Its power? Using light (without UV, of course) to target the beneath-the-skin bacteria that’s linked to acne.

Tria Beauty Positively Clear Acne Clearing Blue Light, $169, available at Tria Beauty.
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Many affordable exfoliants yield an abrasive texture that feels too harsh on already-compromised skin. This one (which contains salicylic acid and charcoal to help check acne) uses microcrystals to clean more gently. Its key ingredients are also derm-approved: Dr. Peredo calls charcoal “a tried and true ingredient for keeping pores clear.”

Bioré Charcoal Acne Scrub, $6.49, available at Target.
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We swear by Renee Rouleau's Anti-Cyst Acne Treatment, but the celebrity esthetician has just given us cystic zit sufferers even more of a fighting chance at clear skin with this new anti-inflammatory mask, made especially to target cystic zits before they blow up. Prone to monthly hormonal breakouts? Use this gel mask a few days before your cycle to treat acne before it forms.

Renee Rouleau Rapid Response Detox Mask, $60.50, available at Renee Rouleau.
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This mask zaps hormonal pimples and heals cystic acne, but makes doing so feel downright chic. While it has exfoliating AHAs that work to clear acne, the most plentiful ingredient is honey, which means it'll keep your skin moisturized and soft — and clarified.

Tata Harper Clarifying Mask, $68, available at Sephora.
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For a more potent spot treatment for painful, cystic acne, try this topical serum that targets the acne formation beneath the skin's surface, forcing the cyst to a head. Seriously, it's like magic.

Renee Rouleau Anti Cyst Treatment, $45.50, available at Renee Rouleau.
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