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.
“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.”
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.