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. 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-heavy clientele, notes that these suckers can start deep in the skin, one or 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.
And 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 as 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.”
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.
Ahead, get pro advice on how best to tackle deep-rooted acne at home.
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