Cystic Acne 101: Everything 2 Pimple-Whispering Skin Experts Want You to Know

You know that little old saying, "Shit happens"? Well, acne happens. Uneven skin texture, bumps, pimples, and pustules are a fact of freaking life, and before we begin our deep dive into all things cystic acne, we just want to say this: Acne is normal, acne is complicated, and acne is not anything to feel ashamed of. More and more, we're working to soften the negative stigma associated with bumpy, "imperfect" skin and embrace the natural environment of our complexion instead (which, quite honestly, is almost always the antithesis of glassy, filtered-looking skin—who decided that was the aspiration anyway?!).

All that's to say certain types of acne—like stubborn cystic breakouts—are much more severe and mysterious than others. For instance, if I decided to slather coconut oil all over my face one night and then awoke to an angry rash of zits on my chin days later, that's as simple a solve as computing two and two to get four. Remove the coconut oil and say goodbye to the reactive breakouts. Cystic acne, however, is much more complicated, and the underlying causes aren't usually clear-cut or easy to distinguish and diagnose. Additionally, cystic breakouts are usually the most physically painful and visible, which, given our clear skin–obsessed society, can take a toll mentally. 

Well, we're here to offer some friendly support and information. Even though we feel well versed in the art of getting pimples, we're far from experts in the art of treating them. So, to school us on the who, what, where, when, why, and how of all things cystic acne, I reached out to two amazing experts: Renée Rouleau, celebrity esthetician and CEO of her namesake skincare collection, and Mona Gohara, dermatologist expert in skin of color and the co-creator of Melé—a science-backed skincare brand designed with melanin-rich skin in mind. Keep scrolling to learn all of their tips and protocols for treating cystic acne. 

Cystic acne has a few key defining characteristics that are important to be aware of. First, it's the most severe, stubborn form of acne, and it's usually associated with hormonal imbalance. As Gohara explains, cystic acne comes from the hormonal stimulation of the oil gland. The oil gland produces oil, the oil fuels bacteria, and the bacteria triggers inflammation, resulting in a gnarly breakout.

"People with cystic acne will experience hard, painful bumps that develop deep within the skin and can linger for weeks," Rouleau explains to us. "A true cyst remains as a bump under the skin and rarely surfaces, unlike whiteheads and pustules. Instead, the body reabsorbs the infection. They are the most frustrating type of inflammatory blemishes because they last the longest and can cause long-term scarring." 

Hormones: As we mentioned earlier, cystic acne is primarily driven by our hormones. According to Rouleau, the menstrual cycle, pregnancy, an IUD, and birth control pills can all impact cystic acne (both positively or negatively depending on the person), as they all influence our body's hormone activity. 

Diet: Perhaps you've already heard it around the rumor mill, but dairy, in particular, is problematic when it comes to cystic acne. "If you're developing cystic breakouts along the jawline and neck area, it might be a sign that you’re consuming more dairy than your body can tolerate," notes Rouleau. Our skin naturally acts as an excretory system to get rid of things our body doesn't agree with or has too much of. So if you're sensitive to dairy or you've been imbibing more than usual, you're body might be trying to expel what it doesn't need. 

In general, try to focus on a balanced, clean diet with lots of nutritious greens and healthy fats. And if you suspect dairy could be causing your cystic breakouts, Rouleau recommends completely cutting out dairy for a full three weeks and keeping a food diary, which will help keep you accountable.

"If you don’t develop any new cysts then this might solve your problem," she explains. "It doesn’t mean you'll never be able to eat dairy again—just be mindful as you slowly introduce it back into your diet. The point at which you start breaking out again shows your body’s tolerance level."

Genetics: One of the most frustrating things about acne is how mysterious it is. Every case of acne is unique (there's hardly ever a straightforward quick fix), and experts say there is still a lot of mystery surrounding the underlying causes of acne. That said, both studies and skin experts alike cite genetics (sorry!) as a major player in determining whether or not a person will experience breakouts—cystic acne included.

Clogged pores: Keeping your pores as clean and clear as possible is paramount for anyone who regularly experiences or is especially susceptible to cystic acne breakouts. Dead skin cells, sebum accumulation, and P. acnes bacteria can all cause and worsen cystic breakouts, so make sure you're cleansing regularly (choose something noncomedogenic, gentle, balancing, and hydrating) both morning and night or after strenuous activity or exercise. Additionally, exfoliating once or twice a week will sweep away buildup and help keep skin clear and free of congestion.

As much as we'd love to say there's an easy, fast, straightforward treatment for cystic acne (or any type of acne for that matter), that's just not the case. The cause and presentation of acne is highly individual, so first and foremost, Gohara says the very best thing you can do is make an appointment with a professional. Although the pandemic has made in-office appointments trickly this year, if and when possible, it's best to consult a dermatologist or licensed esthetician. They'll be able to professionally assess your skin and create a game plan for treatment. Supplements, skincare products, in-office treatments, or even prescriptions such as spironolactone, birth control, or Accutane might be recommended depending on the severity of your cystic acne.

That said, while professional care should be your first step toward treatment, I asked Gohara and Rouleau for a list of their top recommendations when it comes to the dos and don'ts of treating cystic acne. Keep scrolling for all of their best insight. 

Just don't do it. Just don't! As Rouleau reiterates, picking and prodding cystic acne is one of the absolute worst things you can do if you're looking to curb the severity of a breakout. If you have a certain bump that's especially tempting or you know you touch your face out of habit, we recommend popping on a hydrocolloid acne patch as a healthy treatment barrier and finger deterrent. These types of patches might not banish your bump completely, but at the very least, they'll act as a barrier between acne and pick-happy hands.  "Despite being sore, you’ll never get that infection out with your fingers, and if you attempt to, you’ll most certainly have a scar that will linger for months," Rouleau warns. Her golden rule of thumb? If a whitehead doesn't form on your bump (which it won't if it's a true cyst), do your very best to keep your hands off. Be patient—eventually, your body will reabsorb the infection, and the bump will go away.

If you're prone to congestion and are trying to control and treat cystic acne, Gohara says heavy creams and oils (or anything with highly comedogenic ingredients), should be avoided at all costs. We recommend opting for oil-free moisturizers or switching out your favorite rich creams for lighter versions if they're available. (For instance, Augustinus Bader's The Cream, $170, would be a better option than the brand's Rich Cream, $170, for people who are acne prone.) 

On the other hand, aggressively depriving your skin of moisture in the effort to curb oil and acne will have the exact opposite effect you think it will. Although it might sound counterintuitive, when the skin thinks it's being starved, it will try to overcompensate by creating even more oil—an automatic retaliation that will only hinder your efforts to treat cystic breakouts. "Using too many drying ingredients will strip the skin barrier and promote inflammation," notes Gohara. "Also, be cautious about some of the 'anti-acne' skincare products on the market. Many are too harsh and will spike irritation." Instead, we suggest prioritizing gentle, hydrating formulas that are specifically designed to keep skin balanced and congestion-free.

Exfoliation is one of the best ways to stay on top of cystic acne and to encourage clear, happy skin. But overexfoliating can do more harm than good and can potentially damage the skin barrier. Gohara recommends incorporating a product like this one from Melé into your routine as needed. It's studded with potent AHAs and BHAs, and she says it's the perfect antidote to help control excess oil. It's safe for melanin-rich skin, and thanks to lactic acid, you'll get added brightening and spot-fading benefits.

Scarring is par for the course when it comes to any kind of acne, cystic included. If you're experiencing stubborn spots, Gohara suggests keeping a targeted serum like this one on deck—it's safe for all skin tones, and it contains strategic ingredients such as niacinamide and retinyl propionate to even out discoloration.

In addition to lifestyle adjustments like managing your stress levels and choosing high-quality, low-glycemic foods, Gohara is a big proponent for retinoids and retinol-containing products when it comes to treating cystic acne: "Retinoids help regulate the shedding of skin cells so that pores don’t clog and bacteria can't settle in as easily." Just like your other exfoliation measures, however, don't hit your skin too hard and too fast with your new retinol. You'll want to follow the directions on the product label, but typically, you'll start with a small application at night once or twice a week and then, depending on how your skin reacts, build your way up. Also, make sure you're extra diligent about daily sunscreen application when using a retinoid. (Celeb esthetician Shani Darden's formula is a fan favorite!)

We always recommend talking to a trusted health professional or nutritionist before tinkering too much with your supplement routine, but according to Rouleau, certain additions like vitamin B-6 or calcium magnesium may be especially helpful for cystic acne. (They can help level out the hormonal imbalances, in particular, that occur around our period.) She suggests taking these supplements daily the week leading up to your period for the best results in addition to making slight yet strategic tweaks to your typical skincare regimen. "I also advise subtly switching up your skincare routine this time of the month to help minimize bacteria by using the four products in my Rapid Response Detox Kit ($133)," she tells us. "When used five days before the start of your cycle, these products can help prevent breakouts and create a healthier skin environment."

One of the best ways to quell an angry cystic breakout is by getting a cortisone shot from a dermatologist, but a quick trip to the derm isn't always a realistic option in terms of time or budget (especially this year). That said, Rouleau's iconic Anti Bump Solution ($50) (formerly known as Anti Cyst) is the next best thing to a fancy in-office treatment, and it's regarded as practical magic within the beauty editor circle. The goal is to keep everything as calm, cool, and collected as possible, so finding inflammation-fighting formulas that are still gentle and thoughtfully formulated is key. 

Up next, How to Remove Stubborn Blackheads Like a Celebrity Esthetician

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