Everything you need to know about dealing with these particularly pesky pimples.

By Melanie Rud
September 11, 2019
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Let's be real, there's no good kind of pimple. But if you're looking at breakouts on a scale ranging from bad to worse, then cystic acne falls on the way, way 'worse' end for sure.

"Cystic acne creates the most frustrating type of inflammatory blemishes because they last the longest and can cause long-term scarring," says Austin-based celebrity aesthetician and skin expert Renée Rouleau, founder of Renée Rouleau Skincare. They can also be painful.

Here's the lowdown on cystic acne, including what you need to know—and do—to deal with it.

What Is Cystic Acne?

"Acne presents itself in a variety of shapes and sizes," says Tara Rao, M.D., practicing at Schweiger Dermatology Group in New York City. Mild acne—your run-of-the-mill whiteheads, blackheads, and smaller pimples—is usually described as comedonal acne. When those pimples become large and sore and are deeper in the skin, you're probably looking at cystic acne, she says.

What Does Cystic Acne Look Like?

Where the blemishes lay in your skin is the biggest indicator of cystic acne. If your pimples are on the surface of your skin, i.e. things you could (but shouldn't) squeeze, you're dealing with comedonal acne. On the flip side, "cysts form deep underneath the skin and never come to the surface," explains Rouleau, adding that they're also hard and painful.

Talk about adding insult to injury. Cystic acne often crops up along the chin and jawline, notes Rouelau (more on why in a minute).

What Are Some Cystic Acne Causes?

Like with other acne, you can blame clogged pores (usually with oil and dead skin) and the bacteria (in this case p.acnes) that feeds off this gunk.

With cystic acne, bacteria causes inflammation and swelling deep in the pores. Whether or not you end up having it largely boils down to genetics and luck of the draw, though good ol' hormones also play a major role.

"Cysts are typically triggered by a surge of hormones, which is why they commonly occur around a woman's menstrual cycle," says Rouleau. "During this time, the skin's oil glands become hypersensitive to the hormone surge and react by overproducing sebum." Mid-cycle, there's also a dip in estrogen and spike in testosterone, which triggers sebum production. (Related: 6 Surprising Things Making Your Acne Flare Up)

All of this ultimately leads to those engorged, swollen, hard blemishes under the skin. And hormonal acne—also often referred to as adult acne—often pops up around the chin and jawline.

Another possible trigger: dairy. According to Rouelau, cystic acne might be a sign that you're consuming more dairy than your body can tolerate. (FYI, there have been several studies showing a correlation between acne and dairy. Recently, a 2018 study published in Nutrients found that the intake of milk, yogurt, and cheese all upped the likelihood of acne in people from age seven to 30.) The exact connection is still unclear, but the general consensus is that it once again goes back to hormones and that the hormone levels in milk stimulate excess sebum production. (Related: 10 Surprising Foods That Cause Acne)

What Is the Best Cystic Acne Treatment?

Now's really the time to call in the big guns (read: skin docs) since most of the common OTC acne treatments won't be able to reach blemishes buried deep in the skin. "Cystic acne is best addressed by a dermatologist who can suggest topical medicines, oral medicines, and sometimes cortisone injections," says Dr. Tao. (Topical and oral antibiotics are commonly prescribed, as is spironolactone, an oral drug that addresses the hormonal component.)

Above all, adopt a 100 percent hands-off policy: "Don't pick at cysts," says Rouleau. "They're not meant to come to the surface and doing so can cause scarring or lingering redness that lasts for weeks." Keeping your hands away from your face will also be helpful in mitigating the spread of bacteria (and FYI, all blemishes are related to bacteria in your pores).

What you can do is up your prevention game. Rouleau suggests cutting out dairy for three weeks to see if that's the culprit. (Related: Following a Dairy-Free, Raw Vegan Diet Helped My Horrible Acne)

As far as topicals go, be wary with standard spot treatments—most dry out the surface of the skin, further trapping the bacteria that's buried deep underneath causing the pimple, she says. Benzoyl-peroxide is one good ingredient to look for since it both kills the acne-causing bacteria and has anti-inflammatory benefits. The caveat: Look for it in a lower concentration (2.5 percent), since studies shows that it's as effective as higher percentages, but less drying. Find it in Neutrogena On-The-Spot Acne Spot Treatment (Buy It, $6, amazon.com). Rouleau also recommends calming, anti-bacterial masks to ward off breakouts without causing any further irritation or stress to your complexion. Try: Renée Rouleau Rapid Response Detox Masque (Buy It, $54, reneerouleau.com).

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