Like most of your body, even acne changes as you age. Though cystic acne can be found in teens and young adults, it usually appears as “adult” cystic acne in our mid-to-late twenties and beyond. Considered to be a severe form of acne, cystic acne is a result of oil, dirt and dead skin cells becoming trapped fairly deep in the pore, ultimately blocking it altogether.
Unlike a typical whitehead or blackhead, cystic acne can be excruciatingly painful and appear to look much more infected than an average pimple. So, what can we do to treat these cysts and where should we start? We caught up with skin care expert, Christina Ponzio-Guarino, MS, PA-C, to get some answers and relief.
Who gets cystic acne?
Cystic acne is most prevalent during times of hormonal changes in the body (puberty, perimenopause, etc.). According to Ponzio-Guarino, cystic acne is more commonly seen in female adults. Because it is found so much deeper in the pore, a cyst typically does not come to a head. Unlike an average breakout, cystic acne can also linger for a couple of weeks before it fully heals and is predominantly found around the chin and jawline.
“Many women have painful breakouts in sync with their menstrual cycle due to the hormonal response,” says Ponzio-Guarino. “The increase in testosterone triggers the sebaceous glands to release more sebum and combined with bacteria and inflammation/shedding of cells, this ends up clogging the pore much more severely.”
Related: The Acne and Birth Control Relationship
What are some tips for getting rid of cystic acne at home?
Cystic acne cannot as easily respond to at-home ingredients in the same way an average breakout could. Products like all-natural coconut oil or lemon juice have been known to aid in acne control, but Ponzio-Guarino’s first recommendation is to leave the cysts alone and absolutely avoid picking. Cysts have a much higher chance to leave behind more serious scars. The only thing that could safely assist in relieving pain and irritation is applying ice directly to the area. Ice can help in reducing redness and size due to shrinking some of the blood vessels.
“When cysts are present, the skin is in high distress,” says Ponzio-Guarino. “There should be no exfoliation or much of anything touching the cysts to avoid damaging them further.” As far as at-home treatments go, she recommends keeping things to a minimum. “If seeing a dermatologist isn’t easily accessible, I’d suggest using an extremely gentle cleanser and moisturizer only with increased percentages of either salicylic acid or benzoyl peroxide,” says Ponzio-Guarino.
Related: Salicylic Acid vs. Benzoyl Peroxide
When should you see a dermatologist for treatment?
You should take the time to visit your doctor if your cystic acne is severely painful, becomes infected, is causing head or neck pain or actively growing worse with time. If over-the-counter cleansers and treatments continue to be ineffective, antibiotics and other oral medications can be prescribed by your dermatologist to control cystic acne.
“The two medications that really help are Spironolactone (a diuretic) and for women, birth control,” says Ponzio-Guarino. “Other antibiotics can also be used to help mostly control the inflammation while we’d give those two at least four to six weeks to begin working.” Topically, Ponzio-Guarino suggests prescription tretinoin or retinoids to help unclog the follicles, but adds that severe cystic acne is primarily controlled with oral medication.
If you need to see a dermatologist to have a cyst drained or injected with steroids, Ponzio-Guarino says, “An intralesional kenalog steroid injection is great to make a cyst go away quickly, especially for important occasions.” A numbing application is applied so a draining or injection should not be painful, but Ponzio-Guarino warns that possible risks of overuse of injections can be atrophy—skin cell degeneration—if the area is injected too often, if too much is used or if it is not injected at the correct depth.
Related: What to Expect at Your First Dermatologist Appointment