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What is a Cyst?

A cyst is a benign, encapsulated lesion that consists of a fluid sac which contains liquid, or semi-fluid material. It can vary in shape, size and location. The most common types of cysts are reviewed here.

Acne, acne cysts, and sebaceous cysts are benign skin lesions and are one of the most common reasons which patients consult with dermatologists like Dr. Michele Green in Manhattan.  Sebaceous cysts are the most common type of cyst, and are slow-growing noncancerous bumps on the skin. However, if sebaceous cysts are left untreated, they tend to enlarge, get infected, and cause cosmetic scarring. Dr. Michele Green treats these sebaceous cysts in her Upper East Side NYC office each day. Through her minimally invasive techniques, she treats these cysts in a cosmetically elegant way, and avoids any unnecessary scarring.

What is a Sebaceous Cyst?

A Sebaceous cyst is like a large pimple. Similar to acne, sebaceous cysts form within or near hair follicles. Sebaceous cysts are benign, firm or palpable growths, which can present as a small lump under the dermis. These cysts are formed from dirt, or excess oil, or a build-up of dead skin and sebum which gets trapped due to clogged hair follicles. Sebaceous cysts can grow rapidly, enlarging over the course of days or weeks.

These cysts most commonly present on the face, back and chest, where the majority of sebaceous glands exist. They do not occur on the palms of the hand or soles of the feet. Sebaceous cysts form a lump under the skin and initially looks like a small bump. The overlying skin is usually flesh colored or yellow in appearance due to the build up of sebum, pus, and keratin. These cysts grow slowly and can also be formed from trauma. Sebaceous cysts may initially be painless, although as large cysts develop, they often become painful. Most sebaceous cyst are not life-threatening, and they can often resolve on their own. However, some sebaceous cysts  do not resolve and need further treatment. Depending on the location of the cyst, the amount of discomfort, the possibility of infection and scarring, and the cosmetic ramifications, these cysts will need to be treated and removed by Dr. Green in her NYC office.

1. Understand What’s Happening:

• Cystic Acne: Cystic acne occurs when a hair follicle becomes deeply clogged with oil, dead skin cells, and bacteria. The clog becomes inflamed and forms a painful, large cyst beneath the skin’s surface. These cysts are often swollen and tender.
• Blackheads: Blackheads form when pores become clogged with oil and dead skin cells. When the clog reaches the surface, the oxidation of the oil gives it a black color. Blackheads are typically open comedones, meaning the pore remains open to the air.

When these two skin issues collide—deep cystic acne with a visible blackhead—it can be tough to manage, but with the right treatment approach, they can be controlled.

2. Step-by-Step Treatment Plan:

A. Gentle Cleansing

• What to do:
  Use a gentle, non-comedogenic cleanser that won’t strip your skin of natural oils but will help remove excess oil, dirt, and dead skin cells. Look for products that are sulfate-free, as harsh cleansers can worsen acne.
• Why it helps:
  Cleansing removes dirt and excess oil that contribute to clogged pores, helping to prevent new blackheads and cystic acne from forming.

B. Exfoliation

• What to do:
  Exfoliating is essential to clear out dead skin cells, which can clog pores. You can use chemical exfoliants like salicylic acid (a beta-hydroxy acid or BHA) or benzoyl peroxide to target both blackheads and acne.
• Why it helps:
  Salicylic acid penetrates deep into the pores to break down oil and dead skin cells, which is particularly useful for both blackheads and cystic acne. Benzoyl peroxide helps reduce acne-causing bacteria and can help prevent cystic breakouts.
• Note: Start slow with exfoliants to avoid over-drying or irritating the skin.

C. Targeted Treatment for Cystic Acne

• What to do:
  For cystic acne, you may need a stronger treatment:
  • Retinoids (Retinol or Tretinoin): Topical retinoids help prevent pores from becoming clogged and promote skin turnover, reducing both acne and blackheads over time. Adapalene (a type of retinoid) is available over-the-counter and is often recommended for acne.
  • Spot Treatments: Use spot treatments that contain benzoyl peroxide, sulfur, or salicylic acid. These ingredients can help reduce the size and inflammation of cystic acne.
  • Corticosteroid Injections: If the cystic acne is very large or painful, a dermatologist can inject a steroid into the cyst to reduce inflammation quickly.
• Why it helps:
  Retinoids are one of the most effective treatments for cystic acne because they speed up cell turnover and reduce the formation of clogged pores. Benzoyl peroxide targets acne bacteria, helping prevent the infection and inflammation that contribute to cystic acne.

D. Blackhead Extraction (Carefully!)

• What to do:
  If you have blackheads that are very noticeable or prominent, you may be tempted to extract them yourself. If you do decide to attempt this, make sure your hands are clean and use a blackhead extractor tool after you’ve steamed your face to open the pores.
• Why it helps:
  Blackhead removal can help clear out clogged pores. However, be cautious not to cause scarring or push the bacteria deeper into the skin, which can worsen cystic acne.

E. Consistent Use of Non-comedogenic Products

• What to do:
  Ensure that all the products you’re using—moisturizers, sunscreens, makeup—are non-comedogenic, meaning they won’t clog your pores.
• Why it helps:
  Many skincare and makeup products can clog pores, making cystic acne and blackheads worse. Using the right products reduces the risk of further breakouts.

F. Consider Professional Treatments

• What to do:
  If over-the-counter treatments aren’t working, consult a dermatologist. They may suggest professional treatments such as:
  • Chemical Peels: These can help exfoliate deeper layers of skin, removing dead skin cells and reducing blackheads and acne.
  • Microdermabrasion: A dermatologist or licensed esthetician can use this treatment to exfoliate the skin and clear out blackheads.
  • Laser Treatments: Some lasers target acne bacteria and reduce inflammation, helping treat cystic acne and scarring.
• Why it helps:
  Professional treatments are often more potent and targeted than home skincare and can accelerate results, particularly when cystic acne is severe or stubborn.

G. Don’t Pick or Squeeze

• Why it helps:
  Picking or squeezing cystic acne or blackheads can push the bacteria deeper into the skin, causing further inflammation, scarring, and possibly spreading the infection. It’s best to leave it to professionals or use the right treatments to help the acne heal naturally.

3. Lifestyle Considerations:

• Diet: While not the sole cause of acne, studies have shown that high-glycemic foods (like processed sugar) and dairy can exacerbate acne. Maintaining a balanced diet may help manage your skin.
• Stress Management: High stress can trigger hormonal changes that worsen acne. Practicing stress-relieving activities like yoga, meditation, or exercise can be beneficial.
• Sleep: Adequate sleep supports skin regeneration, so aim for 7-9 hours per night to help your skin repair itself.

4. Patience is Key

Cystic acne and blackheads can be persistent, but with consistent care, the situation should improve. Treatments can take time (often several weeks) to show significant results, so stay consistent and gentle with your skincare routine.

1. Understanding the Causes of Cystic Acne and Blackheads

Cystic Acne

• Cause: Cystic acne occurs when hair follicles become clogged with a combination of dead skin cells, oil (sebum), and bacteria, which can lead to inflammation. Unlike typical pimples, cysts develop deeper within the skin, forming large, painful, and often swollen lumps.
• Reference: A study published in Dermatology Clinics explains that cystic acne is caused by increased sebum production, clogged hair follicles, and bacterial overgrowth. Specifically, Propionibacterium acnes is one of the bacteria involved in the development of cystic acne (Zaenglein et al., 2018).

Blackheads

• Cause: Blackheads form when a pore is clogged with sebum and dead skin cells. Unlike cystic acne, blackheads are open comedones, meaning they are exposed to air. The dark color comes from oxidation of the sebum within the pore.
• Reference: According to a study published in Dermatology Times, keratinocytes (skin cells) along with sebum cause the formation of both blackheads and whiteheads. The oxidation of sebum at the pore opening causes the black coloration seen in blackheads (Draelos, 2005).

2. Step-by-Step Treatment Plan

A. Gentle Cleansing

• Why it Helps:
  Cleansing helps remove dirt, oil, and impurities that contribute to clogged pores. A gentle cleanser can also prevent the skin from becoming irritated or stripped of essential oils, which can worsen acne.
• What to Do:
  Choose a sulfate-free, non-comedogenic cleanser that won’t disrupt your skin’s barrier function. For acne-prone skin, look for cleansers containing salicylic acid.
• Reference: A study in the Journal of Drugs in Dermatology highlighted that gentle cleansers are less likely to irritate acne-prone skin, compared to harsher formulations (Draelos, 2015).

B. Exfoliation

• Why it Helps:
  Exfoliation helps remove dead skin cells from the surface of the skin, preventing clogged pores. Chemical exfoliants, like salicylic acid or glycolic acid, penetrate deeper into the pores to clear out oil and debris that cause acne and blackheads.
• What to Do:
  Use salicylic acid (BHA) or benzoyl peroxide to treat acne. Salicylic acid is especially effective for blackheads because it dissolves oil inside pores.
• Reference: The American Academy of Dermatology suggests that salicylic acid is highly effective in treating non-inflammatory acne, including blackheads, by exfoliating the skin and preventing clogged pores (Zaenglein et al., 2018).
• Note: Over-exfoliating can irritate the skin, so be sure to use exfoliating products sparingly (2-3 times a week).

C. Targeted Treatment for Cystic Acne

• Why it Helps:
  For deep cystic acne, stronger treatments are needed to address inflammation and bacteria under the skin. Retinoids, benzoyl peroxide, and topical corticosteroids can reduce cyst formation and accelerate healing.
• What to Do:
  • Retinoids (Tretinoin, Adapalene): Retinoids promote skin cell turnover, helping to prevent clogged pores and reduce the size of cysts. Adapalene is available over-the-counter and is proven to be effective for acne.
  • Benzoyl Peroxide: Benzoyl peroxide kills acne-causing bacteria and reduces inflammation, making it effective for treating both blackheads and cystic acne.
  • Corticosteroid Injections: For large cysts, a dermatologist can inject a corticosteroid directly into the cyst to reduce inflammation rapidly.
• References:
  • A systematic review published in JAMA Dermatology confirmed that retinoids help with both inflammatory acne (like cysts) and non-inflammatory acne (like blackheads) (Zaenglein et al., 2016).
  • A study in Dermatology Clinics explains that benzoyl peroxide is effective in reducing Propionibacterium acnes and preventing acne breakouts (Burris et al., 2005).

D. Blackhead Extraction (Carefully!)

• Why it Helps:
  While it’s tempting to squeeze blackheads, doing so incorrectly can lead to scarring, infections, or worsening acne. If done properly, blackhead extractions can clear clogged pores without causing further damage.
• What to Do:
  If you choose to extract blackheads at home, steam your face to open the pores. Then, use a blackhead extractor tool gently. Alternatively, consider having blackhead extractions performed by a professional esthetician or dermatologist.
• References:
  The British Journal of Dermatology notes that professional extractions performed by a licensed provider can remove blackheads effectively and prevent skin damage (Chien et al., 2014).

E. Consistent Use of Non-comedogenic Products

• Why it Helps:
  Using skincare products that are labeled non-comedogenic ensures that they won’t clog your pores, which can exacerbate both cystic acne and blackheads.
• What to Do:
  Choose moisturizers, sunscreens, and makeup that are specifically labeled as non-comedogenic.
• Reference: According to American Academy of Dermatology, products with the non-comedogenic label are ideal for acne-prone skin as they do not contain ingredients that promote the formation of acne (Zaenglein et al., 2016).

F. Professional Treatments

• Why it Helps:
  If over-the-counter treatments aren’t effective, a dermatologist can provide more advanced treatments.
• What to Do:
  • Chemical Peels: These remove the top layer of skin to reduce blackheads and acne.
  • Microdermabrasion: This mechanical exfoliation technique clears clogged pores and can reduce the appearance of blackheads.
  • Laser Treatments: Some lasers target acne-causing bacteria and reduce inflammation, which can help treat cystic acne and prevent future breakouts.
• Reference: According to a study in Dermatologic Surgery, chemical peels can help reduce the severity of acne by deep exfoliation, clearing clogged pores and reducing inflammation (Kessler et al., 2015).

G. Don’t Pick or Squeeze

• Why it Helps:
  Squeezing acne or blackheads can push bacteria deeper into the skin, making the acne worse and increasing the risk of scarring.
• What to Do:
  Always resist the urge to pick or pop pimples, especially cystic acne. Use topical treatments or visit a professional for extraction instead.
• Reference: A study in Clinical Dermatology emphasizes that manual extraction by untrained individuals can cause skin damage and worsen acne, while professional extractions can be safe and effective (Lee et al., 2004).

3. Lifestyle Considerations:

• Diet:
  While the link between diet and acne isn’t fully understood, some studies suggest that high-glycemic foods and dairy may worsen acne. Reducing these foods can be beneficial for some individuals.
  • Reference: A study in The Journal of the American Academy of Dermatology found that a high-glycemic diet (rich in processed sugars and carbs) can exacerbate acne (Adebamowo et al., 2008).
• Stress Management:
  Stress increases cortisol levels, which can lead to increased oil production and acne flare-ups.
  • Reference: The Journal of Investigative Dermatology published research linking psychological stress to an increase in acne severity (Yosipovitch et al., 2007).
• Sleep:
  Adequate sleep promotes skin healing and can reduce inflammation.
  • Reference: Research in Clinical and Experimental Dermatology confirms that sleep deprivation can compromise the skin’s barrier and healing processes (Huang et al., 2010).

4. Patience is Key:

Both cystic acne and blackheads can take time to improve, even with the right treatment. Consistency is critical, and you may need to give your treatment regimen several weeks to show visible results.

• Reference: According to the Journal of Dermatological Treatment, acne treatments typically take 4-6 weeks to show noticeable improvement (Draelos, 2015).