Understand “How to Treat Cystic Acne Effectively (Photo& Video)

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.

Dealing with big cystic acne can be tough, as it’s deeper and more painful than regular acne. Cystic acne occurs when pores become clogged with oil, dead skin cells, and bacteria, leading to an infection beneath the skin. Unlike other forms of acne, cystic acne tends to form large, painful bumps or nodules under the skin that can be red and swollen. Here’s how to treat cystic acne effectively, with both at-home solutions and professional treatments:

1. Topical Treatments for Cystic Acne

A. Retinoids

Retinoids are one of the most effective treatments for cystic acne because they speed up cell turnover, prevent clogged pores, and reduce inflammation.

• Solution: Topical Retinoids (Adapalene, Tretinoin)
  • How it works: Retinoids increase skin cell turnover and prevent clogged pores, which is key in treating cystic acne.
  • Product Examples: Differin Gel (Adapalene 0.1%) or Retin-A (Tretinoin).
  • How to Use: Apply a thin layer at night after cleansing. Start with 2–3 times a week to allow your skin to adjust, then gradually increase usage.

B. Benzoyl Peroxide

Benzoyl peroxide kills the bacteria that contribute to acne and can help reduce inflammation and redness in cystic acne.

• Solution: Benzoyl Peroxide Gel (2.5% or 5%)
  • How it works: It works by killing acne-causing bacteria and reducing inflammation.
  • Product Examples: Clean & Clear Persa-Gel 10 or Neutrogena On-the-Spot Acne Treatment.
  • How to Use: Apply a thin layer directly on the cystic acne area once or twice a day. It can be drying, so follow with a moisturizer.

C. Salicylic Acid

Salicylic acid can help unclog pores and reduce the swelling and redness of cystic acne, though it’s less effective than benzoyl peroxide for deeper cysts.

• Solution: Salicylic Acid (BHA)
  • How it works: It penetrates deep into the pores to exfoliate the skin and clear out the buildup of oil and dead skin cells.
  • Product Example: Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant.
  • How to Use: Apply 2-3 times per week to the affected area after cleansing.

2. Oral Treatments for Severe Cystic Acne

If topical treatments don’t work, or if you have severe cystic acne that doesn’t respond to over-the-counter products, a doctor may prescribe oral treatments.

A. Oral Antibiotics

Oral antibiotics, such as tetracycline, doxycycline, and minocycline, can help reduce inflammation and control acne-causing bacteria in the body.

• Solution: Doxycycline or Minocycline (prescription only)
  • How it works: These antibiotics reduce the bacteria that contribute to acne and have anti-inflammatory properties.
  • How to Use: Take as prescribed by your doctor, typically for a few months. These are usually prescribed for moderate to severe cases of cystic acne.

B. Oral Contraceptives (for females)

For women, hormonal changes can contribute to cystic acne, especially around the jawline. Oral contraceptives can help regulate hormones that trigger acne.

• Solution: Combined Oral Contraceptives
  • How it works: Certain birth control pills can regulate the hormones that cause acne, particularly androgens (male hormones).
  • How to Use: Only available with a prescription from your doctor. You may need to try a few different types to find one that works for your skin.

C. Isotretinoin (Accutane)

Isotretinoin is a potent oral medication used for severe cystic acne that hasn’t responded to other treatments. It works by drastically reducing oil production, preventing clogged pores, and reducing acne-causing bacteria.

• Solution: Isotretinoin (Accutane)
  • How it works: It’s a high-dose form of vitamin A that targets all factors contributing to acne. It’s considered a last-resort treatment due to its potential side effects but is highly effective for severe cystic acne.
  • How to Use: It is only prescribed by a dermatologist and requires regular check-ins due to possible side effects (dry skin, joint pain, etc.).

3. At-Home Care to Manage Cystic Acne

While you’re treating cystic acne with medications, here are some additional steps you can take at home to help manage it:

A. Ice Packs for Inflammation

Applying an ice pack or cold compress can reduce the swelling and pain associated with cystic acne.

• How to Use: Wrap an ice cube in a clean cloth or use a cold compress, and hold it on the cyst for 5–10 minutes. This can reduce redness and swelling.

B. Avoid Picking or Popping

Picking at cystic acne can cause it to become more inflamed, increase the risk of scarring, and even lead to more breakouts.

• Tip: Keep your hands away from your face to prevent transferring dirt and bacteria to the skin, which can worsen the acne.

C. Non-Comedogenic Skin Care

Use a gentle skincare routine that’s non-comedogenic (won’t clog pores). Look for moisturizers, sunscreens, and cleansers that are labeled as such.

• Solution: Gentle, Non-Comedogenic Moisturizer
  • Product Example: Neutrogena Hydro Boost Water Gel or CeraVe PM Facial Moisturizing Lotion.

D. Use a Clay Mask for Spot Treatment

Certain clay masks (such as those with bentonite or kaolin clay) can help to draw out impurities from the skin and calm inflammation.

• Solution: Clay Masks for acne-prone skin
  • Product Example: Aztec Secret Indian Healing Clay or Origins Clear Improvement Active Charcoal Mask.
  • How to Use: Apply the mask to the cystic acne areas and leave it on for 10–15 minutes. Use once a week or as needed.

4. Professional Treatments for Cystic Acne

A. Cortisone Injections

For large, painful cysts, dermatologists can inject a corticosteroid (like triamcinolone) directly into the cyst. This can reduce inflammation and shrink the cyst, helping it heal faster.

• How it works: The injection speeds up the healing process and can make the cyst less noticeable in just a few days.
• When to get it: If you have a particularly painful cyst that isn’t responding to topical treatments.

B. Chemical Peels

A dermatologist can perform chemical peels to exfoliate the skin deeply and reduce acne outbreaks.

• How it works: Chemical peels use acids (like salicylic acid or glycolic acid) to exfoliate the outer skin layers and help clear clogged pores.

C. Laser Treatments

Laser treatments, like the Nd:YAG laser, target sebaceous glands to reduce oil production, helping prevent acne flare-ups.

• How it works: These lasers can also reduce scarring and help with overall acne treatment.

Summary: Treatment Plan for Cystic Acne

1. At-Home Care: Use gentle cleansers, topical treatments like benzoyl peroxide or salicylic acid, and avoid picking at the cysts.
2. Oral Treatments: Consider antibiotics or oral contraceptives if topical treatments aren’t enough. If the acne is severe, isotretinoin may be necessary.
3. Professional Help: If your cystic acne persists, a dermatologist can help with cortisone injections, chemical peels, or laser treatments.

Cystic acne can be tricky to treat, but with the right approach, you can manage and significantly reduce flare-ups. If over-the-counter products don’t work, it’s best to consult a dermatologist for more advanced treatments.

What is Cystic Acne?

Cystic acne is a severe form of acne that involves deep, inflamed breakouts. Unlike superficial blackheads or whiteheads, cystic acne forms under the skin and typically appears as large, painful lumps filled with pus. It occurs when pores are clogged with oil, dead skin cells, and bacteria, causing inflammation and infection in deeper layers of the skin. These cysts can be painful, tend to leave scars, and are more resistant to over-the-counter treatments.

Treating Cystic Acne: Detailed Solutions & Treatments

1. Topical Treatments

A. Retinoids (Vitamin A Derivatives)
Topical retinoids are one of the most effective treatments for cystic acne. They promote cell turnover and prevent pores from becoming clogged.

• Mechanism: Retinoids like Adapalene (Differin) and Tretinoin (Retin-A) work by increasing the turnover of skin cells, which reduces clogged pores and prevents new cysts from forming.
• Efficacy: A study published in Dermatology and Therapy found that topical retinoids reduce the number of comedones (clogged pores), and decrease inflammation, helping with cystic acne over time. The study showed significant improvement in cystic acne with adapalene (Differin) used over 12 weeks.Reference: “Efficacy of topical retinoids in acne vulgaris: A review.” Dermatology and Therapy, 2015.
• Product Examples:
  • Differin Gel (Adapalene 0.1%) — FDA-approved for over-the-counter use.
  • Retin-A (Tretinoin) — Prescription-only, often recommended for more severe acne.
• How to Use: Apply a thin layer in the evening after cleansing. Start with 2-3 times per week, and increase frequency gradually.

B. Benzoyl Peroxide
Benzoyl peroxide is one of the most common ingredients in acne treatments. It works by killing acne-causing bacteria and reducing inflammation.

• Mechanism: Benzoyl peroxide works by killing Propionibacterium acnes (the bacteria that cause acne) and reducing oil production, which makes it effective for inflamed cystic acne.
• Efficacy: A clinical trial published in the Journal of the American Academy of Dermatology showed that benzoyl peroxide was effective in reducing the size and severity of inflammatory acne lesions, including cysts.Reference: “Comparison of topical benzoyl peroxide and oral antibiotics in the treatment of moderate acne vulgaris.” Journal of the American Academy of Dermatology, 2002.
• Product Example: Neutrogena On-the-Spot Acne Treatment (Benzoyl Peroxide 2.5%) or Clean & Clear Persa-Gel 10 (Benzoyl Peroxide 10%).
• How to Use: Apply a thin layer directly to the affected areas once or twice daily after cleansing.

C. Salicylic Acid
Salicylic acid (a BHA or beta-hydroxy acid) is used to help exfoliate the skin and clear out clogged pores. It works well for mild cystic acne, especially when combined with other treatments.

• Mechanism: Salicylic acid penetrates the pores to help dissolve excess sebum and skin cells, reducing the likelihood of blockages and inflammation.
• Efficacy: A study in Dermatology Research and Practice found that salicylic acid is effective for treating non-inflammatory acne and mild inflammatory acne, though it is less effective for cystic acne compared to benzoyl peroxide.Reference: “Salicylic acid in the treatment of acne vulgaris: A review.” Dermatology Research and Practice, 2012.
• Product Example: Paula’s Choice 2% BHA Liquid Exfoliant or Neutrogena Oil-Free Acne Stress Control Triple-Action Toner.
• How to Use: Apply 2-3 times per week, after cleansing, to affected areas.

2. Oral Medications

If topical treatments aren’t sufficient, or if you have severe cystic acne, oral medications may be prescribed.

A. Oral Antibiotics
Oral antibiotics, such as doxycycline and minocycline, are frequently prescribed to reduce bacteria and inflammation in moderate-to-severe acne.

• Mechanism: These antibiotics target P. acnes, reducing the bacteria that contribute to acne, and help reduce inflammation.
• Efficacy: A study published in Clinical Infectious Diseases indicated that oral antibiotics, especially tetracycline and doxycycline, are effective in reducing acne-related bacteria and decreasing the severity of cystic acne.Reference: “Tetracycline and doxycycline for acne vulgaris: A review of the evidence.” Clinical Infectious Diseases, 2012.
• Product Examples: Minocycline or Doxycycline (prescription).
• How to Use: Take as prescribed by your doctor, typically for 3–6 months.

B. Oral Contraceptives (For Women)
Hormonal birth control pills are often prescribed for women who experience acne due to hormonal fluctuations (e.g., around the menstrual cycle or during puberty).

• Mechanism: These medications regulate hormones, specifically reducing androgens, which are hormones that can stimulate sebaceous (oil) glands, leading to acne.
• Efficacy: A clinical review published in JAMA Dermatology found that combined oral contraceptives are effective in reducing acne in women, especially when the acne is hormonally-driven.Reference: “Oral contraceptives for the treatment of acne: A systematic review.” JAMA Dermatology, 2017.
• Product Examples: Yaz, Ortho Tri-Cyclen, and Estrostep.
• How to Use: Prescription-only, taken daily.

C. Isotretinoin (Accutane)
Isotretinoin is a potent oral medication that is prescribed for severe cystic acne that has not responded to other treatments. It’s a form of vitamin A that drastically reduces oil production and shrinks sebaceous glands.

• Mechanism: It targets all causes of acne—excess oil, clogged pores, bacterial growth, and inflammation. It’s typically a last-resort treatment for severe cases.
• Efficacy: Studies have shown that isotretinoin leads to long-term remission for up to 80-90% of patients with severe cystic acne. However, it comes with significant side effects (dry skin, joint pain, birth defects), so it requires careful monitoring by a dermatologist.Reference: “Long-term safety of isotretinoin use for acne.” Journal of the American Academy of Dermatology, 2006.
• Product Example: Accutane (generic isotretinoin).
• How to Use: Taken as prescribed by a dermatologist, often for 4-6 months.

3. Professional Treatments

A. Cortisone Injections
For very large, painful cysts, a dermatologist can inject a corticosteroid directly into the cyst. This reduces inflammation and can shrink the cyst within a few days.

• Mechanism: The corticosteroid reduces swelling and pain and speeds up the healing process by reducing the inflammatory response.
• Efficacy: Studies show that corticosteroid injections are highly effective in rapidly reducing cyst size and pain, often with noticeable improvement in a few days.Reference: “Corticosteroid injections for acne vulgaris: A review.” The Journal of Clinical and Aesthetic Dermatology, 2015.

B. Chemical Peels
Chemical peels use acidic solutions to exfoliate the skin and clear clogged pores. They are especially useful for reducing scarring and preventing new cysts from forming.

• Mechanism: Glycolic acid or salicylic acid peels help to exfoliate the upper skin layers, unclog pores, and reduce inflammation.
• Efficacy: According to Dermatologic Surgery, chemical peels can help with reducing acne lesions and preventing the formation of new cysts when used as part of an acne management routine.Reference: “The effectiveness of chemical peels for acne vulgaris: A systematic review.” Dermatologic Surgery, 2014.

C. Laser Treatments
Laser treatments, such as the Nd:YAG laser, can help target the sebaceous glands to reduce oil production and treat acne.

• Mechanism: Lasers penetrate deeper layers of the skin to target oil glands, reducing acne lesions and preventing future breakouts.
• Efficacy: Research published in Lasers in Surgery and Medicine indicates that laser treatments can be effective for treating inflammatory acne, including cystic acne.Reference: “Laser treatment for acne vulgaris.” Lasers in Surgery and Medicine, 2011.