“If topical treatment alone does not improve acne, or if acne is severe or extensive, oral medications are the best option. If you’ve tried several topical medications without success, or if your condition is severe, oral acne medications are usually the next step in the treatment process. Treatment usually includes oral antibiotics and applying a prescription gel or topical cream to the skin. Depending on people with acne, treatment may include using prescription creams to prevent acne, taking antibiotics to kill bacteria that contribute to acne, or, if acne is severe, taking stronger medications such as like isotretinoin, or even minor surgery. Even if you have tried topical acne treatments such as creams or gels without any lasting results, laser therapy may be the right solution for you. While I would like you to try natural remedies first, if you are not seeing improvement and severe hormonal acne is making your quality of life worse, other treatments can make a real difference. While it may take a while, treating hormonal acne from the inside out until your hormones are in their natural, happy balance will allow your skin to truly heal.

While my approach isn’t an instant solution, and won’t replace everyone’s multi-drug regimen, hormonal acne can be very sensitive to a more holistic approach, which means less medication and more patches. While the studio treatments offered by Carolina Skin Care can be very effective in treating acne, patients should also commit to taking care of their skin at home. Multiple topical treatments, whether it’s steroids for eczema or topical antibiotics for acne, topical treatments may help in the short term, but in the long run, it can damage the skin, making you more likely to take it in the future. In addition to other treatments, you can take the most obvious step to soothe stress-related acne: reduce stress. If the creams and antibiotics you have been prescribed are not working, or if you cannot tolerate the side effects that medications may cause, you may want to consider acne treatments, which can be provided at your doctor’s office.

Cystic acne and blackheads are both types of acne, but they have different characteristics and require different treatment approaches. When you’re dealing with big cystic acne blackheads, you’re likely facing a combination of clogged pores (which lead to blackheads) and deep, inflamed acne cysts (which can be painful and large).

Here’s how to treat and manage both blackheads and cystic acne:

What is Cystic Acne with Blackheads?

• Blackheads are open comedones, where a pore becomes clogged with dead skin cells, oil, and debris, and the trapped sebum oxidizes, turning it black.
• Cystic Acne involves deep, painful, and inflamed cysts under the skin. These cysts are typically filled with pus and can be large, red, and very tender.

When cystic acne forms in areas that also have clogged pores (like blackheads), it can lead to more complex acne lesions, including painful bumps that don’t come to a head.

Step-by-Step Guide to Treating Big Cystic Acne and Blackheads

1. Cleanse Gently

• Use a gentle cleanser: Start with a mild, non-comedogenic (won’t clog pores) facial cleanser that’s specifically formulated for acne-prone skin.
  Recommended Products:
  • CeraVe Foaming Facial Cleanser (good for oily or acne-prone skin)
  • Neutrogena Oil-Free Acne Wash (contains salicylic acid)
  • La Roche-Posay Effaclar Purifying Foaming Gel

  Why it works:
  Cleansing twice a day helps remove dirt, oil, and bacteria that contribute to both blackheads and cystic acne without irritating the skin.

2. Use Exfoliating Treatments (But Not Too Harsh)

Exfoliating helps remove dead skin cells that can clog pores and contribute to both blackheads and cystic acne.

• Salicylic Acid (BHA) is an excellent option for both cystic acne and blackheads, as it penetrates deep into pores to dissolve the buildup of dead skin and oil.Recommended Products:
  • Paula’s Choice 2% BHA Liquid Exfoliant
  • The Ordinary Salicylic Acid 2% Solution

  Why it works:
  Salicylic acid penetrates deeply into the pores and helps dissolve the substances that block them, preventing both blackheads and cystic acne. Chemical exfoliation (like salicylic acid) is less abrasive than physical exfoliants (scrubs), which can irritate cystic acne.

3. Apply Topical Treatments for Cystic Acne

For cystic acne, stronger treatments are needed, as the inflammation is deep under the skin.

• Benzoyl Peroxide: This is effective for treating deep cystic acne by killing the bacteria that cause inflammation and helping to reduce the size of the cyst. Recommended Products:
  • PanOxyl Acne Foaming Wash (10% Benzoyl Peroxide)
  • Neutrogena On-the-Spot Acne Treatment (2.5% Benzoyl Peroxide)
• Retinoids: Retinoids (like adapalene) are a gold standard for acne. They increase skin cell turnover, prevent clogged pores, and help reduce inflammation. Differin Gel is available over the counter and works well for both blackheads and cystic acne.Recommended Products:
  • Differin Gel (Adapalene 0.1%)

  Why it works:
  Benzoyl peroxide helps kill acne-causing bacteria and reduces inflammation. Retinoids increase cell turnover, preventing new blackheads and acne from forming while also helping to clear up existing lesions.

4. Don’t Squeeze or Pop

• Avoid touching, squeezing, or popping cystic acne. Cystic acne is deep under the skin, and attempting to pop it can lead to scarring, infection, or making the acne worse.Why it works:
  Squeezing cystic acne can push bacteria deeper into the skin, cause more inflammation, and make the cysts larger and more painful.

5. Spot Treatments

You can use spot treatments to target individual cystic acne lesions. These treatments contain concentrated ingredients to reduce inflammation and help the cysts heal faster.

• Sulfur: Sulfur-based spot treatments can help reduce inflammation and break down the oil in acne.
• Tea Tree Oil: Tea tree oil has anti-inflammatory and antimicrobial properties and can help reduce the size and redness of cystic acne.Recommended Products:
  • Mario Badescu Drying Lotion (contains sulfur and salicylic acid)
  • The Body Shop Tea Tree Oil

  Why it works:
  These spot treatments are designed to target specific acne lesions, so they can help heal cystic acne and reduce the swelling around blackheads.

6. Moisturize

Even oily or acne-prone skin needs moisturizing. Choose a non-comedogenic moisturizer to ensure your skin stays hydrated without clogging pores.

• Oil-Free Moisturizers: These provide hydration without contributing to acne or blackheads.Recommended Products:
  • Neutrogena Hydro Boost Water Gel
  • CeraVe Daily Moisturizing Lotion

  Why it works:
  Moisturizing helps maintain your skin’s natural barrier, preventing excessive oil production and irritation from treatments like retinoids or benzoyl peroxide.

7. Consider Professional Help

If your cystic acne and blackheads are particularly severe, or if they don’t improve with over-the-counter treatments, it’s important to consult a dermatologist.

• Dermatological Treatments:
  • Corticosteroid injections: A doctor can inject a corticosteroid into large cystic acne lesions to quickly reduce inflammation and prevent scarring.
  • Chemical Peels: Professional chemical peels can help clear the skin by exfoliating deeper layers and preventing blackheads.
  • Extraction: In-office extractions by a professional can safely remove blackheads without damaging the skin.

8. Maintain a Consistent Routine

Consistency is key when managing both cystic acne and blackheads. Stick with your routine for several weeks to see noticeable improvements. Acne treatments take time, and quitting too early can prevent you from seeing results.

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What NOT to Do:

• Don’t over-exfoliate: Over-exfoliating can irritate and inflame cystic acne, worsening the condition.
• Don’t use harsh scrubs: Physical exfoliants or scrubs can irritate and inflame cystic acne, leading to scarring and further breakouts.
• Don’t skip sunscreen: Acne treatments (especially retinoids and benzoyl peroxide) can make your skin more sensitive to the sun. Use a broad-spectrum sunscreen (SPF 30 or higher) to protect your skin.

Prevention Tips for Blackheads and Cystic Acne:

• Don’t touch your face: Avoid touching your face throughout the day, as this can transfer oil and bacteria to your skin.
• Regularly cleanse your skin: Wash your face twice daily to keep pores clear.
• Use oil-free makeup: Look for makeup labeled as non-comedogenic to reduce the chance of clogged pores.

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References and Studies

1. American Academy of Dermatology (AAD):
   • Acne treatment guidelines provide evidence-based recommendations on treating cystic acne and blackheads. They emphasize the role of salicylic acid, benzoyl peroxide, and retinoids in treating both types of acne. AAD Acne Treatment
2. Journal of Clinical and Aesthetic Dermatology:
   • A study discussing the effectiveness of topical retinoids and benzoyl peroxide for treating both comedonal (blackheads) and inflammatory acne (including cystic acne). J Clin Aesthet Dermatol. 2014 Jan; 7(1): 21-28. PubMed Study
3. PubMed:
   • Research on the role of salicylic acid and retinoids in preventing and treating comedonal and cystic acne, focusing on the use of these ingredients in a clinical setting. PubMed Acne Treatment

Step-by-Step Treatment for Big Cystic Acne with Blackheads:

1. Gentle Cleansing

It’s important to start with gentle cleansing that removes excess oil and dirt without over-drying or irritating the skin.

• Use a non-comedogenic cleanser designed for acne-prone skin. Look for cleansers that contain salicylic acid or benzoyl peroxide. These ingredients target both blackheads and cystic acne by preventing pores from becoming clogged and reducing inflammation.Recommended Products:
  • CeraVe Foaming Cleanser for Oily Skin (contains ceramides and niacinamide)
  • Neutrogena Oil-Free Acne Wash (contains salicylic acid)

  Reference: A study published in the Journal of the American Academy of Dermatology (JAAD) shows that salicylic acid helps in clearing clogged pores and preventing acne breakouts. Salicylic acid is also effective in treating comedones (blackheads), a precursor to cystic acne (JAAD, 2016).

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2. Exfoliate with Salicylic Acid or Retinoids

• Salicylic Acid (BHA) is a type of beta hydroxy acid that works as a chemical exfoliant. It penetrates deeply into pores and helps break down the buildup of dead skin cells, which can clog pores and lead to blackheads and cystic acne.
• Retinoids, such as adapalene (found in Differin Gel), help by increasing cell turnover, preventing clogged pores, and reducing the size and inflammation of cystic acne.Recommended Products:
  • Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant (salicylic acid)
  • Differin Gel (Adapalene 0.1%) (retinoid for acne)

  Reference: The Journal of Clinical and Aesthetic Dermatology discusses how salicylic acid reduces acne lesions, including blackheads, while retinoids like adapalene significantly improve both non-inflammatory (blackheads) and inflammatory (cystic acne) lesions by speeding up skin cell turnover (J Clin Aesthet Dermatol, 2014).

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3. Use Benzoyl Peroxide for Cystic Acne

Benzoyl peroxide is an effective treatment for cystic acne as it kills the bacteria (P. acnes) that contributes to inflammation and acne formation. It also helps reduce the overall size of cystic acne lesions.

Recommended Products:

• PanOxyl Acne Foaming Wash (10% Benzoyl Peroxide)
• Neutrogena On-the-Spot Acne Treatment (2.5% Benzoyl Peroxide)

Reference: The Journal of the American Academy of Dermatology highlights the clinical benefits of benzoyl peroxide for inflammatory acne, including cystic acne, and recommends it as a standard treatment. It works by killing the bacteria in the pores and reducing inflammation, which makes it effective for cystic acne treatment (JAAD, 2017).

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4. Spot Treatments for Cystic Acne

For individual cysts, spot treatments can be useful to reduce inflammation and pain.

• Sulfur-based treatments can help dry out cysts and reduce redness.
• Tea Tree Oil: Contains antimicrobial properties and has been shown to reduce inflammation and help treat cystic acne.Recommended Products:
  • Mario Badescu Drying Lotion (contains sulfur and salicylic acid)
  • The Body Shop Tea Tree Oil

  Reference: Research in the Journal of Dermatological Treatment supports the use of tea tree oil as a natural anti-inflammatory agent for acne, with significant reduction in lesion size when applied topically (J Dermatol Treat, 2016).

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5. Moisturizing

Even if you have oily or acne-prone skin, moisturization is crucial to help prevent over-drying and irritation from acne treatments like salicylic acid or benzoyl peroxide. Choose oil-free and non-comedogenic moisturizers.

• Look for moisturizers that contain hyaluronic acid or glycerin, which hydrate the skin without clogging pores.Recommended Products:
  • Neutrogena Hydro Boost Water Gel
  • CeraVe Daily Moisturizing Lotion

  Reference: The American Academy of Dermatology emphasizes the importance of moisturizing even for acne-prone skin, as dehydration can worsen acne and irritation, particularly with the use of drying treatments like benzoyl peroxide (AAD Acne Treatment Guidelines).

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6. Professional Treatment Options

If your cystic acne and blackheads are persistent and difficult to manage, a dermatologist may recommend professional treatments such as:

• Corticosteroid Injections: Used to reduce swelling and pain in large cysts.
• Chemical Peels: Professional chemical peels can help exfoliate the skin deeply and reduce both blackheads and cystic acne.
• Extraction: In-office extraction can safely remove blackheads without scarring, especially if they are large or persistent.Reference: According to a study in Dermatologic Surgery, corticosteroid injections are highly effective in treating large cystic acne lesions by rapidly reducing inflammation and improving healing (Dermatol Surg, 2006).