Of all the different types of acne, cystic acne is perhaps the most persistent – and definitely the most physically painful. If you’ve experienced these red, angry spots that live teasingly under the surface of the skin, never quite coming to a head, you’ll know exactly what we mean. But that’s not the only reason why cystic spots win the unpopularity contest – they’re also much more difficult to treat than blackheads, whiteheads or closed comedones.
If you’ve tried every trick in the book, and come up short every time, don’t give up just yet. We’ve spoken to the country’s leading acne experts to discover exactly how to manage these deep-seated breakouts safely and effectively. Stay with us for everything you need to know about treating, covering, and preventing cystic acne, both at home and in the hands of a dermatologist.
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What Is Cystic Acne?
‘The term cystic acne is used to describe large, red, painful, deep lumps that look like boils and represent the most severe form of the condition,’ explains consultant dermatologist Dr. Justine Kluk. Like other types of acne – think blackheads and pustules – these persistent blemishes are caused by an abnormal level of sebum mixing with dead skin cells deep inside our pores. ‘This leads to blockages, activation of a bacterium known as cutibacterium acnes and subsequent swelling, pus and inflammation.’
What Causes Cystic Acne?
According to Kluk, hormones are a key player in sparking a bout of acne, which explains why you always seem to spot a cyst looming around the same time as your period. This is because hormonal fluctuations can stimulate oil production and thicken the lining of the pores.
What’s more, genetics, our diet and lifestyle can also play a role.
Cystic Acne Treatment – The Professional Options
Sadly, eliminating cystic acne isn’t as easy as slapping on a face mask and crossing your fingers. If your case is acute, it might be worth considering professional treatment.
‘Treatment of cystic acne can be challenging and may require a combination of medicines,’ says Dr. Kluk, who advises seeking a referral to a consultant dermatologist. She stresses the importance of making an appointment sooner, rather than later, as leaving things too long may lead to scarring. ‘An oral retinoid medication called isotretinoin is often required to control cystic acne. Sometimes oral antibiotics and corticosteroids (which may also be injected into the most inflamed cysts) are also prescribed,’ she explains.
Debbie Thomas, skin expert and founder of D.Thomas Clinic, also recommends a course of isotretinoin (aka Roaccutane), for extremely persistent cases of cystic acne. However, this powerful treatment shouldn’t be taken lightly. While it can be incredibly effective in suppressing excess oil production and turning over dead skin cells, there are many less appealing side effects to consider, and lifestyle changes that must be made – all of which will be explained by your dermatologist.
‘On lower doses and if monitored correctly, there is much less risk of unwanted side effects with Roaccutane,’ says Thomas. ‘Just remember, your skin will become more sensitive while taking it, so be gentle and protect it from the sun every day with an SPF 50.’
Next up, lasers. Thomas highly recommends a course of laser facial treatments, which can be cocktailed with microneedling sessions (do not try this at home), and salon-strength peels.
‘The key is to go to someone who is experienced at managing acne-prone skin. I find I have to tailor the treatment to each person to get the best results. A point to remember is that acne is closely linked to hormones, so it is triggered internally, and the symptoms show externally. This means that there is no real cure for acne but rather ways to manage the symptoms – so prepare for a long-term plan and not a quick fix.’
Cystic Acne Treatment – The At-Home Tool Kit
At-home treatments for cystic acne do exist, though – and they can be pleasingly effective when it comes to mild-to-moderate cases.
Like most experts, Thomas considers retinol the most powerful and proven ingredient when it comes to treating acne – but you must use it correctly, and be patient.
‘Retinol can now be bought over the counter at a 0.5% strength, or you can get a prescription from your doctor for 1% or higher. You need to use retinol consistently and regularly for 6-12 weeks to see the results,’ she says. It’s best to introduce your skin to this ingredient slowly: try applying it every other night for the first fortnight. If that still leaves you with dryness and irritation, try scaling back to one application every third night.
Another option is salicylic acid. ‘It’s oil-soluble so it can penetrate much deeper than other acids, and is also slightly antibacterial and anti-inflammatory,’ says Thomas. Again, this pore-clearing acid can be drying, so always layer a light hydrator on top.
What Not To Do – And What Not To Buy
While topical products may help to keep acne-prone skin healthy, Dr. Kluk is keen to stress that serums and skincare alone won’t bring severe cystic acne under control. However, she does recommend sticking to a few skincare principles while on your path to clearer skin…
- Never try to pick or squeeze cysts. This can lead to infection and increase the risks of scarring.
- Don’t attempt to scrub or exfoliate the skin. This can increase swelling and redness.
- Use a mild cleanser and moisturiser, and possibly a sunscreen in the morning too. This may be all that is necessary whilst you complete your course of medication.
As Thomas adds, some products may actually contribute to the formation of blockages in the pores, ultimately exasperating your acne. She advises ditching the oils, balms and richer creams, looking instead for products – both skincare and makeup – marked ‘non-comedogenic’, (non pore-blocking). ‘Also avoid overly drying products,’ she says. ‘Drying out the surface just causes more redness and irritation but will rarely penetrate deep enough to effect the cyst.’
Cystic Acne – The At-Home Routine
Of course, everyone’s skin is unique, and the treatment that works for your BFF may not do a thing for you. However, Thomas’ no-messing routine for cystic acne-prone skin makes a brilliant jumping-off point for anyone attempting a skin transformation – even if it’s a stop-gap while you wait for a dermatologist’s appointment.
- Wash with a salicylic-acid face wash to keep pores as clean as possible.
- Apply a vitamin C serum. This helps protect the skin and reduces the likelihood of post-inflammatory pigmentation.
- Apply a lightweight lotion.
- Finish with an oil-free SPF.
- Wash with your salicylic cleanser again.
- Apply retinol (initially only every third night).
- Apply a light hydrator – a serum or lotion is great – containing niacinamide to reduce enlarged pores and calm the skin.
This article originally appeared on ELLE UK.