How to Get Rid of Cystic Acne

The best way to get rid of cystic acne is to see a dermatologist, and sooner beats later. It’s not the answer anyone hopes for, but it’s the one the American Academy of Dermatology (AAD) gives: deep, painful breakouts need a dermatologist’s help, and products you can buy online or in a store are unlikely to treat them effectively. Cysts and nodules form deep in the skin and often leave permanent scars, and the sooner treatment starts, the fewer scars you’ll have. A drugstore routine still has a job. It can keep your skin calm and your hands off the bump. So book the appointment first, then use the six products below as supporting acts while you wait. None of them is a cure, and we won’t promise that any of them clears acne.

What helps while you wait for the appointment

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Is it a cyst or an ordinary pimple?

An ordinary pimple sits near the surface. A cyst or nodule is the same clogged pore gone deeper. These breakouts develop when the swelling reaches far down into the skin, so they feel tender or painful, and you may not see much at all, only feel the lump.

The two words aren’t quite interchangeable. A cyst contains pus and a nodule doesn’t, so a nodule feels harder. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) uses “cystic acne” as another name for severe nodular acne. Either way, both are deep and both can scar.

Why the drugstore can’t finish this job

There’s no hedging on this one. You can’t clear severe acne with treatment you buy at the store: you either wait it out or see a dermatologist, and waiting can take years.

Scarring is the reason not to wait. Deep blemishes often cause permanent scars as they heal, and living with untreated acne for a long time raises the risk. Dark marks eventually fade on their own. Scars are permanent. We’ve written about what can improve pitted acne scars, but preventing the next one is the cheaper project.

What a dermatologist can offer

Prescription topicals. The AAD’s treatment guidance, which this whole section follows, lists four retinoids used for acne: adapalene, which is sold without a prescription, and the prescription retinoids tazarotene, tretinoin and trifarotene. A dermatologist may include more than one topical, such as benzoyl peroxide or a topical antibiotic, to fight the different causes of acne. Topicals work best for mild to moderate acne and are sometimes used along with another treatment for more serious acne. Our tretinoin vs. retinol explainer sorts out the names.

Oral antibiotics, for a limited time. Dermatologists prescribe an antibiotic for the shortest time possible, usually three to four months, along with another acne medicine such as benzoyl peroxide, because an antibiotic taken alone can lead to antibiotic resistance. How much it does for deep nodules is a question for your dermatologist. The guidance on severe acne lists an antibiotic plus a medicine you apply to the skin as often the first treatment recommended, while the main treatment page says an oral antibiotic can effectively treat moderate-to-severe pimples but not nodular acne.

Hormonal options for women. Some combined birth control pills are FDA approved for acne, and the pill has been found effective on nodules and cysts. Not everyone can take it, so tell your dermatologist if you smoke, have heart disease, are pregnant or plan to be. Spironolactone is the other option. It can treat deep-seated, tender acne on the lower face, jawline or neck when other treatments haven’t worked. It’s generally only for women, and anyone who can become pregnant must use birth control while taking it because it can cause serious birth defects. Our post on spironolactone for acne covers the questions to bring with you.

Isotretinoin. You may know the old brand name, Accutane. Dermatologists prescribe it for nodular acne that hasn’t responded to other treatments. A course usually takes four to five months, and it often results in prolonged clearance, which can be permanent for some patients. It comes with a check-in with your dermatologist every 30 days and enrollment in a risk-management program called iPLEDGE. MedlinePlus says pregnant women shouldn’t take it because it causes severe birth defects.

A corticosteroid injection for one painful cyst. A dermatologist can inject a deep, painful cyst or nodule with a corticosteroid, which speeds healing, lowers the risk of scarring and flattens most of them within 48 to 72 hours. It’s for one especially painful bump, not a face full of them. “Only a doctor should inject a corticosteroid,” the AAD says.

If you’re pregnant or trying. The AAD says isotretinoin, tazarotene and spironolactone should never be taken during pregnancy, and that most experts recommend stopping adapalene and tretinoin. For benzoyl peroxide, it says to talk with your obstetrician or dermatologist first.

Step by step: what to do at home meanwhile

1. Keep your hands off it. Picking at or squeezing a nodule or cyst can make it more noticeable and raise the risk of infection, discoloration and scarring, especially on darker skin.
2. Use a warm washcloth, and ice if it hurts. For a deep, painful pimple, soak a clean washcloth in hot water and apply it warm and damp for 10 to 15 minutes, three times a day. The point is to help the pimple move closer to the surface so it can heal, not to pop it. Ice relieves the pain of nodules and cysts.
3. Wash gently, up to twice a day. Use a gentle, non-abrasive cleanser and your fingertips. Scrubbing irritates acne-prone skin, and so do astringents, toners and exfoliants.
4. Add one over-the-counter treatment. For a deep pimple, the options are adapalene, azelaic acid, benzoyl peroxide and salicylic acid, in a thin layer, because too much can irritate your skin. Topical medications are more effective once the pimple is at the surface.
5. Moisturize. Benzoyl peroxide and retinoids tend to dry and irritate the skin, and a daily moisturizer helps skin tolerate them.
6. Wear sunscreen. The checklist is broad-spectrum, water-resistant, SPF 30 or higher, and labeled non-comedogenic.

1. Differin Gel

Differin Gel is an over-the-counter drug with one active ingredient, adapalene 0.1%. Its label gives its use as the treatment of acne. It’s on this list because adapalene is one of the four over-the-counter ingredients recommended for a deep, painful pimple, and it’s the retinoid you can buy without a prescription.

The label is blunt. Use it once a day, in a thin layer over the whole affected area. The leaflet says it isn’t a spot treatment and shouldn’t be used on a single pimple, so dabbing it on one cyst misses the point. Acne may look worse in the early weeks, and results may take up to three months. The label says to use sunscreen, and to ask a doctor before use if you’re pregnant or breastfeeding.

2. PanOxyl Acne Creamy Wash 4% Benzoyl Peroxide

PanOxyl Acne Creamy Wash is a drug too: benzoyl peroxide 4%, labeled for the treatment of acne. PanOxyl also sells a 10% foaming wash, and we’d skip it. It’s best to start low, at 2.5%, to avoid dry, irritated skin, and the 4% is the closer of the two.

The label says to massage it in for one to two minutes, rinse, and start with one use a day. It warns that benzoyl peroxide can bleach hair and dyed fabric, so use a white towel. If you bought the Differin as well, note that both labels say irritation is more likely when you use more than one topical acne medication at a time. Give one product four to six weeks before adding a second.

3. Hero Mighty Patch Original

Hero Mighty Patch Original is a hydrocolloid sticker with no drug in it. Be clear about what you’re buying. Hero says the hydrocolloid absorbs fluid and that the patch works in six hours to shrink the look of pimples, and its headline claim is about whiteheads. Hero makes no claim about cysts or nodules, so don’t buy it expecting one.

It’s on the list because a hydrocolloid patch can protect the skin and improve healing on a deep, painful pimple, and because Hero describes it as a physical shield against picking. That’s the job we’d give it: a sticker between your fingers and the bump. Our roundup of the best pimple patches compares other options.

4. Vanicream Gentle Facial Cleanser

Vanicream Gentle Facial Cleanser is the plain one. Vanicream calls it soap-free, pH balanced and non-comedogenic, and says it’s mild enough to use twice a day. It’s free of dyes and fragrance. It isn’t an acne treatment and doesn’t claim to be. All we want from a cleanser here is a clean face and no added irritation.

5. CeraVe PM Facial Moisturizing Lotion

CeraVe describes CeraVe PM Facial Moisturizing Lotion as oil-free and non-comedogenic, with niacinamide, hyaluronic acid and three ceramides. Those are two of the label terms acne-prone shoppers should look for on a moisturizer.

Skipping moisturizer because your skin is oily is a mistake once you start a retinoid or benzoyl peroxide. The Differin leaflet says a moisturizer may help with dryness and irritation, and adds a shopping tip of its own: avoid products with alpha hydroxy or glycolic acids. This lotion’s ingredient list has neither.

6. La Roche-Posay Anthelios Clear Skin Sunscreen SPF 60

La Roche-Posay Anthelios Clear Skin Sunscreen SPF 60 has four chemical filters (avobenzone, homosalate, octisalate and octocrylene), and its label says to reapply after 80 minutes of swimming or sweating. The product name on the label includes the words oil free. La Roche-Posay also calls it non-comedogenic and fragrance free; those two terms are the brand’s description, not part of the drug facts label. On those terms it matches the sunscreen checklist above.

Two caveats. It has no mineral filters, so if you prefer zinc oxide this isn’t your sunscreen. And the label’s inactive ingredients include beeswax, which is worth knowing if waxes have bothered your skin before.

What not to do

• Don’t pop it or lance it. Squeezing can push the contents deeper, which can mean scars, more pain and infection. Draining a cyst is a procedure for a medical office.
• Don’t use toothpaste. None of its ingredients fight acne, and they can irritate or harm your skin.
• Don’t buy isotretinoin online without a prescription. It puts your health at serious risk.

When to book the appointment

For cysts, now. The AAD doesn’t ask you to try the drugstore first when acne is deep and painful. It says you can benefit from seeing a dermatologist when acne causes cysts and nodules, hasn’t cleared with treatment you can buy without a prescription, or makes you uncomfortable. MedlinePlus says to contact a provider if you have cysts or if you develop scars as your acne clears.

If it’s one deep bump and your first, the home advice applies, with a limit: see a dermatologist if it doesn’t go away or if you develop several. For over-the-counter treatment in general, the same guidance gives four to six weeks on one page and six to eight on another before a dermatologist should take over. We’d go by the shorter one. Book now and cancel if you turn out not to need it.

If I Were You

If you have one large, painful cyst and something important this week, call a dermatology office and ask whether a corticosteroid injection is an option. Until then, use the warm washcloth, ice and a patch.

If the cysts keep coming, several at a time, book the appointment today and keep the routine plain in the meantime: gentle cleanser, one treatment, moisturizer, sunscreen.

If they cluster on your chin and jawline and flare around your period, say so at the appointment. Both are signs of hormonal acne, which is where the pill and spironolactone come in.

If you’re pregnant, trying or breastfeeding, don’t start any acne treatment from this list on your own. Ask your obstetrician or a dermatologist first.

If the deep bumps are in your armpits, groin or under your breasts, it may not be acne. Hidradenitis suppurativa causes acne-like cysts where skin touches skin, and it’s treated differently.

Bottom line

Cystic acne is a dermatologist’s problem, and the best thing you can buy for it is an appointment. While you wait, keep it boring: hands off, a warm washcloth, a gentle wash, one over-the-counter treatment used the way its label says, moisturizer and sunscreen. Skip anything that promises to shrink a cyst overnight. The fastest-acting option here is a corticosteroid injection, and it comes from a doctor. More routines for breakout-prone skin are in our skin archive.