It can be frustrating to spend money on an expensive skin care product or pricey treatment, only to find it doesn’t work well for your skin. This is especially true if you’re prone to breakouts and feel as though you’ve tried nearly every cleanser and serum on the drugstore shelf, hoping to clear them up.
It turns out that if you suffer from the severe inflammatory breakouts known as cystic acne, most products you’ll find over the counter aren’t going help your skin — no matter what the label claims. That’s because the cysts form deep in your skin. “If you attempt to use a traditional spot-drying treatment, this won’t do anything other than dry out the surface of the skin, which is not where the infection is,” explains Renée Rouleau, a celebrity esthetician and founder of Renée Rouleau Skincare.
Here’s why a trip to your dermatologist and some lifestyle changes are your best bet for achieving clear skin if you suffer from cystic acne.
What’s the difference between regular breakouts and cystic acne, anyway?
Fundamentally, cystic breakouts and other acne occur for the same reason: a blockage of the ducts between the oil gland and the surface of the skin, according to Dr. Craig Kraffert, a board-certified dermatologist and president of Amarte Functional Skin Care. But the differences stop there. “It’s what happens after this blockage occurs that determines the type of acne and acne lesions that develop,” says Kraffert. “Cystic acne occurs due to massive inflammation of the backed-up oil gland structure.” This inflammation results in large, often painful “cysts” and can leave scarring behind.
Why your over-the-counter products aren’t working
Unfortunately, cystic acne can be difficult to treat. “Cystic pimples are often large and ‘juicy,’ due to a high degree of inflammation, leading to redness and swelling within the bump,” explains Dr. Estee Williams, a dermatologist in New York City. “The reason that most over-the-counter products aren’t effective is that, often, cystic acne requires oral medication to curb the inflammation from inside the body.”
Still, Kraffert says you shouldn’t completely throw your at-home skin care routine out of the window. As all breakouts have the same origin (blockage of the oil-gland ducts) you can prevent future breakouts and cysts from forming. But the majority of topical products you’re using at home won’t treat current, or active, cystic acne.
What the experts recommend
So what can be done if you’re experiencing cystic breakouts? Make an appointment with a dermatologist ASAP. “Most of the frustration with cystic acne stems from the trial-and-error experience of purchasing and using skin care products that prove not to work well. Save your time and money and see a dermatologist to help you get on track,” Willams recommends.
She says if there’s a hormonal imbalance causing your cystic acne, you’ll need blood work to detect it.
Then, your dermatologist may recommend a prescription treatment, such as isotretinoin (formerly Accutane.) “Although there are many myths regarding the dangers of isotretinoin, it is actually quite safe,” notes Kraffert.
For women who are pregnant or hoping to become pregnant, and are also prone to cystic acne, dermatologists can prescribe topical alternatives. “Ironically, you are more likely to get a safe acne med by seeing a dermatologist and getting a prescription than buying something over-the-counter with, for example, salicylic acid or benzoyl peroxide, which are not considered safe in early pregnancy,” cautions Williams.
What else your dermatologist can do for you
If you’re not too thrilled about taking medication, requesting cortisone shots from your dermatologist is a popular alternative. “We have patients who drive one to two hours for these shots, which take five seconds. It’s hard to believe,” Williams says. She also suggests asking your dermatologist about high-tech treatments, like the M22 intense pulsed light (IPL) treatment. Williams uses this light-based therapy to decrease bacteria counts and reduce redness for her patients. She also recommends Isolaz treatments, which she describes as “vacuum suction followed by flashes of broadband light.” Both options target deep into pores and can reduce redness in as little as 24 to 48 hours.
Don’t forget about your esthetician
Valery Stein, an esthetician at Paul Labrecque Salon and Spa in New York City, says she can’t prescribe medication for cystic acne. For that reason, it’s important to see your dermatologist, if possible, in addition to booking a spa day. But what estheticians can do is offer supplementary treatments in addition to your medication, including deep-cleansing facials, extractions on existing acne, and glycolic peels. “I especially like the combination of an anti-acne facial and/or medical facial that includes a glycolic peel,” she says. “I’ve seen this produce visible results many times.”
How to treat cystic acne at home
If you can’t make it to a dermatologist or esthetician due to financial or other logistical constraints, you still have options. Rouleau helped developed a specific, at-home cystic acne treatment for this reason. “This is a groundbreaking problem-skin treatment, exclusively formulated to quickly relieve these types of blemishes,” she says. “When applied directly on the cyst, it can eliminate it more rapidly, without a trip to the doctor’s office.” You can buy the Anti Cyst Treatment ($45.50) serum on her website.
Pain, go away
Rouleau also says it’s important not to pick at cysts, as tempting as it may be. “Despite being sore, you’ll never get that infection out,” she says. “If you attempt to [pick at them] you’ll most certainly have a scar that will linger for months. The rule is: If a whitehead does not form (which they never do if it’s a true cyst), then hands off!”
One at-home trick that she recommends for cystic acne pain is to apply ice. “It can help take down swelling to reduce soreness,” she notes.
San Diego-based dermatologist Dr. David Lortscher adds, “If you tolerate NSAIDS, a little Advil or something similar by mouth for several days can help decrease the swelling and tenderness somewhat.”
Consider your lifestyle
Lastly, don’t underestimate lifestyle changes. Some can make a big difference if you’re prone to cystic acne. Kraffert says studies have shown that maintaining a low-to-healthy BMI (body mass index) can cut your risk for cystic acne in half. Eating more salmon and trout may also lead to clear skin. “Diets rich in fish seem to protect against acne, while milk consumption, especially skim milk, is correlated with up to a two-fold increase in acne risk,” he says. Interestingly, smoking or eating chocolate doesn’t seem to make a difference when it comes to cystic breakouts.
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