There's acne, and then there's cystic acne-those blemishes that are swollen, red, and live under the skin. While those zits may not rear their ugly heads like other pimples, they're painful-and difficult to get rid of. That's because, unlike with your typical zit, cystic acne treatments need to work below the surface of your skin.
While basically everyone will experience these suckers in their lifetime, they’re more common if you suffer from hormonal acne. “Cystic acne has the same genetic and environmental risk factors as ordinary acne, with family history, medical history, lifestyle, and diet all playing a role,” says says Estee Williams, MD, a dermatologist in NYC.
If you do see a cystic zit brewing beneath the surface of your skin, it's best to treat it ASAP. "Early treatment prevents scarring and hyperpigmentation, so it helps to catch cystic acne early," says says Tony Nakhla, MD, dermatologist and founder of Eighth Day skincare.
While a quick visit to your dermatologist for a cortisone shot is definitely the fastest way to get rid of a cystic breakout, it's not always feasible. So try these at-home steps to help deal with your painful breakout.
1. Exfoliate the spots with acid.
The first step to treating cystic acne is to ensure your breakout is free of makeup, dirt, and oil that can further clog your pores. If your skin is actively breaking out, it's already inflamed and sensitive, so opt for a nonabrasive acid exfoliator, like one of these exfoliators specifically for acne-prone skin.
2. Kill the acne-causing bacteria.
Once you’ve cleansed your face, you’ll want to ensure you get rid of the bacteria that’s responsible for the face invader. Over-the-counter benzoyl peroxide products, like this one from La Roche-Posay, will kill the bacteria within the follicle that is the culprit of the inflammatory process, says Irene Gladstein, MD, founder and medical director at Enhance Aesthetic Arts in New York City.
3. Stop the swelling.
Due to the inflammation surrounding cystic zits, they stick out like a sore thumb. The easiest way to bring them back down: ice. “Ice constricts the blood vessels and assists with swelling,” says Dr. Gladstein. If the swelling doesn’t improve, however, you might need a script from your dermatologist for something stronger. “Often times cystic acne requires oral medication to curb the inflammation from inside the body,” says Dr. Williams.
4. Reduce the redness.
An over-the-counter hydrocortisone cream that contains at least 1% hydrocortisone can help calm redness and shrink down the size of the zit. It's important to note that the longer you leave it on, the better your results will be. "Put a heaping amount on the area of concern overnight, and that usually does the trick," says Peter Siatta, MD, a clinical instructor at NYU's Department of Dermatology.
He also recommends milk soaks, which offer a deep clean and can reduce redness in the process. Simply apply three times a day for 10 minutes at a time, using a mixture of cold whole milk and water (soak a cotton pad in the mixture and press it onto skin). The secret behind a milk soak that makes it so effective? Lactic acid. The powerful alpha-hydroxy acid contains antimicrobial properties that target dead skin and clogged pores.
5. Do not (repeat: DO NOT!) try to pop it.
Cystic pimples don't contain puss and never come to a head, so picking at a cystic pimple (or any bump on your face, for that matter) creates a breeding ground for bacteria and infection. Not to mention, picking one of these bad boys is the fastest route to leaving an acne scar, which is way harder to treat than the breakout.
6. Don't forget about the rest of your face.
While you are slathering a cocktail of treatments on that mammoth zit, it’s important not to neglect the rest of your complexion. “Keeping your skin moisturized with a very light lotion that won’t clog your pores will protect your skin from the drying effects of any acne-combatting measures,” says Dr. Gladstein. Try this gel-cream from Neutrogena.
While you should try to keep your face as clean and makeup-free as possible, if you do have to apply some concealer to help get you through your day, make sure you're reaching for an oil-free product. "Using cover up is not bad as long as you are using oil-free makeup, which tends to be less likely to clog pores and exacerbate the acne," says Dr. Nakhla.
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