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.
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 acne condition,' explains consultant dermatologist Dr. Justine Kluk. Like other manifestations of acne – think whiteheads 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.'
ELLE Edit: Cystic Acne Treatments
This legendary toner is designed to be swiped over problematic patches after cleansing. Trust us, it works.
Studies have found blue light therapy to deliver significant improvements in inflammatory conditions such as acne, and this pocket-sized torch is the easiest way to reap the benefits. Simply hold it over cystic spots for three minutes a time.
While a regular hydrocolloid spot sticker will do little good on a deep cystic spot, these clever ones feature tiny microdarts that send a combination of niacinamide and salicylic acid straight to the source of the problem.
This bargain salicylic-acid treatment has garnered endless rave reviews.
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.
Best 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. Studies have found it to be incredibly effective, but this powerful treatment shouldn’t be taken lightly. While you can expect to see a reduction in your acne within approximately 4-6 months, there are many less appealing side effects of isotretinoin 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 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.'
The Best 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 topical 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 third night for the first fortnight, and monitor any redness and irritation you experience. If it feels sore or inflamed, scale things back until your skin acclimatises more.
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 beta-hydroxy-acid can be drying, so remember that less is more, and always layer a light hydrator on top.
ELLE Edit: Retinols For Cystic Acne
Pure and stabilised retinol (rather than a weaker derivative) makes this night cream a powerful option for resurfacing those pesky scars.
The only reliable retinol to cost less than £6
La Roche-Posay Retinol 0.3% + Vitamin B3 Serum
La Roche-Posay's retinols are recommended by so many dermatologists. This serum is a great entry point into the world of 'active' skincare.
Medik8 Crystal Retinal 1 Serum
Medik8 specialises in retinol products, and this one is the best starting point. Once you've finished the tube, progress onto the stronger Crystal Retinal 3.
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. Yes, we know it's tempting, but you will not win.
- Don’t attempt to scrub or exfoliate the skin. This can increase swelling and redness.
- Use a mild cleanser and moisturiser, and 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 will rarely affect a cyst, and really just causes more redness and irritation.'
ELLE Edit: Make-Up For Cystic Acne
This breathable foundation was created for use post-surgery, meaning it's as kind to the skin as possible. A game-changer for congested complexions.
A high-coverage formula that treats while it conceals. Brilliant.
The OG oil-free foundation, and still the best.
bareMinerals Original Loose Mineral Foundation SPF15
This classic mineral foundation is still a godsend for red, angry and sensitive skin. Buff it on, building the layers to cover angry red spots.
The Best Products For Cystic Acne
Of course, everyone’s skin is unique, and the treatment that worked for your mate 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.
AM:
- 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.
ELLE Edit: Spf For Cystic Acne
A brilliant everyday sunscreen that won't break you out.
The extra-light texture of this SPF will appeal to anyone with acne-prone skin.
Avene Very High Protection Mineral Fluid SPF50+
A beauty-editor favourite, this sunscreen uses mineral filters that are generally kinder on irritated skin and has a subtle mattifying effect.
Fan-favourite Drunk Elephant knows how to craft a stellar SPF. This one is silky, nourishing and reliable.
PM:
- Wash with your salicylic cleanser again.
- Apply retinol (initially only every third night, before working slowly up).
- Apply a light hydrator – a serum or lotion is great – containing niacinamide to reduce enlarged pores and calm the skin.
ELLE Edit: Face Wash For Cystic Acne
Salicylic acid sits alongside hydrating glycerin in this balancing cleanser.
Packed with high levels of salicylic acid, this gel cleanser is a real heavy hitter.
CeraVe Hydrating Cleanser
Working to cleanse without stripping the skin, this affordable staple is the ideal partner to your new retinol.
Free from oils and packed with both AHAs and BHAs, this is a stellar cleanser with added exfoliating powers.
