Cystic-acne sufferers know that a cyst is not the same beast as your garden- variety pimple. While whitehead pimples sit on the surface of the skin (which, though unsightly, means they’re easier to treat and conceal), cysts can linger under the surface of the skin like oil-filled balloons, growing bigger and more inflamed over time. The scarring can be severe, too, making skin appear pockmarked and fissured, which is why dermatologists approach it with a powerful combination of topical treatments and antibiotics, moving on to scorched-earth methods like Accutane or a hormonal drug like Spironolactone if those fail.
But the milder cases can benefit from some topical over-the-counter treatments, too: “OTC options should be limited to when you have only one or two cysts,” though, says dermatologist Noelani Gonzalez, the director of cosmetic dermatology at Mount Sinai West. “Otherwise you should go see your dermatologist sooner than later to avoid any scarring.” We spoke with six dermatologists to hear more about the most effective cystic-acne treatments to use at home.
Best overall cystic-acne treatment
Differin Adapalene Gel 0.1% Prescription Strength Retinoid Acne Treatment
Four of the dermatologists we spoke to were in agreement that integrating a retinoid into your skin-care routine is essential to preventing cysts. Retinoids, which we’ve touched on before, are beneficial for exfoliating the skin and purging your pores of dirt and oil, which is why Dr. Joshua Zeichner, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital, says they’re helpful for cysts, too. He recommends Differin, the only prescription-strength retinoid that’s available over the counter. “Differin should be the first OTC product someone with cystic acne should use,” says Dr. Samer Jaber, founder of Washington Square Dermatology. Differin gel contains Adapalene, a medication that decreases inflammation, prevents new acne from forming, improves blackheads, and helps improve discoloration, he explains. Zeichner says you can use a pea-size amount and start applying it every other night as your skin gets adjusted to it. Dr. Debra Jaliman, an assistant professor of dermatology at Mount Sinai’s Icahn School of Medicine, also recommends Differin but stresses that since retinoids make your skin more sensitive to the sun, applying an SPF in the morning is nonnegotiable.
Best sunscreen for cystic acne
EltaMD UV Clear Broad-Spectrum SPF 46
Jaliman loves Elta MD UV Clear SPF 46 — a longtime Strategist favorite — because “it’s lightweight, oil-free, and suitable for those who are prone to acne.” Not only does it protect from UV damage, but it is also specifically formulated to treat acne simultaneously. It contains niacinamide and B3, which will fade hyperpigmentation; hyaluronic acid, which will moisturize; and lactic acid, which will clear pores and reduce shine.
Best topical gel for cystic acne
Clean & Clear Persa-Gel
Since benzoyl peroxide is often prescribed in office for handling cystic acne (it kills acne-causing bacteria within the hair follicle), it was a popular choice among dermatologists we spoke to as an over-the-counter treatment. There are a couple of different options out there, from face washes to topical creams to body washes, but dermatologist Ross S. Levy, of CareMount Medical and the director of dermatologic surgery at the Albert Einstein College of Medicine, says that typically “the benzoyl peroxide (5 to 10 percent) topical creams or gels are more effective than the cleansers or washes.” The only danger with benzoyl peroxide to be mindful of is that it will stain clothing and pillowcases. Clean & Clear Persa-Gel, which contains 10 percent benzoyl peroxide, is one of Gonzalez’s go-to recommendations for treating cystic acne at home.
Best spot treatment for cystic acne
La Roche-Posay Effaclar Duo Acne Treatment Cream With Benzoyl Peroxide
“Products like Effaclar Duo from La Roche-Posay have some of these ingredients,” too, says Gonzalez: specifically, 5.5 percent benzoyl peroxide, with additional micro-exfoliating lipo-hydroxy acid. Dr. Morgan Rabach, a dermatologist and co-founder of LM Medical NYC, is also a fan of the product and says that it helps pimples shrink and disappear more quickly, while Jaber notes that the product has a ton of beneficial “anti-inflammatory and anti-bacterial effects.”
Best mask for cystic acne
Neutrogena Rapid Clear Stubborn Acne Daily Leave-on Face Mask
For an overnight solution or something that covers a larger surface area (rather than a smaller spot treatment), Zeichner also recommends Neutrogena’s rapid-clear leave-on mask. The idea is that you spread benzoyl peroxide all over your face but it’s not a wash-off mask, so you’re getting a prolonged exposure to the antibacterial peroxide. He says it’s helpful for treating the pimples you have and preventing new ones from popping up.
Best cleanser for cystic acne
Clean & Clear Acne Triple Clear Facial Cleanser With Salicylic Acid
Even better than one stand-alone cream is a multipronged combination of acne treatments. “A good place to start is to use a combination of salicylic acid, benzoyl peroxide, and a topical retinoid,” says Zeichner. “Salicylic acid helps remove excess oil from the surface of the skin and exfoliate the dead cells, while benzoyl peroxide kills acne-causing bacteria and helps reduce inflammation.” Zeichner likes Clean & Clear Acne Triple Clear face wash with salicylic acid in it, but says to sit with it for a bit to let it sink into skin. “Allow salicylic acid to sit on the skin while you sing the alphabet before rinsing, to ensure enough contact time for it to do its job.”
Best body cleanser for cystic acne
Panoxyl Acne Creamy Wash
If you are struggling with cystic acne on your chest or back, Jaber suggests using a wash like Panoxyl in the shower, which contains 4 percent benzoyl peroxide to kill acne-causing bacteria.
Best exfoliator for cystic acne
SkinMedica AHA/BHA Cream
Using an effective chemical exfoliator is super-important to aid cell turnover and unclog pores, which will hopefully keep cysts from forming in the first place. Harsh physical scrubs should be avoided since they typically only cause more damage long-term. Morgan loves this cream from SkinMedica, which contains a combination of alpha-hydroxy acid and beta-hydroxy acid to improve skin texture. She also has this advice for patients to keep breakouts from getting worse: “Avoid oily cosmetics, sunscreens, and hair products, stay away from harsh products and abrasive tools, and do not pick or squeeze blemishes.”
Best ointment for cystic acne
Cortizone 10 Maximum Strength Ointment, 2 Ounce
Both Gonzalez and Jaliman suggest buying a hydrocortisone cream to reduce painful inflammation and redness. Gonzalez says that you can even mix in a drugstore cortisone cream with a homemade blend of benzoyl peroxide and salicylic acid. It’s not going to be as effective as an in-office cortisone shot, but it’ll help reduce inflammation nonetheless.
Best moisturizer for cystic acne
Neutrogena Hydro Boost Hyaluronic Acid Hydrating Water Face Gel Moisturizer for Dry Skin
When it comes to hydrating the skin, Jaliman says patients should stay away from any creams that contain heavy oils. Morgan agrees and notes that using an oil-free water-based moisturizer will keep skin hydrated while preventing breakouts. She recommends this one from Neutrogena, which contains hyaluronic acid to keep skin supple and moisturized. It is also dye- and fragrance-free.
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