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.
Milder cases can benefit from some topical over-the-counter treatments, too, but dermatologist Noelani Gonzalez, the director of cosmetic dermatology at Mount Sinai West, notes that “OTC options should be limited to when you have only one or two cysts.” Otherwise, she says, “you should go see your dermatologist sooner than later to avoid any scarring.” When it comes to OTC options, we asked Gonzalez and nine more dermatologists about the most effective cystic-acne treatments to use at home, and share their suggestions below. Before we begin, though, we should note that none of the derms we spoke to recommend using all of the items on this list, because many contain potent actives like retinoids, acids, and benzoyl peroxide. Rather, they suggest pairing products that contain stronger actives with gentler, non-irritating ones. With this in mind, the below list begins with the most-recommended product by our derms, before continuing to note their other recommendations as you’d use them in any skin-care routine, starting with cleansers and sunscreen and ending with nightly spot treatments, to help you determine which things may work best for you.
Best overall cystic-acne treatment
Four of the dermatologists we spoke to say 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,” adds Dr. Samer Jaber, the 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 a must if you are going to use it.
Best facial cleansers for cystic acne
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.”
Unlike salicylic acid, benzoyl peroxide doesn’t exfoliate, but it does have other acne-fighting properties including anti-bacterial powers, making it a great treatment for both comedonal and inflammatory acne, explains board certified dermatologist Dr. Hadley King. She describes AcneFree’s Oil-Free Acne Cleanser as “an excellent benzoyl peroxide product,” because while it is “strong enough to be effective,” it is still gente on the skin because it contains micro-benzoyl peroxide (which is less irritating to the skin than typical benzoyl peroxide) and hydrating ingredients such as glycerin.
If your routine already includes lots of topical products with active ingredients like retinoids or benzoyl peroxide, a milder cleanser may be a better choice in order to prevent further skin irritation, according to Dr. Marisa Garshick, a clinical assistant professor of dermatology at NYP-Cornell. “For those who suffer from oily skin but can’t tolerate salicylic acid, this foaming wash helps to reduce excess oil without drying out the skin,” she says, due to it’s non-comedogenic, non-acnegenic, and oil-free formula that has ingredients like oil-reducing zinc oxide.
Best serum for cystic acne
Garshick told us that, regardless of skin type, having a potent antioxidant serum in your routine to protect the skin from free-radical damage is a good idea. “Many patients with cystic acne are also concerned about discoloration and brown spots that occur from the breakouts, and this vitamin C serum can also help to improve the skin tone,” she says, adding that this is a great option that won’t cause additional breakouts. While Skinceuticals CE Ferulic is typically considered the holy grail of vitamin C serums, Phloretin CF is a much better choice for oily skin types. It contains L-ascorbic acid and ferulic acid, but does not contain pore-clogging vitamin E. Dr. Marina Peredo of Skinfluence NYC agrees about vitamin C, saying it “helps build collagen, brightens the skin, and reduces hyperpigmentation.” To get the most of its free-radical-fighting benefits, a vitamin C serum should be applied in the morning in conjunction with SPF.
Best moisturizers for cystic acne
When it comes to hydrating the skin, Jaliman says patients should stay away from any creams that contain heavy oils. Dr. Morgan Rabach, a dermatologist and co-founder of LM Medical NYC, 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.
“This oil-free moisturizer is a great option for those with acne because not only will it hydrate the skin without clogging the pores, but it also contains ceramides,” says Garshick. Ceramides help to strengthen the skin barrier, which allows it to better tolerate active anti-acne ingredients. This moisturizer also is formulated with niacinamide, which can help to reduce redness and inflammation that can go along with acne breakouts, she explains. Garshick notes that the company makes a similar version with SPF called La Roche Posay Toleriane UV Double Repair Moisturizer.
Best sunscreen for cystic acne
Speaking of sunscreen, 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
Since benzoyl peroxide is often prescribed for handling cystic acne (it kills acne-causing bacteria within the hair follicle), products containing the topical antiseptic were a popular choice among dermatologists we spoke to about over-the-counter treatments. 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 (who is also 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.” Clean & Clear Persa-Gel, which contains 10 percent benzoyl peroxide, is one of Gonzalez’s go-to recommendations for treating cystic acne at home. You can apply a thin layer of Persa-Gel to the entire face, or use it as a spot treatment. But beware: Benzoyl peroxide will stain clothing and pillowcases, so try to keep it off of any that you particularly love.
Best exfoliator for cystic acne
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 mask for cystic acne
For an overnight solution or something that covers a larger surface area (rather than a smaller spot treatment), Zeichner recommends Neutrogena’s rapid-clear leave-on mask. The idea is that you spread benzoyl peroxide all over your face, but since it’s not a wash-off mask, 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 spot-treatment creams for cystic acne
According to Gonzalez, “products like Effaclar Duo from La Roche-Posay have ingredients” effective at treating cystic acne, with this specific cream containing 5.5 percent benzoyl peroxide as well as micro-exfoliating lipo-hydroxy acid. Rabach is also a fan of the La Roche-Posay cream and says that it helps pimples shrink and disappear faster. Jaber agrees, noting that the product has a ton of beneficial “anti-inflammatory and anti-bacterial effects.”
PCA Acne Cream combines the acne-destroying effects of benzoyl peroxide with lactic acid, “which helps to hydrate skin as well as exfoliate the scaling that sometimes can develop with use of benzoyl peroxide,” according Dr. Brendan Camp, of New York-based MDCS: Medical Dermatology & Cosmetic Surgery. It also contains acne-fighting tea-tree-leaf oil.
Best spot-treatment patches for cystic acne
Camp says that he occasionally sees patients come into his office wearing pimple patches, which he says can “allow for better penetration of medication, healing, and deter the wearer from picking their acne.” Many pimple patches, or acne dots, contain hydrocolloid, which allows the dot to absorb moisture and dry the pimple out, he explains. However, sometimes that can cause a cyst to swell and become more visibly apparent, which is why he recommends Skyn Iceland’s Blemish Dots as the best patches to treat cystic acne. They “contain salicylic acid, a beta-hydroxy acid, that penetrates deeper into pores and breaks up plugged follicles.” They also contain volcanic ash to help absorb impurities, so they do not swell up or change appearance, he adds.
Best inflammation-reducing ointments for cystic acne
According to Camp, “While an injection with a corticosteroid is one of the fastest ways to neutralize a cystic acne blemish, it may not always be feasible to make an appointment with your favorite dermatologist.” For an alternative treatment, you can apply a topical corticosteroid, like CeraVe Hydrocortisone Cream, to help reduce redness, swelling, and pain, he adds. While this and the below spot-treatment ointment do not contain acne-fighting actives like the other spot treatments above, they will help make painful cysts less swollen and uncomfortable. CeraVe markets this cream as an eczema treatment, but Camp promises it can be used to spot treat an inflammatory acne lesion. And, as an added bonus, this cream contains niacinamide to help calm the skin.
Both Gonzalez and Jaliman also 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 body cleansers for cystic acne
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.
If you’re dealing with chest or back breakouts and would prefer to use a physical exfoliant to help unclog pores and keep your skin feeling smooth, Dove’s Gentle Exfoliating Wash is a great option, according to Garshick, because “it helps to clean out the pores, while still being gentle on the skin.” Dove’s body wash relies on exfoliating beads — which can sometimes be too rough to use on your face — to buff away dead body skin. Regularly exfoliating can also help to improve skin tone and reduce the appearances of dark marks and scars over time.
Best body spray for cystic acne
Garshick also loves this salicylic-acid acne spray, which she says is great for getting hard to reach, breakout-prone places, such as the back, chest, and shoulders. “The salicylic acid helps to unclog the pores and eliminate dead skin cells, leaving the skin looking clear,” he explains. While you can use it anytime, he says it’s particularly great to use post-workout at the gym.