How to Treat Stubborn Cystic Acne
Life is filled with ironies — so take this one as an example. As a teenager, I would get the occasional pimple, if that. Nothing major. Now that I'm in my twenties, however, I break out all the time. I honestly feel like my hormones think that I'm ten years younger than I actually am.
Those painful, hard cysts on my chin that won't come to a head and fester on my face, like some sort of soul-sucking, life-ruining face crater? They are the worst. But luckily for me, and by extension you, we were able to speak with celebrity esthetician Renee Rouleau and Dr. Shuting Hu, founder of Acaderma, about why our skin decides to go a little crazy sometimes.
What Causes Cystic Acne
Cystic acne forms deep beneath the skin's surface. Like pimples, cystic acne can be caused by clogged pores that are filled with excess oil, dead skin cells, and bacteria. This causes the skin's dermis (the middle layer) to swell up, which leads to an infected lump on the skin's surface. "Some causes of cystic acne can't be helped, such as age, stress, and genetics," says Dr. Hu. "Teenagers are more likely to get cystic acne due to hormone changes, as well as women who are going through menopause."
Where Does Cystic Acne Usually Appear?
"Cystic acne usually occurs in the chin and jaw areas," says Rouleau. "The reason for this is often due to the hormonal shifts and imbalances in the body. Hormones stimulate oil production, which leads to the growth of bacteria getting trapped in the pore." Rouleau adds that in addition to hormonal reasons, cystic acne breakouts might also indicate that you are getting more dairy than your body can tolerate (more on that later).
How do You Know if You're Dealing With Cystic Acne?
Cystic acne usually stays under your skin — no matter what method you employ, cysts will never rise to the surface of the skin. All skin is prone to cystic acne, but because this type of acne is caused by a build-up of bacteria, excess oil, and dry skin cells, those with oily skin are more likely to experience this problem.
Melanin-rich skin is also prone to acne due to the higher lipid content. "It gets easily inflamed and often produces excess melanin and sebum which can ultimately lead to cystic acne," says Dr. Hu. "In addition, there are certain ingredients that make skin more likely to develop cysts. For melanin-rich skin, mineral oil can cause cysts, pimples, and blackheads. Mineral oil is often found in face creams, lotions, and moisturizers. Skin of color produces excess melanin and sebum when it comes in contact with mineral oil, this can lead to clogged pores and inflammation, which in turn can result in cystic acne."
How Can I Prevent Cystic Acne?
1. Stop touching your face and chin.
You probably already know the importance of cleansing your skin at night to remove acne-causing bacteria that may have manifested itself during the day, but you may not realize that minimizing the number of times you touch your face on a daily basis is also crucial. According to Rouleau, all blemishes are related to bacteria getting trapped the pores, we can prevent unnecessary bacteria from making its way onto our chin by avoiding resting our heads on our hands.
Also important? Don't pick your face, says Ranella Hirsch, M.D., a Boston-based dermatologist. "In many cases, picking is what takes a sterile wound without bacteria and introduces a portal for bacteria to enter," she explains. "This is often the infection we see after picking — so please don't."
2. Keep your cell phone clean.
Making sure your cell phone is clean. This is a small, simple change that can make a world of a difference. Like touching your face, cell phones are not the cause of acne, but they can potentially make acne worse due to the presence of bacteria on your mobile device, experts say.
Be sure to wipe down your phone daily to avoid unnecessary bacteria from getting onto your skin and contributing to cystic acne.
3. Try stress-busting activities — and get more sleep.
Not only can stress lead to exhaustion and increase feelings of anxiety, but it may be playing a role in your breakouts, says Debra Jaliman, M.D., an NYC-based dermatologist and assistant professor of dermatology Icahn School of Medicine at Mount Sinai,
"Stress causes your body to make hormones like cortisol, which prompts glands in your skin to make more oil," she explains. "Excess oil can lead to breakouts." That's why Dr. Jaliman recommends decreasing stress with meditation, exercise, and other lifestyle changes (like catching more zzzs) to not only make you feel more at ease but, perhaps, improve your skin.
4. Use a spot treatment formulated exclusively for stubborn cysts.
If you're looking for a spot treatment for your cysts, you might consider trying the much-lauded Renée Rouleau Anti-Cyst Treatment, which according to Rouleau, contains "a purified form of lactic acid helps dissolve cells blocking the pore, as well as purifying within the pore to help prevent future breakouts." Bye-bye festering angry mountain on my face!
5. Exfoliate regularly.
If you're dealing with cystic acne, it's important to remove the dead, dry skin cell buildup by focusing on exfoliation, Rouleau says. The more you remove the surface dry cells, the less the oil will stay trapped and clogged under the skin, which should help make those clogged bumps start to disappear. Rouleau suggests chemical exfoliation with alpha-hydroxy acids (AHAs), like glycolic acid and lactic acid, and beta hydroxy acids (BHAs), like salicylic acid.
6. Break a sweat in a ponytail.
Hot yoga devotee? Dr. Hirsch recommends sweeping your hair up and off of your face before working out. When you're done, make sure you immediately cleanse your face with a product that contains salicylic acid 1% in order to offset acne-causing bacteria.
7. Drink hot lemon water first thing in the morning.
As soon as you wake up in the morning (and after you've hit snooze multiple times), Rouleau says you'll want to head to the kitchen and whip up some hot lemon water, her personal skin secret. Why? It could help flush out and purify the body internally, potentially reducing toxins and bacteria in the small intestine where the cycle of acne may begin for some people.
Squeeze fresh lemon into a mug full of hot water and drink it when you wake up. If you don't have a fresh lemon handy, you can pour in lemon juice. Use enough so that the water tastes very lemon-y.
8. Try eliminating dairy from your diet.
Visit a dermatologist and you'll find it's not uncommon for a doc to make dietary recommendations in addition to topical solutions for breakouts, especially when it comes to dairy, says California-based dermatologist Caren Campbell, M.D.
In fact, a 2018 study showed intake of any dairy — including milk, yogurt, and cheese — "regardless of amount or frequency" was linked to higher odds for acne occurrences in individuals seven to 30 years old (when compared to individuals who did not consume dairy at all). Dr. Campbell says she also recommends patients avoid dairy-based powders, like whey protein, for these same reasons.
Rouleau agrees, adding: "The hypothesis is that since the majority of milk in the U.S. comes from pregnant cows (and some cows are given growth hormones), the hormone levels in milk may play a role in excess sebum production, which promotes acne. Since sebum production is influenced by androgens and hormonal mediators (such as insulin-like growth factors found in milk and other animal products), the consumption of milk, cheese, and yogurt may become factors that influence endogenous hormones and mimic the hormones that trigger oil production in the skin to ignite the acne process." The end result? More painful, stubborn pimples that won't budge from your chin.
9. Don't overdo it with masks and deep treatments.
When you're dealing with acne, it can be easy to think the best course of action is the most heavy-duty treatment that will dry your acne up. But using deep treatments on a daily basis could lead to over-stripping the skin and actually cause you to produce even more oil and, therefore, more breakouts, Dr. Jaliman says.
Dr. Hirsch added: "Take things down a notch by saving masks or deep skin treatments for a once a week treat."
10. Avoid sugar.
There is some truth to the whole you-are-what-you-eat adage — at least when it comes to your skin, Dr. Jaliman says.
In addition to dairy, "Diet affects adult acne when people eat a high glycemic diet, aka they eat a lot of sugar that is processed," she says. Dr. Jaliman says if she notices a patient is struggling with acne and consumes excess sugar, then she recommends they swap chocolate, baked goods, candies, white pasta, white bread, and other high glycemic, processed foods for a healthier sugar alternative, like fresh fruit.
Rouleau also noted, "If you are experiencing breakouts occurring on your cheek and cheekbone area, it may be due to excessive acidic foods in your diet like, tomatoes, pasta sauce, salsa, and citrus fruits/juices. If you get breakouts in these areas, try cutting back and your skin may clear up."
11. Try drinking spearmint tea.
If you want to go the natural route to help neutralize acne-inducing hormones, Dr. Campbell says you can try brewing spearmint tea, which acts as a plant-based anti-androgen, or "a compound that has the biological effect of blocking or suppressing" male sex hormones, like testosterone, that may lead to acne, according to a study published in the International Journal of Endocrinology & Metabolism.
Dr. Campbell recommends consuming three cups of spearmint tea, iced or hot. But take note: "Since this influences hormones, it's important not to do this while pregnant," she says.
12. Try taking oral probiotics.
Our digestion can be affected by stress, which shifts our inner microbial systems, leading to inflammation, Rouleau says. This, in turn, changes the type and number of bacteria that live in the gut to unhealthy bacteria.
"Eventually the gut lining becomes leaky and toxins are released into the bloodstream causing inflammation throughout the body," she says. "[This] can result in a flare-up of breakouts due to the shift in gut bacteria, and subsequent inflammation."
For that reason, Rouleau says oral probiotics may regulate the imbalance of bacteria and reduce oil levels to treat acne. She says you can find supplements in health food stores, or just make probiotics a part of your everyday diet by eating yogurt with live active cultures (assuming dairy isn't your cause of breakouts), miso soup, and sauerkraut.
Rouleau noted: "It's important to chat with your doc to find out if this is right for you."
13. Consult with your dermatologist and/or ob-gyn.
When in doubt, consult a healthcare expert. In addition to your dermatologist, Rouleau says you may want to touch base with your ob-gyn.
"A gynecologist may be most beneficial since they have a better understanding of hormonal fluctuations," she says. "They will most likely have your hormone levels checked via a blood test and prescribe oral medications such as birth control pills (or switch your current dosage) or spironolactone, a popular drug that can work well for balancing hormones."
Rouleau added: "Some doctors take more of a natural approach and may suggest vitamin supplements or have other dietary recommendations."
And remember — it's important to be realistic about your skin. Making some of these changes may prove to be beneficial in the long run, but they might take time to noticeably change or affect the condition of your skin. That means a little patience and diligence may be necessary (but will very well be worth it).
14. Avoid products that produce excess melanin and sebum.
For those with melanin-rich skin, avoid products that contain ingredients that can cause the skin to produce excess melanin and sebum. "Certain products can lead to inflammation and clogged pores, which make your skin more susceptible to developing cysts," says Dr. Hu. "Ingredients to avoid include mineral oil, paraffin, synthetic wax, and drying surfactants such as sodium laureth sulfate, and sodium lauryl sulfate."
15. Keep your skin hydrated and moisturized, especially during the winter.
If you are are living in colder climates, cell turnover rate is slow, which means the skin dries out and accumulates more dead skin cells on the surface. These dead skin cells can clog pores, which can lead to inflammation and cystic acne. "When looking for a moisturizer that will truly nourish the skin, look for products containing humectants, emollients, and occlusives," says Dr. Hu. This will keep skin at optimal hydration and nurture your skin during harsher weather conditions."