Cystic Acne Treatments: OTC and Prescription Treatments, Home Remedies and More

• Cystic acne is the most severe type of acne
• Cystic acne develops when excess oil and dead skin cells clog pores and cause the skin to rupture
• A dermatologist is usually needed for successful cystic acne treatment
• Treatment options include oral and topical medications, along with steroid injections
• Even after successful treatment, acne scars may result

What Is Cystic Acne?

Cystic acne breakouts are marked by large, painful pustules that can look like boils. Normally, when dead skin cells clog your pores a small pimple can develop. If bacteria gets trapped there, redness and swelling also can occur.

But if the infection goes deep into the skin, nodules and cysts can form, usually requiring aggressive management by a dermatologist. Some of the cysts and nodules may contain pus. Cystic acne usually forms on the face, including the jawline, but can also appear on the neck, chest and back. Cystic acne breakouts tend to be larger than types of acne breakouts.

This kind of severe acne can affect anyone, but it’s most common among people with overactive oil glands. Teenagers and women face the highest risks. Hormonal changes, such as the start of puberty, can lead to cystic acne, as well as other types of skin blemishes. Cystic acne is also more common among people who have frequent acne breakouts.

Does Cystic Acne Go Away?  

Cystic acne doesn’t disappear on its own. Leaving the pimples and blemishes alone or using daily cleansers won’t be enough once the breakout becomes severe. But a dermatologist can often treat severe acne effectively, as long as you adhere to the treatment plan and administer appropriate self-care.

Over-the-counter skincare products may be part of your overall treatment plan, but strong prescription-strength drugs may be needed, along with steroid injections at the site of the blemishes and procedures to drain pustules. Because a cystic acne breakout can get out of hand quickly, it’s best to find a doctor or physician’s assistant who specializes in dermatology to begin treatment as soon as possible.

Severe breakouts can leave lingering acne scars. Treating acne scars with a combination of laser therapy, resurfacing agents, injections, and other medications can often lead to satisfactory results.

Over-the-Counter Cystic Acne Treatments

In its very early stages, cystic acne may respond to over-the-counter treatments. Their effectiveness and the time it takes to see results vary considerably, as most topical products come in several different strengths. In addition, the severity of your acne and the way your skin cells respond are also important and unique factors. These over-the-counter treatments are generally safe to use. Side effects are usually limited to skin irritation, but be sure to follow the directions carefully and consult a doctor or pharmacist if you’re using multiple skincare products.

Benzoyl peroxide

Benzoyl peroxide is used to treat mild, moderate and severe acne breakouts. It’s considered one of the more reliable and effective treatments. In mild cases, it can clear up pimples in less than a week by helping to speed up the turnover of skin cells. But for serious cystic acne, a combination of benzoyl peroxide and prescription medications may take a month or more to be effective. Benzoyl peroxide is typically used along with topical antibiotics to manage severe acne breakouts.

Retinol

A form of vitamin A, retinol contains a lower concentration of retinoic acid—the active ingredient in many skincare products that help reduce acne and promote healthier skin—than is found in related prescription products known as retinoids. As a result, retinol can take longer to produce results—as much as three to six months of daily use. In addition to helping unclog blocked pores, retinol has anti-inflammatory properties that can help keep severe acne breakouts from recurring.

Azelaic acid

Part of a class of medications called dicarboxylic acids, azelaic acid has anti-inflammatory qualities that help reduce swelling and redness. It also kills the bacteria to help keep your pores clean. Daily azelaic acid may take up to four weeks to produce noticeable results in cases of severe acne.

Hydrocortisone

Over-the-counter hydrocortisone cream is a steroid treatment that is much milder than steroid injections your dermatologist may recommend for severe acne treatment. Hydrocortisone can help reduce some of the redness and inflammation associated with cystic acne within a few days, but for long-term results, it’s more effective when used with other medications.

Prescription Treatments

Major cystic acne breakouts typically require prescription-strength antibacterial medications and other drugs to clear up oily skin. In some cases, spot treatment of prescription steroids is necessary to reduce inflammation. Because prescription medications are much stronger than over-the-counter treatments, the side effects may also be more serious. Be sure to discuss possible side effects with your dermatologist and make sure he or she knows all the cleansers and medications you are using on your skin.

Isotretinoin 

Isotretinoin is a commonly prescribed retinoid. It comes in a pill and is taken once or twice a day, depending on its strength and the doctor’s recommendation. A course of isotretinoin usually takes about four or five months, though some acne breakouts respond more quickly.

Topical retinoids

Retinoids also come in creams and gels for topical treatment. These powerful medications include adalapene and tazarotene. Their anti-inflammatory properties make the use of topical retinoids effective cystic acne treatments, especially when coupled with oral antibiotics.

Spironolactone 

This drug is part of a class of drugs called potassium-sparing diuretics. They’re typically used to maintain healthy fluid levels, and are often prescribed to people for high blood pressure and heart failure. Because it can also affect certain hormone levels, it is also prescribed to women for hormonal acne—the kind that is often characterized by breakouts along the jawline. Taking birth control pills can have similar positive effects on acne and skin health. Men usually aren’t prescribed spironolactone because side effects can include increased breast tissue.

Oral antibiotics

Oral antibiotics are staples of cystic acne treatment. Using oral antibiotics along with topical treatments may be the best combination to combat cystic acne. Amid rising concerns about antibiotic resistance, the use of oral antibiotics should be carefully supervised by your dermatologist. You should take these medications exactly as prescribed without stopping them too soon or taking them longer than is necessary.

Steroid injections

Injections of corticosteroids directly into nodules can help reduce inflammation and may help reduce scarring after the skin heals. The injections, usually of cortisone, may be painful, but they can lead to noticeable results within a few days, and the pain of the shots will ease quickly.

Home Remedies for Cystic Acne

Home remedies may help complement your dermatologist’s care, but they usually aren’t enough to completely clear up severe acne breakouts. In some cases, they may help reduce your risks of future breakouts or ease painful symptoms.

Cold compress

A clean, cold compress placed gently on skin affected by cystic acne may ease some of the pain and may help some of the swelling go down. Try an ice cube or cold pack wrapped in a paper towel or other thin covering.

Vitamin A

Eating a diet rich in vitamin A or taking supplements that contain this important nutrient may help improve the health of your skin from the inside out. Leafy green vegetables and colorful fruits like melons, as well as most types of seafood are all good sources of vitamin A. Topical vitamin A products, such as retinol, may be helpful, but should be used under the direction of your dermatologist.

Diet

Research suggests that a low-glycemic diet—one that doesn’t cause spikes in your blood sugar levels—may help reduce your risk of acne breakouts and help maintain healthier skin. This means avoiding or reducing your intake of foods with added sugars and starchy foods such as white potatoes and enriched flour.

Draining Cystic Acne

Treating large pustules associated with cystic acne may require draining the cysts. This type of spot treatment isn’t like popping zits at home. To effectively drain cystic acne, a dermatologist must first sanitize your skin and numb it with a local anesthetic. Then your doctor will insert a special needle into the cyst and drain the fluid from within. A sample of the fluid is usually sent to a laboratory to make sure it is benign (non-cancerous).

Cyst drainage only takes a few minutes per cyst, but it can have long-lasting benefits. There are usually no side effects, though some acne scarring may result depending on the severity of the cyst.

Takeaway

With the help of a dermatologist and a combination of treatments, you can usually get cystic acne under control. The two keys are patience and consistent treatment. If you are to apply a medicated lotion or other topical treatment on your skin daily, don’t skip a day. The same is true with oral medications. By following you doctor’s advice and maintaining proper skin hygiene, you can look forward to days when your skin looks and feels significantly better than it does now.