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How to treat cystic acne, according to dermatologists

We spoke to dermatologists about the best treatments for cystic acne that can help avoid painful bumps and future scarring.
Experts told us in-office treatments and oral medications are the best ways to treat cystic acne.
Experts told us in-office treatments and oral medications are the best ways to treat cystic acne.

Millions of people deal with acne every year in the U.S., but those who suffer from cystic acne know how stubborn they can be compared to ordinary pimples. Cystic acne is fairly self-explanatory: It’s a severe form of acne that results in large, pus-filled cysts forming underneath the skin’s surface, which makes them much more painful than normal acne bumps and, depending on the severity, can lead to a significant amount of scarring. Though this type of acne can be hard to treat, it’s certainly not impossible — in fact, our dermatologists recommended treating cystic acne as soon as possible to avoid permanent scarring in the future.

SKIP AHEAD Best treatments for cystic acne | What causes cystic acne? | What active ingredients can help cystic acne? | How to treat scarring | Tips for crafting a cystic acne skin-care routine

To help you determine the best ways to minimize the appearance of cysts or treat this type of acne altogether, we spoke to dermatologists about the best over-the-counter and prescription treatments to seek out. We also listed their recommendations for the best products to shop that can be used in conjunction with more intensive treatments.

How to treat cystic acne

You may be familiar with OTC acne treatments like benzoyl peroxide, salicylic acid and retinol (a vitamin A derivative) to treat ordinary, run-of-the-mill pimples. However, all of the experts we consulted noted that these types of acne-fighting ingredients simply aren’t strong enough to cure cystic acne.

“Usually, deeper cystic acne requires a trip to the dermatologist and some type of oral or medical intervention,” explained Dr. Mona Gohara, board-certified dermatologist at Dermatology Physicians of Connecticut. Some of the most effective treatments for cystic acne include in-office cortisone injections and oral prescription medications like birth control pills, spironolactone and isotretinoin (usually known by its brand name, Accutane) to treat the underlying internal cause of the cysts.

“Topically, it's really hard to treat cystic acne — over-the-counter products may help mitigate the inflammation and bring it down a bit, but making it go away is a lot trickier and they will not be effective if used alone,” Gohara said.

The most important takeaway when it comes to cystic acne — especially if you're noticing scarring — is that it requires early intervention and seeing a board-certified dermatologist “to prevent permanent scarring,” Dr. Emma Weiss, board-certified dermatologist and assistant professor of dermatology at the University of Colorado Anschutz Medical Campus, noted.

However, our experts noted that certain OTC acne treatments can be beneficial to use in conjunction with more powerful prescription treatments. Dr. Tracy Evans, a board-certified dermatologist and medical director of Pacific Skin and Cosmetic Dermatology, recommended “cleansing your skin with a wash that contains salicylic acid or alpha hydroxy acid at least a couple of times a week and moisturizing with an oil-free moisturizer that’s gentle on the skin.” Weiss also noted that those with acne-prone skin should stick to non-comedogenic lotions, makeup and any other products that would be applied to the face in order to not clog pores.

Best products to help treat cystic acne

Our experts noted that OTC products aren’t going to treat cystic acne, but can play a part in improving your situation. Below, we rounded up a few expert-recommended OTC products that can help treat cystic acne when used with oral medications and in-office treatments. Each of the following products are non-comedogenic and include acne-fighting active ingredients like salicylic acid, benzoyl peroxide and adapalene, or a gentle formula that’ll help keep irritation and inflammation caused by cystic acne at bay.

CeraVe Acne Foaming Cream Face Cleanser

Weiss recommended this foaming cream cleanser with 4% strength benzoyl peroxide as a great option if you have cystic acne around the body. “It has added ingredients like hyaluronic acid and niacinamide that can be good for those dealing with acne,” she said. CeraVe says this wash can gently remove dirt, excess oil and makeup, and it can help prevent new acne from forming. The non-comedogenic wash is also fragrance- and paraben-free.

Neutrogena Oil-Free Salicylic Acid Acne Wash

Dr. Eileen Deignan, a board-certified dermatologist and chief of dermatology at Emerson Hospital, previously recommended this salicylic acid cleanser to help unclog pores and calm acne. The face wash contains 2% salicylic acid and the brand says It's suitable for most skin types since it's free of oils, fragrances and parabens.

Panoxyl Acne Foaming Wash

Panoxyl’s foaming wash is a popular option that contains 10% benzoyl peroxide and can be used on the face and body. However, Weiss noted that a wash with a high concentration of benzoyl peroxide like this one can be irritating to some people, so she recommended introducing the product gradually into your skin-care routine.

Paula's Choice Skin Perfecting 2% BHA Liquid Exfoliant

Recommended by Weiss, this liquid leave-on exfoliant from Paula’s Choice contains 2% salicylic acid to help remove dead skin cells and unclog pores. It’s also formulated with green tea to help soothe irritated skin, according to the brand.

Neutrogena Rapid Clear Stubborn Acne Spot Gel

Gohara said her patients love this spot treatment from Neutrogena. The gel contains 10% benzoyl peroxide and can be placed directly on top of acne to reduce the size and redness, as well as actively fight future breakouts, according to the brand. Neutrogena recommends applying a thin layer of the acne gel one to three times daily.

CeraVe Daily Moisturizing Lotion

“For my acne prone patients, I recommend moisturizing with a gentle, non-comedogenic moisturizer to keep their skin barrier intact,” said Weiss. This daily moisturizing lotion from expert-favorite brand CeraVe is formulated for sensitive skin and contains hyaluronic acid and ceramides to help retain the skin’s natural moisture, according to the brand. CeraVe says the moisturizer can provide up to 24 hours of hydration.

La Roche-Posay Toleriane Double Repair Face Moisturizer

One of our favorite expert-recommended face moisturizers for acne-prone skin and rosacea, the La Roche-Posay Toleriane Double Repair Face Moisturizer is both gentle for sensitive skin and contains ingredients like niacinamide and ceramides to hydrate the skin, according to the brand. La Roche-Posay says this moisturizer offers 48-hour hydration and can be used on the face, neck and hands.

Differin Adapalene Gel 0.1% Acne Treatment

Weiss told us that adapalene products like Differin Gel “can be helpful when used in conjunction with other treatments” and can help cure inflammation, deep clean pores and prevent new pimples from forming. The brand recommends applying a thin layer of the gel treatment to the affected areas of the skin after cleansing and before moisturizing.

La Roche-Posay Effaclar Adapalene Gel

Another adapalene product recommended by Weiss, La Roche-Posay’s Effaclar Adapalene Gel, which contains 0.1% adapalene to help unclog pores and fight acne. This gel is also slightly gentler and more moisturizing than the Differin gel, according to people who have used both.

What causes cystic acne?

Cystic acne is a type of inflammatory acne that causes deep, painful lesions underneath the skin due to the accumulation of oil, bacteria and dead skin cells. Much like regular acne, the cysts can range from mild — you might develop one or two cysts on your chin around your menstrual cycle, for example — to severe, which can involve the entire face and even the chest and upper back, according to Weiss.

Causes of cystic acne include hormonal changes or triggers related to puberty, menopause and pregnancy or underlying medical conditions like polycystic ovary syndrome (PCOS), as well as stress and genetics, Weiss said. Certain people may also have an increased risk of developing cystic acne, including those with a family history of cystic acne and teenagers going through puberty.

What active ingredients can help with cystic acne?

There are three common active ingredients in over-the-counter products that can help reduce inflammation caused by cystic acne: salicylic acid, benzoyl peroxide and adapalene. Though not very effective in treating cystic acne when used on their own, these active ingredients can be beneficial when used with in-office treatments and oral medications. Keep in mind, however, that many of these ingredients can be strong and irritating, so they may not be suitable for more sensitive skin.

Salicylic acid

Salicylic acid is a beta hydroxy acid that helps fight acne by targeting excessive oil production and removing dead skin cells. This ingredient “can be effective in treating cystic acne by targeting and addressing some of the underlying causes of acne,” Weiss said.

Benzoyl peroxide

Benzoyl peroxide can also be used to help treat cystic acne by “fighting bacteria and inflammation,” Weiss said. You’ll often see products highlighting very high concentrations of benzoyl peroxide (usually around 10%), but both Weiss and Gohara noted there isn’t much evidence to suggest that higher strengths are better at treating acne.

“There are actually some studies that show that 2.5% benzoyl peroxide and 10% benzoyl peroxide have a minimal difference in terms of their efficacy in acne treatments,” Gohara said. People with cystic acne that experience sensitivity or dryness “may be able to tolerate the lower strength ingredients better,” Weiss noted.


Retinoids are powerful acne treatments that can be effective at reducing inflammation. Topical retinoids can help increase skin cell turnover and unclog pores that may be contributing to the initial formation of cystic acne, Weiss said. While prescription retinoid gels and creams are the most effective at treating cystic acne, adapalene — the only topical retinoid treatment available over-the-counter — works well to regulate the turnover of cells lining the pores to reduce clogging. But keep in mind that this ingredient can be very drying — Gohara recommended introducing this ingredient gradually into your skin-care routine, using a small amount and moisturizing afterward. “Your skin is already irritated with the cystic acne, the last thing you want to do is stoke the fire,” she said.

How to treat cystic acne scarring

One of the biggest concerns with cystic acne is the potential for severe and even permanent scarring, which is why “you’ll want to get on a treatment that is going to take care of cystic acne sooner rather than later,” Evans said. “People who have very severe cystic acne can scar pretty fast and their skin is so sensitive and irritated that it can be really hard for them to put anything on,” she added.

However, scarring is hard to treat for anyone — and cystic acne scars may require more intensive treatments like laser resurfacing of the skin, microneedling, hydrafacials and injectables that can break up the scar tissue using small needles, Evans explained.

Tips for establishing a cystic acne skin-care routine

Since people with moderate to severe cystic acne tend to have sensitive and irritated skin, our experts noted to keep a few things in mind — and some common misconceptions to avoid — when crafting your skin-care routine.

Simplify your skin-care routine. Weiss recommended not going overboard with the number of active ingredients you're introducing in your skin-care routine. “If you're experiencing irritation or dryness, consider only using one or two active ingredients at a time or using the lowest percentage of salicylic acid or benzoyl peroxide so that is not too irritating," she said.

Gradually introduce products. “I always recommend to my patients that they should be using products in a really slow and incremental way,” said Gohara. When using more irritating ingredients like benzoyl peroxide and adapalene, she recommended starting with a pea sized amount once or twice a week, and then gradually increasing it to three times a week while monitoring irritation.

Avoid harsh scrubs. Evans noted there’s a misconception that those with acne should dry out acne, so they’ll often use too many strong, irritating products. She advised against using abrasive exfoliants since people with cystic acne can have very sensitive, inflamed skin. Products formulated with alcohol or scrubs containing small beads can be extremely irritating — “this is a condition that needs to be treated from the inside out, so you have to be more gentle with your skin care,” Evans said.

Meet our experts

At Select, we work with experts who have specialized knowledge and authority based on relevant training and/or experience. We also take steps to ensure that all expert advice and recommendations are made independently and with no undisclosed financial conflicts of interest.

  • Dr. Emma Weiss is a board-certified dermatologist and assistant professor of dermatology at the University of Colorado Anschutz Medical Campus.
  • Dr. Tracy Evans is a board-certified dermatologist and medical director of Pacific Skin and Cosmetic Dermatology.
  • Dr. Mona Gohara is board-certified dermatologist at Dermatology Physicians of Connecticut.
  • Dr. Eileen Deignan is a board-certified dermatologist and chief of dermatology at Emerson Hospital.

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