The Sitch on Those Underground Zits: 8 Best Cystic Acne Treatments to Try

Cystic acne is like the deep, dramatic sister of the pimple family (which also includes our girls Whitehead, Pustule, and Papule, to name a few).

While nobody loves having clogged, inflamed skin, cystic acne can be particularly painful and tough to treat. Since cysts occur much deeper in the skin than your everyday whitehead, topicals often just won’t cut it. That’s why — if possible — the pros always recommend visiting a dermatologist to address your cystic acne concerns.

Most of the time, a combo treatment of topical (like a retinoid) + oral meds (like antibiotics or oral retinoids) will be prescribed for cystic acne, but there’s no one-size-fits-all regimen.

Here’s the deep dive on how to treat that acne deep beneath the dermis.

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Cystic acne tends to consist of large pimples deep beneath your skin. Other types of acne (like blackheads, whiteheads, papules, and pustules) are more surface-level, sitting on top of the skin rather than deep beneath it.

Cystic acne can sometimes look and feel similar to a boil (aka a skin infection that involves an inflamed hair follicle). They can also be pus-filled, red, and suuuuper tender to the touch.

These painful bumps appear most commonly on your face, chest, back, neck, and arms — but they can also show up on your thighs and booty.

According to dermatologist Dr. Heidi Waldorf, cystic acne is caused by a combo of:

• Genes. If your ‘rents or sis have cystic acne, you’re more likely to get it, too.
• Excess sebum. Some people have a predisposition for excess sebum (aka the oil that your skin secretes), Waldorf explains. If you have excess sebum, your everyday zit might become more inflamed.
• Keratinization of sebaceous follicles. When your skin cells make too much of the protein keratin (called hyperkeratinization), you’re more likely to get acne, including the cystic kind.
• Hormones. Hormones, especially testosterone, play a role in the production of cystic acne, Waldorf says. This might be why those with polycystic ovarian syndrome (PCOS) or high testosterone are more likely to get cystic pimples.

Waldorf breaks it down like this: First, “sticky” skin cells and “thicker” sebum forms your basic whitehead or blackhead. Then this “sebaceous follicular unit” (basically skin + hair follicle) stretches, and bacteria reproduce inside of it.

These bacteria trigger an inflammatory response in your bod that creates the red acne “papules” and “pustules” (aka those pesky zits). As the inflammation increases and bacteria grows, pressure builds and the walls of the follicular unit break. The body then tries to wall off this fiery area from the skin and surrounding tissue, which creates a cyst.

Because cystic acne tends to be more challenging to treat than your average pimple, visiting a dermatologist is always recommended if possible. “Cystic acne does not respond well to topicals alone,” Waldorf says.

That’s why alongside a topical regimen, Waldorf might recommend:

• Low-dose antibiotics (in the tetracycline fam, such as minocycline). These antimicrobial, anti-inflammatory antibiotics mitigate harmful bacteria that worsen cystic symptoms.
• Hormonal therapy. “For genetically female patients who are not planning a pregnancy, hormonal therapy may be helpful,” Waldorf says, “especially if the cysts worsen around their menstrual cycle or with a diagnosis of polycystic ovary syndrome.” This might mean estrogenic BC pills or anti-testosterone therapy (like spironolactone or aldactone).
• Oral retinoids. Waldorf says the oral retinoid Isotretinoin (the controversial Accutane) is the most effective way to clear the acne and reduce scarring. Although Waldorf says it’s been used successfully and safely for 40 years, it must be taken under the strict oversight of a board-certified dermatologist due to the need for monthly check-ups. You also shouldn’t become pregnant while taking Isotretinoin.

That being said, some topical TLC couldn’t hurt. These include:

• Topical retinoids. Creams or gels with tretinoin, tazarotene, triferotene or adapalene are especially helpful for treating whiteheads and blackheads but also may help ease cystic acne symptoms. According to Waldorf, these Vitamin A derivatives are the foundation of acne treatment because they boost cell turnover in the sebaceous follicles and reduce inflammation. These treatments can also reduce hyperpigmentation that may occur after pimples fade, especially in darker skin tones. These days, some pretty potent retinoids are available OTC.
• Benzoyl peroxide. Topical treatments with benzoyl peroxide fight acne-causing bacteria and help reduce inflammation.
• Salicylic acid. Similar to benzoyl peroxide, salicylic acid works to remove dirt, oil, and bacteria. It’s a comedolytic, Waldorf explains, which means it inhibits the formation of comedones (aka whiteheads and blackheads).
• Topical antibiotics. Topical antibiotics like clindamycin wipe out acne-fighting bacteria, Walldorf says.
• Corticosteroid injections. Your derm can also inject individual cysts with small amounts of corticosteroid, Waldorf says. This reduces inflammation, redness, and cyst size in a jiff.

We spent time chatting with the pros, scoping out pages of ratings and reviews, and doing ingredient research —that way, you don’t have to Google your life away.

To select the best cystic acne products, here’s what we considered:

• At-home treatments. Cystic acne is tough to treat, which is why we recommend consulting with the pros to see if you could benefit from prescription treatment. But for the purposes of this article, we focused on solid at-home treatments for peeps that don’t need or want to go the prescription route. These can also be used alongside prescription treatments if you get a healthcare pro’s OK to do so.
• Active ingredients. We looked to derms and the latest research to determine the best ingredients to treat cystic acne, and selected formulas that truly deliver.
• Reviews. You’d hardly hit up a restaurant without checking out the reviews these days, so why put something on your precious skin without covering all your bases? We sifted through the stars for you, finding products that buyers genuinely rave about.
• Price. I mean, what good is the internet without options? Whether you want to splurge on something fancy or stick to the basics, we found effective cystic acne treatments out there at various price points.

Best over-the-counter (OTC) cystic acne treatment

Differin Gel

• Price: $
• Standout ingredients: adapalene
• Size: 0.5 ounce (oz).
• Skin type: oily
• Pros: powerful, prescription strength now available OTC
• Cons: may cause skin irritation, sensitivity

Previously only available via prescription, Differin gel is prob your strongest OTC bet for fighting cystic zits. Its key ingredient is the retinoid adapalene (0.1 percent), which is an FDA-approved acne treatment that helps to exfoliate the skin, purge the skin of oil and dirt, and reduce inflammation.

While it won’t necessarily dissolve your cystic zits overnight, it can stop new pimples from popping up and ease symptoms of existing ones. Since most peeps with cystic acne have skin on the oilier side, it’s perfect for anyone who tends to *ahem* shine a little brighter. (Present! 🙋‍♀️) Reviewers say it may take 12 weeks to truly see results, but that they’re worth the wait.

This prescription-strength cream can take some getting used to, though. Plan to use a pea-size amount 1x a week and work your way up to every other to daily use. If redness, dryness, or irritation occurs, cut back use.

Always do a patch test before introducing any new skin care product, but especially an extra-strength one like Differin. And since retinoids can make your skin super-sensitive to the sun, load up on the SPF.

Best spot treatment for cystic acne

Clean & Clear Advantage Acne Spot Treatment

• Price: $
• Standout ingredients: salicylic acid, witch hazel
• Size: 0.75 oz
• Skin type: oily, combo
• Pros: cheap and effective
• Cons: contains fragrance and alcohol, might cause irritation for dry and sensitive skin

With 2 percent salicylic acid and an affordable price, the Clean & Clear Advantage Acne Spot Treatment is spot on.

Though Waldorf stresses that even the toughest topical treatments won’t necessarily eradicate cystic acne, salicylic acid does a pretty legit job of purging those comedones (aka blackheads and whiteheads) before they turn into bigger (and cystic) probs.

The salicylic acid essentially works as an anti-inflammatory and chemical peeling agent, helping to uncover the healthier, less-inflamed skin beneath the surface. That’s why this spot treatment can also make existing cysts look a lot better come morning — but it’s prob a bit too strong for your whole face. You don’t want to wake up looking like a snake.

Some reviewers say they hate the added fragrance, though — which also makes it a no-go for extra sensitive skin.

Best benzoyl peroxide for cystic acne

Proactiv Emergency Blemish Relief

• Price: $$
• Standout ingredients: benzoyl peroxide
• Size: 0.33 oz
• Skin type: any, but may irritate sensitive skin
• Pros: works quickly
• Cons: may cause redness

Another A+ spot treatment comes from Proactiv, the brand that supposedly everyone from P. Diddy to Kendall Jenner swears by.

According to our research, this stuff actually does work. Like salicylic acid, this benzoyl peroxide formula works to remove dead skin cells that may otherwise clog pores and make acne worse. The “peeling” effect of benzoyl peroxide tends to be even more intense, though, so be prepared: Though it may work even better than salicylic acid formulations, it’s more likely to irritate sensitive skin types. It’s also known for staining fabric. :/

Reviewers say it can make even the toughest cystic zits disappear in days. A few did complain that it may slightly burn the afflicted area, though.

Best cystic acne scar treatment

Murad InvisiScar Resurfacing Treatment

• Price: $$$
• Standout ingredients: salicylic acid, centella asiatica (cica), hydroxytyrosol, vitamin C
• Size: 1 oz.
• Skin type: any, but may not work for sensitive types
• Pros: lighter acne scars
• Cons: won’t necessarily erase scars, takes some commitment, may not work for sensitive skin

Unlike other types of acne, scarring often comes with the cystic territory (as if the original zits didn’t scar you enough). While scarring can be challenging to treat at home after the fact, this formula does a pretty legit job at tackling old marks as well as preventing new ones from forming.

Murad Invisiscar Resurfacing Treatment contains salicylic acid, which works to deeply exfoliate the skin to remove scars under the surface. Cica minimizes inflammation, while antioxidants hydroxytyrosol and vitamin C lighten up dark pigmentation that sometimes appears in the cystic aftermath.

You’ll need to use this product at least 2x daily for several months to see results. While lots of reviewers say it works to lighten acne scars, a few had issues with bumps, irritation, or even more acne from using.

Best back cystic acne treatment

CeraVe Body Wash with Salicylic Acid

• Price: $
• Standout ingredients: salicylic acid
• Size: 10 oz
• Skin type: any
• Pros: more bang for your buck than using face wash on your back
• Cons: may not be quite tough enough for serious cysts

Since back skin tends to be thicker than the skin on your face, the pores and hair follicles are likewise larger — which can mean even larger, more irritated cysts.

While you can technically use any of your face products on your back, doing so can quickly become costly. CeraVe simplifies things a bit with a body wash formulated with salicylic acid, which unclogs pores and deeply exfoliates to combat existing cysts and keep new ones from popping up.

Bye, bacne! Lots of reviewers say it’s legit for banishing back zits, though a few did say they didn’t notice a difference between this and their regular body wash.

Best cystic acne treatment for pregnancy

La Roche-Posay Effaclar Duo Dual Acne Treatment with Benzoyl Peroxide

• Price: $$
• Standout ingredients: benzoyl peroxide, lipo-hydroxy acid
• Size: 1.35 oz
• Skin type: any (especially oily or sensitive skin types)
• Pros: gentle
• Cons: may pill when combined with other products

Retinoids, fragrance, and parabens are a big no-no during pregnancy. But benzoyl peroxide is considered safe to use in limited amounts and it’s a pretty good bet for most skin types.

It also has lipo-hydroxy acid, a gentler salicylic acid derivative (also safe to use in limited amounts). If regular doses of salicylic acid have proven a little *too* acidic for your skin, this treatment might be what you need.

It’s also free of fragrance, oil, or parabens, which makes it especially legit for pregnant peeps and folks with oily or sensitive skin. (Or those who just hate when their skin products smell like flowers.)

Though most reviewers have piled on the stars, some claim it causes pilling when used under makeup and other products.

*Note: While benzoyl peroxide and salicylic acid are both considered safe for use during pregnancy, both are only safe when used in limited amounts, so talk with your OB before using these ingredients.

Best face washes for cystic acne

Differin Daily Deep Cleanser

• Price: $
• Standout ingredients: benzoyl peroxide
• Size: 4 oz.
• Skin type: sensitive, normal, or oily
• Pros: great for cystic acne
• Cons: may be drying

Here’s another OTC banger from Differin that’ll pair perfectly with its retinoid gel. With 5 percent benzoyl peroxide, this face wash is prescription-strength at a drugstore price point.

Benzoyl peroxide works to kill acne-causing bacteria and reduce inflammation, which is legit in both the prevention and treatment of cystic breakouts. And despite packing a heavy dose of this active ingredient, it’s specially formulated for sensitive skin, so there’s less fear of waking up even *more* inflamed. Most skin types will find it gentle and easy to tolerate.

Reviewers say it’s particularly legit for cystic acne, though some complain it can be a bit drying.

Cetaphil Dermacontrol Oil Control Foam Wash

• Price: $$
• Standout ingredients: zinc gluconate
• Size: 8 oz
• Skin type: sensitive, normal, oily or dry
• Pros: gentle
• Cons: may not be strong enough for severe acne, may not control extreme oil

Cystic acne-prone skin tends to be on the oilier side, but an excess of heavy-duty topicals can easily dry it out to an unsavory degree. If your skin care regimen is already stacked with potent agents like retinoids or benzoyl peroxide, you might want to go for a milder, noncomedogenic cleanser like this one.

This oil-free, paraben-free, foaming formula is ideal for skin that can’t take the harshness of stronger ingredients. It contains zinc gluconate, which experts say reduces inflammation and helps keep acne in check. While it still controls oil, it won’t turn your face into the Sahara.

Reviewers with sensitive skin give it their seal of approval. Some oily folks complain it doesn’t do quite enough to zap oil, though.

Waldorf stresses that anyone with cystic acne should consult a board certified dermatologist ASAP in order to treat the issue effectively and reduce the risk of scarring. “This is not something you can treat with cosmeceuticals or facials,” she explains.

A dermatologist can help direct you to the right course of treatment, which may include both oral and topical meds.

Because cystic acne is considered a severe form of acne, the OTC products will prob not be quite enough to do the trick. That being said, with help from a derm, here’s what you may want to consider when picking your products:

• Narrow it down. You def don’t want to load up on all the products on this list. Since many of these items contain very potent ingredients like retinoids, acids and peroxides, it’s best to pair a stronger product (think a heavy-duty retinoid gel) with a gentler one (like a cleanser with zinc gluconate). Shoot for maybe 2 to 3 products — let’s say a cleanser, spot treatment, and cream or gel.
• Consider your skin type. Stronger actives like retinoids don’t always work with the most sensitive skin types, while gentler benzoyl peroxide treatments may not cut it for the oiliest, most inflamed cysts. Since everyone’s different, it may take some experimentation (and a little pro support) to find what works for you.
• Acne severity. Cystic acne is already considered a severe form of acne, which is why visiting a healthcare pro is recommended. But there’s a difference between cysts that pop up every few months and a rampant issue. If your cystic acne is pretty infrequent, you may be able to mitigate it with a cleanser and cream, while those with regular breakouts will likely need something heavier-duty (think oral meds + a complete topical regimen).

Visit a board-certified derm

To treat cystic acne, Waldorf recommends a straightforward 3-step regimen:

1. See a board-certified dermatologist.
2. Keep your dermatology follow-ups.
3. Try to keep your hands off your acne. We know it’s hard!

Simple, amirite?

Cleanse, topical, moisturize. Repeat.

Unless otherwise directed, it’s best to cleanse before you apply any topical treatments for acne like serums or spot treatments. Afterward, moisturize to seal in the treatment.

As fun as those 10-step K-beauty routines sound, it’s prob best to avoid an extensive routine if you have cystic acne. Too many ingredients at once can worsen symptoms.

Pssst: Always do a patch test to ensure products jibe with your skin.

Don’t. Touch. That. Zit!

“Keep your hands off your acne, cystic or otherwise,” Waldorf says. “Remember that whatever you are getting out, you are also forcing into the skin. That further damages the follicle and exposes the skin and subcuticular tissue to sebum, skin cells, bacteria, and inflammatory cells (aka pus).”

Yum, right? Your body then responds with even *more* inflammation, leading to recurrent cysts and scarring, she says. So to prevent acne and scarring, it’s prob best to take her advice — no matter how tempting it is to make like “Dr. Pimple Popper” and get things popping.

Soothe swelling at home

To soothe cystic swelling, Waldorf recommends applying a topical acne spot treatment and warm compress. (Pro tip: Not hot enough to singe your skin). You can also apply ice to reduce swelling and pain.

To make a warm compress, soak a clean washcloth in hot water and press it onto your cystic acne for 10 to 15 minutes. You can do this 3 to 4 times a day until the swelling reduces.

To apply ice, wrap it in a clean cloth or paper towel and hold it to your skin for 5 to 10 minutes. You can do this twice in a row with a 10-minute break between applications.

According to Waldorf, “Cysts can be avoided — or at least recurrence avoided — by not picking or popping, which can make a smaller acne papule or pustule into a cyst.”

In addition to keeping your hands off your acne, she recommends keeping your phone surface clean with regular alcohol wipe swipes and not holding it too firmly against your face. (Alternative: Headphones FTW.)

Oh, and Wash. Your. Mask! (Also, cross your fingers for the end of COVID.)

Cystic acne can also be aggravated by hair products and some cosmetics. Talk with your doc about what’s right for you.

At the risk of sounding like a TikTok meme that just won’t quit — again, the pros like Waldorf say you should visit a certified derm for any and all cystic acne concerns.

Unlike cystic acne’s more innocent sisters: pustules, papules, and comedones — cysts are a deeper (literally) issue that typically requires professional support.

What are the main causes of cystic acne?

Cystic acne is caused by genes, a predisposition for excess sebum, and hormones. It often happens when dirt, oil, or bacteria get trapped in pores.

What is the best treatment to get rid of cystic acne fast?

A cortisone injection will reduce swelling and inflammation and drastically reduce the appearance of a cyst within hours, but you need to head to a derm for one of those.

Most other treatments, including retinoids and oral medication, can treat the root cause but may take longer.

What shrinks cystic acne? Can I shrink a cystic pimple overnight?

A cortisone injection from your derm may shrink acne in 6 to 48 hours. Otherwise, your best bet is a spot treatment with acne-fighting ingredients like benzoyl peroxide or salicylic acid.

Can you pop cystic acne?

Dr. Waldorf says: “NO!!!!” The dermatologist explains that any poking, prodding, or popping will lead to more inflammation, bacteria growth, and basically, make matters worse.

What’s the best DIY cystic acne treatment?

Unforch, cystic acne is typically pretty severe and requires a little more TLC than your average pimple, so outside of seeing a derm, nailing down a solid skin care routine, and finding spot treatments that work for you, there really aren’t any evidence-based quick-fix DIY cystic acne treatments.

How do I prevent cystic acne?

In addition to visiting a derm for a complete treatment, Waldorf in part recommends:

• not picking or popping cysts
• keeping your phone surface clean (and using headphones or not holding your phone against your face)
• talking with your doc about cosmetics or hair products that may be affecting your skin
• using a combo of a topical (like a retinoid) + and oral medication (like an oral retinoid)
• considering hormone therapy with support from your doctor
• staying on top of cleansing, moisturizing and applying topical treatments

Most cases of cystic acne require support from a dermatologist. Acne cysts tend to be challenging to treat at home and may cause scarring without support from a pro. Many derms prescribe a combo of oral and topical medication.

That being said, prescription-strength topical treatments (like retinoid gels and benzoyl peroxide cleansers) are now readily available OTC at an affordable price. These tend to be very effective.

Staying on top of cleansing, moisturizing, applying topical treatments, and trying not to touch your acne (that means no prodding or popping!) should also help keep cystic acne in check.