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Created for Greatist by the experts at Healthline. Read more

Cystic acne is the sinister cousin of your average pimple. While most zits emerge on your skin’s surface, cystic acne forms down below. And these suckers can’t be popped like regular pimples (your derm would disapprove of that too).

Cystic acne often crops up due to dirt, oil, or bacteria in the pores. Teens, women, folks with oily skin, and older adults with hormonal imbalances tend to be particularly susceptible.

Cystic acne is often large, white or reddish, and raised.

According to the National Institutes of Health, about 80 percent of people between ages 11 and 30 experience acne at some point. Cystic acne is considered the rarest and most severe form, but it’s not entirely uncommon. Celebs like Emma Stone and Lili Reinhart have gotten real about their battles with it.

Whether you’re dealing with a cystic outbreak right now or prepping for the inevitable, here’s the deal.

Cystic acne feels like volcanic craters have spawned from the depths of hell just to spite your face. In reality, it develops when your pores clog up.

Your pores’ sebaceous glands naturally secrete sebum, an oily substance that helps protect the skin and hair follicles. When sebum production spikes because of things like hormonal changes and makeup, a clog can form. These plugged-up pores are the perfect environment for P. acnes (the bacterium that can cause acne) to thrive.

Adolescent hormonal changes tend to be the biggest cause of acne. But there are plenty of other sebum-clogging culprits at work outside the years of teen angst, including:

  • hormonal changes resulting from the menstrual cycle, pregnancy, birth control, hormone therapy, or stress
  • certain oil-based cosmetics, moisturizers, and cleansers
  • certain drugs and chemicals, such as corticosteroids, lithium, and phenytoin
  • high sweat or humidity levels
  • genetics

What’s diet got to do with it?

PSA: Don’t believe your 2002 copy of Cosmo — foods like chocolate and greasy potato chips don’t actually contribute to acne. In fact, the idea that there’s a relationship between diet and acne at all is highly controversial within the scientific and medical communities.

But some studies do suggest that the following dietary changes might improve cystic acne:

Look out for high blood sugar levels

Somewhere along the line, someone probably told you fatty foods like burgers and fries were to blame for breakouts. While that’s not exactly the case, some medical experts suggest a low-glycemic diet might clear up the skin.

High-glycemic foods like white bread, doughnuts, soda, and your favorite cereal can cause blood sugar spikes that lead to inflammation and increased sebum production.

Meanwhile, loading up on low-glycemic, anti-inflammatory foods like fresh veggies, certain fruits, fatty fish, beans, and steel-cut oats can help keep blood sugar (and possibly acne) under control.

Consider cutting back on dairy

The link between dairy and acne is still up for debate. Since dairy consumption can affect hormone levels, it might cause sebum spikes that lead to acne.

A 2019 review of studies suggested that there’s a link between milk consumption and acne, but more research needs to be done to prove causation. The same review found no link between cheese and yogurt consumption and acne, so your pizza or Yoplait habit is probably not off the table.

Take a stroll through the supplement aisle

These supplements may also help keep Krakatoa away:

  1. Vitamin D: In a 2016 study, participants with acne had clearer skin after taking vitamin D supplements for 8 weeks.
  2. Green tea: Have some green tea in your pantry? You might want to put it on your face. A 2013 study found that applying green tea extract to the skin reduced sebum production, which might help control acne.
  3. Fish oil: Fish oil contains anti-inflammatory omega-3 fatty acids. In a small 2014 study, participants who took omega-3 supplements daily for 10 weeks saw a significant decrease in acne.
  4. Vitex: Some research suggests that the medicinal plant Vitex agnus-castus helps fight acne by reducing bacteria growth. But there’s little evidence to support its efficacy or safety.
  5. B vitamins: Vitamin B-5 might help clear up skin, according to a 2014 study. But too much vitamin B-5 might do just the opposite.
  6. CBD: Cannabidiol has anti-inflammatory and antibacterial properties that might help regulate sebum production.
  7. Probiotics: Probiotics may fight inflammation that leads to acne, according to a 2015 study. But there’s not quite enough evidence to back this one up yet.
  8. Barberry: Berberis vulgaris is a berry shrub that might help fight acne-causing inflammation.
  9. Zinc: Some research has identified zinc as a promising alternative to traditional acne treatments.

Persistent cystic acne can be annoying, not to mention painful (srsly — those suckers can hurt). If you think you have cystic acne, see a dermatologist ASAP. They can help you determine a cause and the best course of treatment, which might involve medication.

Since over-the-counter treatments typically aren’t strong enough to treat cystic acne, your derm may recommend a prescription. Here are a few common options to know about:

Oral antibiotics

Antibiotics are sometimes used to treat acne that covers a major section of the skin. They work by decreasing inflammation and bacteria that may contribute to flare-ups. But experts advise against taking antibiotics for extended periods, so they provide only a short-term solution.

Common oral antibiotics prescribed for acne include erythromycin, tetracycline, minocycline, and doxycycline.

Other medications — including blood thinners, diuretics, and psoriasis and diabetes meds — can interfere with antibiotics, so always discuss any meds you’re taking with your doc. Some acne medications aren’t safe to take during pregnancy.

Potential side effects may include:

  • stomach pain
  • diarrhea
  • nausea
  • vomiting
  • sun sensitivity

Isotretinoin (aka Accutane)

Isotretinoin is a super-strong prescription acne medication you’ve probably heard about. According to research from 2009, 85 percent of people see their acne clear up after taking this vitamin A derivative daily for 16 weeks.

But it’s definitely not without controversy. There are some serious risks associated with the drug. Here are just a few potential effects:

  • mood swings
  • inflammatory bowel disease
  • chronic headaches or nosebleeds
  • skin dryness or inflammation
  • blood in urine
  • muscle and joint pain

Isotretinoin can interact negatively with other medications, including steroids, seizure meds, and tetracycline antibiotics. It should never be taken during pregnancy or while breastfeeding.

Topical retinoids

Like isotretinoin, topical retinoids are derived from vitamin A — though they’re not as intense. These gels, creams, and lotions work by clearing up hair follicles that can cause acne.

A dermatologist may combine topical treatments with topical antibiotics for better results.

Cystic acne is generally treated with the retinoids Differin, Avita, Avage, Retin-A, or Tazorac. Side effects may include skin redness or peeling (which is usually temporary) and increased sun sensitivity.

People with eczema or other skin conditions shouldn’t apply topical retinoids to affected areas. Retinoids may also interact negatively with some astringents, toners, and alpha hydroxy acids, so chat with your dermatologist about your skin care regimen before use.

Spironolactone

While spironolactone (Aldactone) is typically used to treat high blood pressure and edema, it works as an acne treatment by controlling high androgen levels that can contribute to acne. It typically works only for women with cystic acne on the lower face and jawline.

Side effects may include:

  • breast tenderness
  • fatigue
  • headaches
  • menstrual irregularities
  • dizziness
  • high potassium levels (hyperkalemia)

Since it can cause irregularities in a developing fetus, never take spironolactone while pregnant or trying to get pregnant. Those with kidney disease also shouldn’t take it.

Lorde has reason to be annoyed with folks who cheerfully suggest she just try “moisturizing!” or “coconut oil!” when she’s had acne for “years and years and years and done all the drugs, tried all the things.”

No one’s a saint when it comes to skin care, but you might consider these tried-and-true home remedies to help keep things under control:

  • Perfect your cleansing regimen. Wash your face once or twice a day with a gentle cleanser that removes dirt and oil. Avoid scrubs or extreme exfoliants, which can make cystic acne worse.
  • Hands off your face. Keeping your hands away from your face — and off your acne — will help keep harmful bacteria at bay.
  • Check your cosmetics twice. Oil-free and noncomedogenic cosmetics are less likely to clog your pores, so take stock of your makeup and moisturizer collection.
  • Wash up before you pass out. Getting up to wash your face when you’re seconds from dozing off mid-Netflix show always feels like a serious feat. But when you do it, you become the hero you deserve.
  • Wash up after you work out. Sweat buildup can clog pores, so always rinse off after you hop off the treadmill.
  • Don’t sweat it. Since stress might contribute to acne, giving yourself some R&R may help your skin as well as your peace of mind.

If these basic steps don’t do the trick, talk to a dermatologist about your options.

Cystic acne is more likely to scar than other types of acne. But if you avoid picking, prodding, or messing with the cysts, you lower the risk.

It might be hard to resist the temptation — especially if you’re a Dr. Pimple Popper fan — but you gotta try. Doing so will also lower your risk of infection.

If you already have acne scars, some treatments might help reduce them. Try these only after your acne’s under control, though:

  • Cystic acne is characterized by large, inflamed cysts under the skin.
  • Since it’s the most severe type of acne, it often doesn’t clear up without the help of a professional. Over-the-counter treatments typically won’t cut it.
  • The link between diet and acne is still up for debate. Reducing blood sugar levels might fight acne-causing inflammation. Some supplements, like zinc and fish oil, also might help.
  • Staying healthy, managing stress, and taking good care of your skin might help diminish symptoms. (Plus, it can’t hurt, right?)
  • Don’t. Touch. Your. Face! (It can worsen the acne, increase your risk of infection, and contribute to scarring.)
  • When it comes to cystic acne, your dermatologist is the only true expert. Always consult a pro for guidance.