- Pimples that live under the skin, or cystic acne, is incredibly hard to treat because it doesn’t respond to topical treatments.
- Cystic acne is usually related to hormone fluctuations.
- Dermatologists recommend oral medications and cortisone injections to treat cystic acne.
There is nothing worse than waking up to discover you have a giant, red, and painful pimple deep under the skin. When we talk about pimples, we often talk about a thing that can be “popped,” but a lot of pimples that live deep under the skin cannot be popped and take days (or even weeks) to disappear.
These under-the-skin pimples are sometimes called “blind pimples,” but their correct term is a cyst or cystic acne.
Cysts are painful, annoying, and difficult (but not impossible) to treat. Here’s what you need to know about cystic acne.
Cysts develop and exist under the skin
A blind pimple/cyst/under-the-skin pimple is “essentially a large, oil filled balloon under the skin with no connection to the surface,” said Joshua Zeichner, MD, director of cosmetic and clinical research at Mount Sinai Hospital.
Debra Jaliman, MD an American Academy of Dermatology’s spokesperson added, “A blind pimple develops from a combination of oil, bacteria, and dirt that gets trapped in the pore. It will look like a lump under the skin.”
Because of the cysts size, inflammation, and proximity to the nerves – they are usually more tender and painful than traditional pimples.
Some cysts are visible, meaning, you can see the red “lump” on the surface of the skin, while others are so deep that although you can feel it, you can’t “see” anything.
The biggest difference between cysts and a whitehead, blackhead, or a pustule (what we consider “traditional pimples”), is that they don’t come to the surface and cannot be extracted.
“Sometimes they can develop a surface pustule that you can drain, but the majority of them often stay deep,” said Dr. Julia Tzu, founder and medical director of Wall Street Dermatology. Or as Dr. Jaliman put it, “Blind pimples don’t have an exit to the skin” and added that attempting to coax a cyst to the surface can “lead to even more irritation and infection.”
Because of the depth and the inflammation surrounding the cysts, Dr. Zeichner said that this kind of acne has a greater chance of leaving a scar “because of damage to collagen under the skin.”
Cystic acne is linked with hormonal acne
Androgen, like testosterone, is the hormone that contributes to the formulation of cysts, said Dr. Jaliman. Everyone is affected by cystic acne equally, and people usually see an increase in cystic acne around hormonal fluctuations like menstruation, during perimenopause, or after starting or discontinuing birth-control pills.
Dr. Tzu added that most hormonal acne manifests as cystic acne, especially around the jawline.
Topical acne treatments rarely work on cysts
When we think of acne treatments, we often think of over-the-counter benzoyl peroxide spot treatments and salicylic based cleansers, but these aren’t that effective on cysts. In fact, anything you put on top of the skin is probably not going to have much effect on the cyst and might just dry your skin out, further exasperating the cyst.
“Because these types of pimples are so deep in the skin, unfortunately, topical medications often cannot penetrate as far as they would need to in order to be effective,” Dr. Zeichner explained, while Dr. Tzu added that “topical medications are mostly anti-inflammatory and have no specific antiandrogenic effects,” which would be necessary to quell a cyst, considering how much hormones play into the development of these kinds of pimples.
Although the doctors agree that topical treatments are not as effective as oral medication, they do prescribe topical antibiotics (like Dapsone) or topical retinoids for patients with cysts.
Cysts respond best to oral medication and cortisone injections
“If your acne is not improving after two to four weeks of over-the-counter treatments, visit a board-certified dermatologist for a prescription regimen,” Dr. Zeichner advised.
The doctors generally prescribe one or more of the following treatments for patients who continually struggle with deep, painful, under the skin cysts:
Oral antibiotics: This helps treat and prevent bacterial growth from an inside-out approach.
Oral Spironolactone: People can be prescribed this oral medication that blocks the effects of acne-causing androgens.
Birth Control: People are also often prescribed certain brands of birth control to manage the hormonal effects of cystic acne.
Cortisone injections: Dermatologist can inject the cyst with cortisone to help reduce inflammation, and cysts generally reduce in size within a day after the injection.
Isotretinoin: Often referred to by its former brand name,Accutane, Isotretinoin is a prescription oral medication for severe acne and is often the last resort after other options fail to work.
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