Cystic Acne 101: Everything 2 Pimple-Whispering Skin Experts Want You to Know

You know that little old saying, "Shit happens"? Well, acne happens. Uneven skin texture, bumps, pimples, and pustules are a fact of freaking life, and before we begin our deep dive into all things cystic acne, we just want to say this: Acne is normal, acne is complicated, and acne is not anything to feel ashamed of. More and more, we're working to soften the negative stigma associated with bumpy, "imperfect" skin and embrace the natural environment of our complexion instead (which, quite honestly, is almost always the antithesis of glassy, filtered-looking skin—who decided that was the aspiration anyway?!).

All that's to say certain types of acne—like stubborn cystic breakouts—are much more severe and mysterious than others. For instance, if I decided to slather coconut oil all over my face one night and then awoke to an angry rash of zits on my chin days later, that's as simple a solve as computing two and two to get four. Remove the coconut oil and say goodbye to the reactive breakouts. Cystic acne, however, is much more complicated, and the underlying causes aren't usually clear-cut or easy to distinguish and diagnose. Additionally, cystic breakouts are usually the most physically painful and visible, which, given our clear skin–obsessed society, can take a toll mentally. 

Well, we're here to offer some friendly support and information. Even though we feel well versed in the art of getting pimples, we're far from experts in the art of treating them. So, to school us on the who, what, where, when, why, and how of all things cystic acne, I reached out to two amazing experts: Renée Rouleau, celebrity esthetician and CEO of her namesake skincare collection, and Mona Gohara, dermatologist expert in skin of color and the co-creator of Melé—a science-backed skincare brand designed with melanin-rich skin in mind. Keep scrolling to learn all of their tips and protocols for treating cystic acne. 

Cystic acne has a few key defining characteristics that are important to be aware of. First, it's the most severe, stubborn form of acne, and it's usually associated with hormonal imbalance. As Gohara explains, cystic acne comes from the hormonal stimulation of the oil gland. The oil gland produces oil, the oil fuels bacteria, and the bacteria triggers inflammation, resulting in a gnarly breakout.

"People with cystic acne will experience hard, painful bumps that develop deep within the skin and can linger for weeks," Rouleau explains to us. "A true cyst remains as a bump under the skin and rarely surfaces, unlike whiteheads and pustules. Instead, the body reabsorbs the infection. They are the most frustrating type of inflammatory blemishes because they last the longest and can cause long-term scarring." 

Hormones: As we mentioned earlier, cystic acne is primarily driven by our hormones. According to Rouleau, the menstrual cycle, pregnancy, an IUD, and birth control pills can all impact cystic acne (both positively or negatively depending on the person), as they all influence our body's hormone activity. 

Diet: Perhaps you've already heard it around the rumor mill, but dairy, in particular, is problematic when it comes to cystic acne. "If you're developing cystic breakouts along the jawline and neck area, it might be a sign that you’re consuming more dairy than your body can tolerate," notes Rouleau. Our skin naturally acts as an excretory system to get rid of things our body doesn't agree with or has too much of. So if you're sensitive to dairy or you've been imbibing more than usual, you're body might be trying to expel what it doesn't need. 

In general, try to focus on a balanced, clean diet with lots of nutritious greens and healthy fats. And if you suspect dairy could be causing your cystic breakouts, Rouleau recommends completely cutting out dairy for a full three weeks and keeping a food diary, which will help keep you accountable.

"If you don’t develop any new cysts then this might solve your problem," she explains. "It doesn’t mean you'll never be able to eat dairy again—just be mindful as you slowly introduce it back into your diet. The point at which you start breaking out again shows your body’s tolerance level."

Genetics: One of the most frustrating things about acne is how mysterious it is. Every case of acne is unique (there's hardly ever a straightforward quick fix), and experts say there is still a lot of mystery surrounding the underlying causes of acne. That said, both studies and skin experts alike cite genetics (sorry!) as a major player in determining whether or not a person will experience breakouts—cystic acne included.

Clogged pores: Keeping your pores as clean and clear as possible is paramount for anyone who regularly experiences or is especially susceptible to cystic acne breakouts. Dead skin cells, sebum accumulation, and P. acnes bacteria can all cause and worsen cystic breakouts, so make sure you're cleansing regularly (choose something noncomedogenic, gentle, balancing, and hydrating) both morning and night or after strenuous activity or exercise. Additionally, exfoliating once or twice a week will sweep away buildup and help keep skin clear and free of congestion.

As much as we'd love to say there's an easy, fast, straightforward treatment for cystic acne (or any type of acne for that matter), that's just not the case. The cause and presentation of acne is highly individual, so first and foremost, Gohara says the very best thing you can do is make an appointment with a professional. Although the pandemic has made in-office appointments trickly this year, if and when possible, it's best to consult a dermatologist or licensed esthetician. They'll be able to professionally assess your skin and create a game plan for treatment. Supplements, skincare products, in-office treatments, or even prescriptions such as spironolactone, birth control, or Accutane might be recommended depending on the severity of your cystic acne.

That said, while professional care should be your first step toward treatment, I asked Gohara and Rouleau for a list of their top recommendations when it comes to the dos and don'ts of treating cystic acne. Keep scrolling for all of their best insight.