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Nothing can ruin my week like a cystic pimple. It's round, it's red, it's bulging, and no amount of concealer or prayer will kill it. You know it's different from a regular pimple when inflammation is forming beneath the surface, says dermatologist Dr. Rachel Nazarian of Schweiger Dermatology Group. "Most cystic lesions begin below the skin when the oil glands and skin cells are 'clogged' and create irritation and inflammation—often in conjunction with surface bacteria," she explains.
In my experience, a cystic zit can last for up to two weeks. Questions cycle through my mind: Do I need to go to the dermatologist's office? Will it scar? Do spot treatments really work? What caused it in the first place?
It's important to know that acne is a complex disease that can be affected by an infinite combination of internal (genetic predisposition, hormone concentrations) and external (diet, stress) factors. Stress, in particular, is one major catalyst to take a closer look at according to dermatologist Dr. Melissa Kanchanapoomi Levin, founder of Entiére Dermatology.
"Stress is an ever constant presence in modern life. While stress does not cause acne, it can exacerbate or worsen it," she says. Previous studies have found that chronic stress can induce a rise in cortisol and androgens which increase oil production, leading to clogged pores and overgrowth of a bacteria called Propionibacterium acnes. She continues, "Overgrowth of the bacteria increases inflammation under the skin, resulting in cystic acne."
Levin adds that newer studies have shown even deeper links between acne and stress, where "[it's] not only because of the systemic rise in cortisol and androgen but also locally secreted neurotransmitters, neuropeptides, and hormones in the skin itself which leads to a triggering and worsening of the stress and acne cycle."
Translation: Being more chill will only be beneficial for your skin in the long run. Meditate. Exercise. KonMari your whole life until everything "sparks joy." And, as you work on big-picture lifestyle changes, try these dermatologists' more tangible steps to take the minute you feel a cystic pimple coming.
Do you need to treat a cystic pimple differently vs other pimples?
"Yes. Absolutely," Nazarian insists. "These lesions have a higher risk of scarring the skin- they should not be pressed or squeezed as this increases the chances of scars or mark formation."
Levin adds that those who experience cystic acne should really be regularly seeing a dermatologist who can prescribe topical and oral medications. If you're taking matters into your own hands, she says Differin is her top over the counter pick. "It contains the retinoid adapalene and there is no irritation. I also like the Differin Daily Deep Cleanser which contains five percent benzoyl peroxide," she says. "Benzoyl peroxide effectively treats inflammatory acne because it reduces a few factors that cause acne—oil production and the P.Acnes bacteria."
What immediate action should you take when you feel a cystic pimple coming?
First thing's first—do not pick. "Picking can worsen scarring and discoloration," Levin says. Meanwhile, Nazarian suggests immediately applying a spot treatment, but making sure it is actually meant for spot application. "Traditional acne medications are not meant to be applied directly to one acne spot, and are usually too drying when a large amount is placed on a small pimple. Most of the time this leads to a "halo of irritation" around the original pimple—which can sometimes be worse than the pimple itself!" Nazarian says. One product she suggests is Proactiv's Skin Purifying Mask, which can be dabbed on pimples and left overnight. "It contains antibacterial sulfur and can break down blackheads with continued use," she says.
What action should you take if the cystic pimple has already risen to the surface?
"I recommend applying a specialized hydrocolloid acne patch called ZitSticka which is a 24 freeze-dried microdarts bandage that self dissolves over two hours to deliver acne-fighting ingredients." It contains oligopeptide-76, a new anti-inflammatory ingredient that's like a gentler benzoyl peroxide without irritation, salicylic acid, niacinamide (which helps with anti-redness) and moisturizing hyaluronic acid.
Nazarian says it's best to see your dermatologist as soon as you feel a zit brewing beneath your skin, but if it's already too late a spot treatment could help here too. Look out for anti-inflammatory ingredients and ones that break down skin cells, like Neutrogena's rapid clear spot treatment. "I also like to use a small amount of over-the-counter hydrocortisone one percent cream to the pimple. It's even better if you leave the cream in the fridge because the cool temperature shrinks down the pimple and diminishes redness," she shares.
When is it the right time to visit the dermatologist to treat a cyst?
"Immediately! Cystic pimples respond very well to injections when done early," Nazarian suggests. "If you can see the small bump forming, or the area feels tender, call your derm!" The injections, administered directly into the cyst, contain a dilute corticosteroid. Levin also suggests seeing a derm for an injection if your cyst is painful. "Cortisone is an anti-inflammatory that shrinks the swollen wall of the cyst," she explains. "Cortisone shots don't work for the pus-filled pimples and are often reserved for cystic blemishes."
While they are not long-term solutions, an injection will make the cyst go away within one to two days—or quicker. "Even after the pimple goes away, the little marks may be scar tissue which will still respond to the injection," Nazarian adds.
How do I avoid the cystic pimple from scarring once it dies down?
"Be diligent about daily sunscreen to encourage rapid fading of dark spots," Nazarian suggests, adding that you should use a minimum of broad spectrum SPF 30 every day. "Additionally, I would suggest really sticking to a topical nightly regimen of a retinoid, which can stimulate collagen and improve scars over time." Nazarian suggests an adapalene gel, which you can use three nights a week to start along with a good moisturizer with it.
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