Cystic-acne sufferers know that a cyst is not the same beast as your garden-variety pimple. While whitehead pimples sit on the surface of the skin (which, though unsightly, means they’re easier to treat and conceal), cysts can linger under the surface of the skin like oil-filled balloons, growing bigger and more inflamed over time. They’re often painful, and the scarring can be severe, making skin appear pockmarked and fissured. That’s why dermatologists approach cystic acne with a powerful combination of topical treatments and antibiotics, moving on to scorched-earth methods like Accutane or a hormonal drug like spironolactone only if those earlier treatments fail.
Milder cases of cystic acne can benefit from topical over-the-counter treatments, but dermatologist Noelani Gonzalez, the director of cosmetic dermatology at Mount Sinai West, notes that “OTC options should be limited to when you have only one or two cysts.” Otherwise, she says, “you should go see your dermatologist sooner than later to avoid any scarring.” To find out which OTC options are actually worthwhile, we asked Gonzalez and other dermatologists about the most effective cystic-acne treatments to use at home, and we’re sharing their suggestions below.
It’s important to note that none of the derms we spoke to recommended using all of the items on this list because many contain potent active ingredients such as retinoids, acids, and benzoyl peroxide. Rather, they suggest pairing products that contain stronger actives with gentler, nonirritating ones. With this in mind, the list begins with the product our experts recommended the most often before continuing with their other recommendations in the order you’d use them in any skin-care routine, starting with cleansers and sunscreen and ending with nightly spot treatments, to help you determine which products may work best for you.
Best overall treatment for cystic acne | Best facial cleanser with actives | Best facial cleanser without actives | Best serum | Best moisturizer | Best sunscreen | Best exfoliator | Best spot treatment | Best less expensive spot treatment | Best spot-treatment patches | Best skin-care device | Best less expensive skin-care device | Best body cleanser | Best body cleanser if you have sensitive skin | Best body spray
What we’re looking for
Active ingredients and their concentrations: When dealing with cystic acne, it’s important to know which active ingredients you’re putting on your skin — especially if you’re already using a prescription acne treatment (think tretinoin or something similar) or tend to be sensitive to certain ingredients like salicylic acid or benzoyl peroxide. We’ve listed the active ingredients in each recommended product as well as their concentrations when available. Another thing to know is that while high concentrations can sometimes translate to a more effective product, they can also lead to more irritation. In any case, before adding an active ingredient into your routine, you should patch-test it on a small area of your skin before slathering it all over.
Consistency: Acne-prone skin is particularly sensitive to thick, rich formulations because they can be pore-clogging and leave skin greasy. Our experts recommend opting for lightweight formulas, which hydrate and treat without sitting heavily on top of the skin.
Price: Cystic-acne treatments are available at just about every price point — ranging from a pricey serum to an affordable light-therapy wand. We’ve noted the cost per ounce for everything mentioned, so you can pick which products work best for your budget.
Best overall cystic-acne treatment
Adapalene (0.1 percent) | Gel | 0.5 ounces (Approx. $28 per ounce)
Four of the dermatologists we spoke to say that integrating a retinoid into your skin-care routine is essential to preventing cysts. Retinoids, which we’ve written about many times before, are beneficial for exfoliating the skin and purging your pores of dirt and oil, which is why Dr. Joshua Zeichner, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital, says they’re helpful for treating cysts. He recommends Differin, the only prescription-strength retinoid that’s available over the counter. Dr. Samer Jaber, the founder of Washington Square Dermatology, adds, “Differin should be the first OTC product someone with cystic acne should use.” It’s a gel that contains adapalene, a medication that decreases inflammation, prevents new acne from forming, treats blackheads, and helps even out discoloration, he explains. Zeichner says you can use a pea-size amount and start applying it every other night as your skin gets adjusted to it. Dr. Debra Jaliman, an assistant professor of dermatology at Mount Sinai’s Icahn School of Medicine, also recommends Differin but stresses that, since retinoids make your skin more sensitive to the sun, applying an SPF in the morning is a must if you are going to use it.
Best facial cleanser with active ingredients for cystic acne
Salicylic acid (2 percent) | Gel | 6.76 ounces (Approx. $2 per ounce)
Two dermatologists name-checked this cleanser from La Roche-Posay, including Dr. Corey L. Hartman, the founder of Skin Wellness Dermatology. Unlike some salicylic-acid cleansers, which can be drying, this one delivers on the actives front while also being hydrating, so it cleanses without drying out your skin. For best results, Hartman recommends leaving the cleanser on for a bit after you work it in. “The longer a cleanser is allowed to have contact with the skin, the more effective it will be,” he says. He does warn that too long can increase the chances of dryness and irritation, though, and suggests letting it sit for about 30 seconds.
Best cleanser without active ingredients for cystic acne
Zinc | Foam | 8 ounces (Approx. $1 per ounce)
If your routine already includes lots of topical products with active ingredients such as retinoids or benzoyl peroxide, a milder cleanser may be a better choice in order to prevent further skin irritation, according to Dr. Marisa Garshick, a clinical assistant professor of dermatology at NYP-Cornell. “For those who suffer from oily skin but can’t tolerate salicylic acid, this foaming wash helps to reduce excess oil without drying out the skin,” she says, because of it’s noncomedogenic, non-acnegenic, and oil-free formula that has ingredients including oil-reducing zinc oxide.
Best serum for cystic acne
Zinc | Serum | 8 ounces (Approx. $1 per ounce)
Garshick told us that, regardless of skin type, it’s good to have a potent antioxidant serum in your routine to protect your skin from free-radical damage. “Many patients with cystic acne are also concerned about discoloration and brown spots that occur from the breakouts, and this vitamin C serum can also help to improve the skin tone,” she says, adding that this Phloretin CF serum from Skinceuticals is a great option that won’t cause additional breakouts. While Skinceuticals CE Ferulic is typically considered the holy grail of vitamin C serums, Phloretin CF is a much better choice for oily skin types. It contains L-ascorbic acid and ferulic acid but does not contain pore-clogging vitamin E. Dr. Marina Peredo, founder of Skinfluence NYC, agrees about vitamin C, saying it “helps build collagen, brightens the skin, and reduces hyperpigmentation.” To maximize its free-radical-fighting benefits, a vitamin C serum should be applied in the morning in conjunction with SPF.
Best moisturizer for cystic acne
Zinc | Gel cream | 1.7 ounces (Approx. $13 per ounce)
When it comes to hydrating the skin, Jaliman says people with acne-prone skin should stay away from any cream that contains heavy oils. Dr. Morgan Rabach, a dermatologist and co-founder of LM Medical NYC, agrees and notes that using an oil-free water-based moisturizer will keep skin hydrated while preventing breakouts. She recommends this one from Neutrogena, which contains hyaluronic acid to keep skin supple and moisturized. It also made our list of the best moisturizers for oily skin, and it’s dye and fragrance free.
Best sunscreen for cystic acne
Zinc oxide, lactic acid, niacinamide, vitamin B3, hyaluronic acid | Lightweight cream | 1.7 ounces (Approx. $13 per ounce)
Speaking of sunscreen, Jaliman loves Elta MD UV Clear SPF 46 — a longtime Strategist favorite — because “it’s lightweight, oil free, and suitable for those who are prone to acne.” Not only does it protect from UV damage, it is also specifically formulated to treat acne simultaneously. It contains niacinamide and B3, which will fade hyperpigmentation; hyaluronic acid, which will moisturize; and lactic acid, which will clear pores and reduce shine.
Best exfoliator for cystic acne
Lactic acid, glycolic acid, citric acid, malic acid, salicylic acid, vitamin E, vitamin B5 | Rich cream | 2 ounces (Approx. $22 per ounce)
Using an effective chemical exfoliator is super-important to aid cell turnover and unclog pores, which will hopefully keep cysts from forming in the first place. Harsh physical scrubs should be avoided since they typically only cause more damage long-term. Morgan loves this cream from SkinMedica, which contains a combination of alpha hydroxy acid and beta hydroxy acid to improve skin texture. She also has this advice for patients to keep breakouts from getting worse: “Avoid oily cosmetics, sunscreens, and hair products, stay away from harsh products and abrasive tools, and do not pick or squeeze blemishes.”