How I Finally Got My Cystic Acne Plague Under Control

by Melissa Kirsch
Originally Published: 
A gril looking in a mirror closeup to her cheek checking did she clear her cystic acne

If you suffer from the dreaded condition of cystic acne, you’ve certainly heard all the conventional wisdom about it: It’s hormonal, topical treatments don’t work, the only way out is the nuclear option, Accutane, and even that might not cure you. I feel your pain because I have lived it, and because I’m that kind of can-do self-care obsessive who never met a hair she didn’t laser, a neck cramp she didn’t acupuncture or an ingrown toenail she didn’t have surgically removed, I have been on a 20-year odyssey to get a handle on my cystic acne. I believe I may finally have succeeded.

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Let’s review what cystic acne is.

According to one of my favorite skincare experts, Paula of Paula’s Choice, cystic acne is one of the most severe forms of acne. Its “lesions actually rupture beneath the surface of the skin, pushing the blockage and swollen contents beyond the reach of traditional, topically applied anti-acne products.” Oil glands overproduce sebum and burst, creating that massive a-hole of a cyst, a painful welt whose mission control seems to be 20,000 leagues under the surface of your skin and feels like a tiny ball bearing and never goes away.

If your cystic acne is anything like mine, you’ve been nursing the same subterranean zits for years—they subside, they re-emerge, they’re always lying in wait there on your chin or your upper lip, and if you’ve been lucky enough to get rid of one, you have an unsightly scar to show for it.

Here’s how I’ve tried to treat it.

I never had severe acne as a teenager. I got (and still do get) the occasional zit or bumpy patch that I usually attributed to stress or my period or not washing my face with Clean & Clear or whatever ridiculously acidic “toner” I was using back then. For this I’m grateful—I know people suffer mightily with real acne, and I know I’m lucky never to have had to deal with a full-face assault.

But these underground zits are a bad time. Here is how I’ve tried to get rid of them:

Popping them: Ha! As if! They don’t have a whitehead, and if you try to pop a cystic zit, it will probably bleed, or an alien will come flying out of it, limbs flailing.

Drying them out: The skin around the cyst dries out, so you get a brown, scaly patch, and the angry mountain at its center is now bright red.

Retin-A: I am still not actually sure what Retin-A does. I know everyone loves it. I’m currently using it to get rid of my regular, garden-variety zits, but it has done very little besides make me so sun-sensitive my whole face vibrates with ache at the lightest breeze.

Changing my pillowcases more frequently: A good idea, but no change.

Getting a facial: Never again am I letting someone without an MD put a needle in my face.

Renée Rouleau Anti-Cyst Treatment: This is the most effective over-the-counter remedy I’ve tried, but it only seems to work if you get the cyst in its early stages, before it has developed a nervous system and bad attitude. It seemed to keep the cysts at bay, but only if I applied it religiously as soon as I got that weird bruise feeling that tells you it’s coming on the day before it starts raging.

Coritsone shots at the dermo: THIS WORKS. But who can go to the doctor every time she has an outbreak? And my dermatologist has cautioned against doing this too much.

Antibiotics: They worked. But you and I both know that this is a terrible long-term solution.

Home acid peel kits: Even I know this is insane now.

Ice: Ice does relieve the pain a little. But it kind of inflames the cyst so it’s no longer a hot painful lump, but a cold painful lump.

Trying to relax: Thanks a pantload, WebMD.

I have not tried hormonal birth control or spironolactone, two off-label prescription remedies I’ve heard work.

What seems to have worked.

I went to the dermatologist assuming there was nothing he could do for the leprous situation on my chin and was just going to give me a few corticosteroid shots to make the most persistent bumps vanish, a short-term solution but one I was down with.

“I know there’s nothing you can give me because these cysts are hormonal and you’re just going to have to give me a shot and that’s fine, but I’m a little aghast that no one has come up with a better solution than hormones because every woman I know has these things and…”

The doctor cut me off. “There actually is a treatment that’s very effective that’s been around for a while. This is what happens when you don’t go to the dermatologist for a decade.”

Did I mention I am fastidious about getting my eyebrows shaped? OK, so it had been a while since I’d been to the dermo, and so I didn’t know about Aczone, a very popular, nonsteroidal topical cream that, along with my effort to be a little more gentle to my skin, seems to be keeping my cystic acne at bay. I know, I couldn’t believe it either, and I want you to know I am not being paid by anyone to recommend this stuff. I’m a normal woman who, before today, was riddled with a series of abnormally swollen pimples on her chin that seemed to possess roots, like an oak. I think that I may have killed the tree.

Here’s my regimen:

–If I wear makeup, I take it off with the only thing you should ever use as a makeup remover, Bioderma Sensibio. It’s gentle for getting just everyday dirt and crud off your skin too. I use it almost every night.

–I wash my face with WATER. That’s right. Water. Maybe a little very gentle soap, like this one, but mostly water and a gentle cloth.

–Retin-A for general skin quality. I am not yet convinced it works, but I’m sticking with it because I think you might have to use it for a few months before anything good happens.

–Aczone on my chin and around my mouth. I don’t use it every night, but if I have any fear there’s anything surfacing, I do. In the first month, I did get that throbbing “I’m coming!” feeling a few times, and I applied Aczone and one spot went away instantly. Another occurred, but went away very quickly.

–Major moisturizer and lip balm. These prescription medications dry you the hell out.

And a LOT of sunscreen every couple hours during the day. I am scared to jinx it, but I’ve been monster zit-free for over a month. I am open to any and all natural method for dealing with these things, as I am committed to not coating myself in chemicals every night, but so far the egg whites and coconut oil and giving up dairy have, alas, been ineffective. If you can’t get a prescription for whatever reason, I do advocate the Renée Rouleau potion I mentioned above, and drinking a bathtub-full of water every day is never a bad idea.

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