


Treat and prevent these painful underground pimples the right way.

Getty/ Margaret Flatley

Not everyone has experienced the pain of cystic acne, but if you do suffer from the skin condition, you know how rough a breakout can be. Cystic acne is a specific type of acne that consists of painful underground pimples that can leave severe facial scarring if not treated correctly.

It sounds scary, but don't worry, we've got all the deets on cystic acne causes, treatment, and prevention so, you can tackle breakouts like a pro. Whether you just have the occasional underground pimple, or you get clusters of them on the regs, this is going to be your cystic acne bible.

Margaret Flatley

Cystic acne occurs when clogged pores filled with oil and dead skin rupture underneath the skin (hence the name: underground pimple), causing the inflammation to spill out into the surrounding tissue.

Your body forms a cyst around it to stop the inflammation from spreading further. This causes painful nodules that feel almost like a pebble under your skin, says Beverly Hills Dermatologist and Owner of Ava MD and Skin Five, Ava Shamban.

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Since these pimples live underneath the skin's surface they don't form whiteheads or blackheads, so they're difficult to pop. The effect is a face covered with red bumps, almost like cobblestones.

"Teens, in general tend to get cystic acne on their cheeks and on their temple, like right at the edge of the eyebrow," Dr. Shamban says.

Unlike normal acne, cystic acne can be super painful because it's 100% inflammatory, meaning they're going to be red and irritated. That also means that, if left untreated, the underground pimples can cause pretty bad scarring.

margaret flatley
margaret flatley
Margaret Flatley

"Cystic acne is multifactorial," says Dr. Shamban, s0, many different things can cause an outbreak, but most likely when you get an underground pimple, it has to do with these five causes:

Genetics: That's right, just like anything, cystic acne can run in the family. So, if your mom or dad suffered when they were a teen, you might have some painful acne in your future as well. Usually, genetic cystic acne will first appear during puberty and last "anywhere from six to eight years," says Dr. Shamban.

Hormones: Androgen hormones overstimulate the sebaceous (oil) glands, which makes your body produce so much oil that it gets stuck in your pores and traps bacteria. The bacteria multiplies, causing the inflammation that starts a cystic pimple.

Basically, when your hormones are raging, your cystic acne will get worse. Because of this, you're more likely to experience a bad breakout during puberty, as well as a few days before each period.

margaret flatley

Stress: When you're under pressure and your stress level rises, your body responds by producing cortisol, another hormone that over stimulates your oil glands.

Processed Food: Yup, all those Pop-Tarts may be causing those bad breakouts. "The processed food we eat isn't good for our skin microbiome," says Dr. Shamban. And while, eating processed foods may not cause you to get cystic acne if you're used to normal breakouts, it will probably make whatever breakouts you do get, a lot worse.

Lack of Sleep: Again, this will just make any acne you have worse, but when you don't get enough sleep, your body raises your cortisone levels to compensate and this could lead to a breakout.

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As stated above, cystic acne is multifactorial, "so it's not just enough to change your cleanser and put on some gels," says Dr. Shamban. You do, however, have a lot of options when in treating underground pimples when it comes to behavioral, over-the-counter, and prescription options.

Behavioral: A lot of the causes of cystic acne are behavioral, meaning you're going to have to change some of your daily actions in order to prevent breakouts. Try eating healthier, getting more sleep, and reducing stress in your life. While a healthy diet won't necessarily make your acne go away, fueling up on key vitamins and nutrients can help, as can avoiding processed foods and artificial sugar. Eat one serving daily of foods with vitamin B6 (one banana or a bowl of whole-grain cereal) to help even out hormone levels; and beta-carotene (two medium carrots) to give skin a smoother texture. This can be easier said than done (especially when it comes to reducing stress), but the effects on your skin will be worth it.

Over-the-Counter Options: Want to take a crack at treating your cystic acne yourself? Start with a salicylic acid, says Dr. Shamban. This anti-inflammatory will reduce the redness in regular pimples and underground pimples.

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You can also try a cleanser with a low concentration of benzoyl peroxide and a light moisturizer and sunscreen.

Humane Benzoyl Peroxide 10% Acne Treatment
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Ultra-Light Face Lotion/Face Moisturizer with Sunscreen

It's important to remember that people with cystic acne tend to have more sensitive skin. So, "you have to treat the skin gently," says Dr. Shamban. "It's not about scrubbing it with brillo pads."

Before you go to sleep try applying an adapalene gel, which can work on your skin as you catch up on those all important Zzzzs.

Differin Adapalene Gel

Finally, products like tea tree oil and aloe gel are good OTC options for reducing redness, according to Dr. Shamban.

Organic Tea Tree Oil
Eve Hansen
Organic Aloe Vera Gel

Dr. Shamban suggests trying the over-the-counter options for about two months. If they aren't working, head to the dermatologist.

"If you're upset about it, then get it taken care of sooner rather than later," she says. "That's the thing about skin problems, there are treatments that work."

Go to the Dermatologist: Your doctor is trained to take care of your acne, so he or she will know what to do to help about the pain and breakouts. They may suggest OTC options that best fit your problem or them could give you some long-term treatments like Epiduo, Aczone, Retin-A or Accutane, a strong oral medication that decreases the amount of oil that your sebaceous glands produce.

A dermatologist might have some short term solutions as well. Meaning, if you get a bad underground pimple right before a big event, like prom or homecoming, don't panic. See your doctor to have him or her inject the pimple with cortisone, a steroid that reduces inflammation under the skin and shrinks swelling around the infection. Within six hours, the pimple should be gone.

Don't pick. Picking at zits not only can make them worse, but it can also lead to permanent scarring. If you're dead set on it, click here for the right way to pop a pimple.

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