The best ways to get rid of cystic acne, according to experts

• Pimples that live under the skin, or cystic acne, is incredibly hard to treat because it does not respond to topical treatments.
• Cystic acne is usually related to hormone fluctuations.
• Dermatologists recommend oral medications and cortisone injections to treat cystic acne.

There is nothing worse than waking up to discover you have a giant, red, and painful pimple deep under the skin. When we talk about pimples, we can talk about things that can be "popped," but a lot of pimples that live deep under the skin (or even weeks) to disappear.

These under-the-skin pimples are sometimes called "blind pimples," but their correct term is a cyst or cystic acne.

Cysts are painful, annoying, and difficult (but not impossible) to treat. Here's what you need to know about cystic acne.

Cysts develop and exist under the skin

A blind pimple / cyst / under-the-skin pimple is "essentially a large, oil filled balloon under the skin with no connection to the surface," said Joshua Zeichner, MD, director of cosmetic and clinical research at Mount Sinai Hospital.

Debra Jaliman, MD, American Academy of Dermatology's spokesperson added, "A blind pimple develops from a combination of oil, bacteria, and dirt that gets trapped in the pore. It will look like a lump under the skin. "

Because of the cysts size, inflammation, and proximity to the nerves – they are usually more tender and painful than traditional pimples.

Some cysts are visible, meaning, you can see the "lump" on the surface of the skin, while others are so deep that you can feel it, you can not "see" anything.

The biggest difference between cysts and a whitehead, blackhead, or a pustule (what we consider "traditional pimples"), is that they do not come to the surface and can not be extracted.

"Sometimes they can develop a surface that you can drain," said Dr. Julia Tzu, founder and medical director of Wall Street Dermatology. But as Dr. Jaliman put it, "Blind pimples do not have an exit to the skin" and added that attempting to coax the surface can "lead to even more irritation and infection."

Because of the depth and the inflammation surrounding the cysts, Dr. Zeichner said that this kind of acne has a greater chance of leaving a "collapse of the skin."

Cystic acne is linked with hormonal acne

Androgen, like testosterone, is the hormone that contributes to the formulation of cysts, said Dr. Jaliman. Increased cystic acne around hormonal fluctuations like menstruation, during perimenopause, or after starting or discontinuing birth-control pills.

Dr. Tzu added that most hormonal acne manifests as cystic acne, especially around the jawline.

Topical acne treatments rarely work on cysts

When we think of acne treatments, we often think of over-the-counter benzoyl peroxide spot treatments and salicylic based cleansers, but these are not that effective on cysts. In fact, anything is going to be much better than that of your skin, and further exasperating the cyst.

Read more: 5 acne spot treatments that actually work, according to experts

"Because these types of pimples are so deep in the skin, unfortunately, topical medications often do not need to be effective," Dr. Zeichner explained, while Dr. Tzu added that "topical medications are mostly anti-inflammatory and antiandrogenic effects, "which would be necessary to have a cyst, considering how much hormones play into the development of these kinds of pimples.

Although they are prescribing topical antibiotics (like Dapsone) or topical retinoids for patients with cysts.

Cysts respond best to oral medication and cortisone injections

If your acne is not improving after two weeks of over-the-counter treatments, visit a board-certified dermatologist for a prescription regimen, "Dr. Zeichner advised.

For the most part, the following applies to patients who are continually struggling with deep pain, painful, under the skin cysts:

Oral Antibiotics: This helps treat and prevent bacterial growth from an inside-out approach.

Oral Spironolactone: People can prescribe this oral medication that blocks the effects of acne-causing androgens.

Birth Control: People are also prescribed certain hormonal effects of cystic acne.

Cortisone Injections: Dermatologist can inject the cyst with cortisone to help reduce inflammation, and cysts generally reduce in size within a day after injection.

Isotretinoin: Often referred to by its former brand name, Accutane, Isotretinoin is a prescription medication for severe acne and is often the last resort after other options fail to work.

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