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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 the standard approach to cystic acne is 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, like the occasional nodule, can benefit from topical, over-the-counter treatments, but dermatologist Noelani González, 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 the best cystic-acne treatments, I asked González and other dermatologists for their recommendations, and I’m sharing their suggestions below. I’ve tested a few of the products they mentioned, though not for the same reasons, so I can only speak to texture and whether it irritated my skin.
It’s important to note that lots of the products mentioned contain potent actives, so you should use one at a time rather than throwing the entire suite of products at your skin. Overdoing it could actually make your skin worse or impact your barrier. I’d recommend picking one active and then from there using gentler products to support your skin.
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 cystic-acne treatment overall
Active ingredients: Adapalene (0.1 percent) | Consistency: Gel | be Price: 0.5 ounces (approx. $28 per ounce)
Retinoids, which we’ve written about many times before, are beneficial for exfoliating the skin and purging your pores of dirt and oil. They’re also a great first line of defense for cystic acne and an ingredient that, according to four of the dermatologists I spoke to, can be used daily for preventing the formation of cysts in the first place. Dr. Joshua Zeichner, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital 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. Differin has a thin, lightweight consistency, and is a nice addition to the nighttime skin care routine. I’ve used it a few times when I’ve had an early stage pimple and found that it helped to move it through the process a bit quicker and lessened hyperpigmentation overall. To start out, I’d recommend using a tiny amount on problem areas and start applying it every other night as your skin gets adjusted to it. You can definitely use it all over, but I prefer just applying it to any areas where I’m experiencing a breakout. As always, 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
Active ingredients: Benzoyl peroxide (2.6 percent), zinc, licorice root | Consistency: Cream | Price: 4.2 ounces (approx. $2 per ounce)
Cleansers can also be an effective way to treat cystic acne. You’ll want to go for something that contains actives but also won’t strip the skin. I like this cleanser from Cetaphil, which makes well-tolerated cleansers that get the skin squeaky clean. This cleanser contains anti-inflammatory, acne-fighting ingredients like benzoyl peroxide, which helps to reduce the amount of bacteria on the skin. Dermatologist Dr. Karan Lal recommended this cleanser from Cetaphil, which, in addition to benzoyl peroxide, includes zinc and licorice root to soothe skin. “It’s low concentration and safe for all skin types,” he says of the cleanser, which contains 2.6 percent BPO. This is on the lower end for the ingredient to be effective (formulations generally start at 2.5 percent), as some formulations go up to 10 percent BPO. As for application, Lal has a tip: “I recommend patients leave it on for one minute before washing it off.”
Best facial cleanser for cystic acne without peroxide
Active ingredients: Salicylic acid | Consistency: Gel | Price: 6.76 ounces (approx. $2 per ounce)
If you’d rather skip the benzoyl peroxide, this one from La Roche-Posay is a good option. The brand is known for its sensitive-skin-friendly formulations, and this medicated gel cleanser is no different. The main active here is salicylic acid, a powerful BHA that helps the skin’s natural exfoliation process, but it also contains hydrating glycerin to offset irritation and dry skin. The concentration of salicylic acid (2 percent) is also something that stood out to me. It’s good for cystic acne in particular because it doesn’t zap what’s on the surface but instead penetrates to deal with bacteria beneath the skin. While I haven’t tried this particular cleanser, I do have a 2 percent salicylic-acid toner in rotation, and so far it has worked wonders for my actives-sensitive skin. Because it isn’t something you leave on, I’d recommend letting it sit for at least 30 seconds to really interact with your skin.
Best cleanser without active ingredients for cystic acne
Active ingredients: Zinc | Consistency: Foam | Price: 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. This one from Cetaphil is a good option because its main active is zinc oxide, which reduces oil and helps with itchy skin (zinc oxide has long been an ingredient in diaper creams). The formula is also noncomedogenic and non-acnegenic, meaning the ingredients won’t clog your pores and make the cysts worse.
Best serum for cystic acne
Active ingredients: Zinc | Consistency: Serum | Price: 8 ounces (approx. $1 per ounce)
Regardless of skin type, it’s good to have a potent antioxidant serum in your routine to protect your skin from free-radical damage. That’s where vitamin C comes in. 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. “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. 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
Active ingredients: Zinc | Consistency: Gel cream | Price: 1.7 ounces (approx. $13 per ounce)
When it comes to hydrating the skin, 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 we’ve written about many times before, naming it the best overall pick for oily skin, dry skin, and the overall best pick for most people. It’s surprisingly hydrating despite its lightweight texture and contains hyaluronic acid, a humectant that draws water into the skin.
Best sunscreen for cystic acne
Active ingredients: Zinc oxide, lactic acid, niacinamide, vitamin B3, hyaluronic acid | Consistency: Lightweight cream | Price: 1.7 ounces (approx. $13 per ounce)
You’ll want to keep every step of your skin-care routine in mind when you have cystic acne, including your sunscreen. I’m a big fan of the EltaMD sunscreen, which has a nice lotion-y texture and contains both chemical and physical SPF. In addition to protecting skin against UV damage, it also helps to treat acne thanks to ingredients like 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
Active ingredients: Lactic acid, glycolic acid, citric acid, malic acid, salicylic acid, vitamin E, vitamin B5 | Consistency: Rich cream | Price: 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.”
Best spot-treatment cream for cystic acne
Active ingredients: Benzoyl peroxide (5 percent) and lactic acid | Consistency: Cream | Price: 0.5 ounces (approx. $72 per ounce)
PCA Acne Cream combines the acne-destroying effects of benzoyl peroxide with lactic acid, “which helps to hydrate skin as well as exfoliate the scaling that sometimes can develop with use of benzoyl peroxide,” according to Dr. Brendan Camp of New York–based MDCS: Medical Dermatology & Cosmetic Surgery. It also contains acne-fighting tea-tree-leaf oil.
Best less expensive spot-treatment cream for cystic acne
Active ingredients: Benzoyl peroxide (2.5 percent) | Consistency: Cream | Price: 0.75 ounces (approx. $9 per ounce)
For a less expensive benzoyl-peroxide cream, there’s Neutrogena On-the-Spot. This one contains a lower concentration than the PCA Cream (lots of formulas contain 5 percent), which lessens the chance of it irritating or drying out your skin. The lower pricepoint also means you’re giving up additional exfoliation by way of ingredients like lactic acid, but this is a good option if you’re looking to try out BP or find higher concentrations too strong for your skin.
Best skin-care device for cystic acne
Active ingredients: Red light
LED-light therapy has become a common, popular acne treatment and can be particularly effective on cystic acne. When I spoke to Corey L. Hartman, founder of Skin Wellness Dermatology, about the best skin-care devices, he told us red light has been shown to penetrate a bit deeper, which is ideal for a deeply burrowed nodule. It works by decreasing inflammation and zapping acne-causing bacteria. Senior editor Crystal Martin is a big fan of the LightStim, calling it a “heavy hitter.” “When I feel the soreness of a hard lump under the skin, I use the red light immediately. Sometimes I can stop a pimple from forming if I feel it early enough,” she says.
Best body cleanser for cystic acne
Active ingredients: Benzoyl peroxide (4 percent) | Consistency: Cream | Price: 6 ounces (approx. $2 per ounce)
If you are struggling with cystic acne on your chest or back, a body wash is ideal. This one from Panoxyl is designed for your face but can be used on your body, and contains 4 percent benzoyl peroxide. Strategist beauty columnist Rio Viera-Newton has previously sung the praises of the brand’s foaming wash, which contains similar ingredients and has a foamy consistency. She says it helped to shrink a blueberry-size zit brewing beneath the surface of her skin and has since helped to keep new acne at bay.
Best body cleanser for cystic acne if you have sensitive skin
Consistency: Cream | Price: 22 ounces (approx. $0.32 per ounce)
In case you can’t tolerate actives, or prefer to use a physical exfoliant to help unclog pores and keep your skin feeling smooth, Dove’s Gentle Exfoliating Wash is a great option, according to Garshick, because “it helps to clean out the pores while still being gentle on the skin.” Dove’s bodywash relies on exfoliating beads — which can sometimes be too rough to use on your face — to buff away dead body skin. Regular exfoliation can also improve skin tone and reduce the appearances of the dark marks and scars left behind by cystic acne over time.
Best body spray for cystic acne
Active ingredients: Salicylic acid | Consistency: Liquid | Price: 8 ounces (approx. $5 per ounce)
For getting hard-to-reach, breakout-prone places, such as the back, chest, and shoulders, this spray from Glytone is a great option. The salicylic acid helps to unclog the pores and eliminate dead skin cells, leaving skin looking clear. While you can use it any time, it’s particularly good to use post-workout, when sweat is at risk of clogging pores.
Best facial spray for cystic acne
In the same vein, I also love the Tower 28 SOS spray, which has one ingredient: hypochlorous acid. I’ve been using it regularly for years, especially after the gym, spritzing my skin as soon as I’m done. Hypochlorous acid is antimicrobial and works by reducing the bacterial load on skin and is generally well tolerated by sensitive-skin types. Lessening bacteria in turn reduces inflammation, and because there aren’t any harsh exfoliants, you can use it every day. It won’t compete with the benzoyl peroxide or retinols in your routine, so it can be added in without worrying about increasing skin sensitivity or triggering an adverse reaction.
Additional reporting by Lori Keong and Dominique Pariso.
Our experts
• Dr. Brendan Camp, of New York–based MDCS: Medical Dermatology & Cosmetic Surgery
• Dr. Y. Claire Chang, of Union Square Dermatology
• Dr. Noelani González, dermatologist and director of cosmetic dermatology at Mount Sinai West
• Dr. Corey L. Hartman, founder of Skin Wellness Dermatology
• Dr. Michelle Henry, founder of Skin & Aesthetic Surgery
• Dr. Samer Jaber, founder of Washington Square Dermatology
• Dr. Debra Jaliman, assistant professor of dermatology at Mount Sinai’s Icahn School of Medicine
• Dr. Karan Lal, dermatologist
• Dr. Marina Peredo, founder of Skinfluence NYC
• Dr. Morgan Rabach, dermatologist and co-founder of LM Medical NYC
• Rio Viera Newton, esthetician and Strategist columnist
• Dr. Joshua Zeichner, dermatologist and director of cosmetic and clinical research in dermatology at Mount Sinai Hospital
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