How to treat the most stubborn acne, according to dermatologists (2024)

June is National Acne Awareness Month and this week at NBC Select, we’re sharing our favorite products to tackle all your acne concerns. Shop treatments for acne scars, teen acne and more on our skin care homepage.

Millions of people deal with acne, but those who suffer from cystic acne know how difficult it is to treat compared to ordinary pimples. Cystic acne is a severe form of acne that results in large, pus-filled cysts underneath the skin’s surface, which usually makes them more painful than normal bumps and, depending on the severity, can cause scarring, says Dr. Emma Weiss, a board-certified dermatologist and assistant professor of dermatology at the University of Colorado, Anschutz Medical Campus. But treating cystic acne is not impossible, and experts recommend starting treatment immediately to avoid permanent scarring.

To help you determine how to minimize the appearance of cysts or get rid of them altogether, I spoke to board-certified dermatologists about the best over-the-counter and prescription treatments to seek out. Their recommendations for the best products to use in conjunction with more intensive treatments are also listed below.

SKIP AHEAD Best treatments for cystic acne | What causes cystic acne? | What active ingredients can help cystic acne?

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How to treat cystic acne

You may be familiar with OTC acne treatments like benzoyl peroxide, salicylic acid and retinol (a vitamin A derivative) that can treat ordinary, run-of-the-mill pimples. However, these acne-fighting ingredients aren’t strong enough to cure cystic acne, our experts say.

Treating cystic acne requires a trip to the dermatologist and likely some type of medical intervention, experts say. Some of the most effective treatments for cystic acne include in-office cortisone injections and oral prescription medications like birth control pills, spironolactone and isotretinoin (usually known by its brand name, Accutane) to treat the underlying causes of the cysts. The most important takeaway is that cystic acne requires early intervention to prevent permanent scarring, says Weiss.

“Topically, it’s really hard to treat cystic acne. Over-the-counter products may help mitigate the inflammation and bring it down a bit. But making it go away is a lot trickier, and [OTC products] will not be effective if used alone,” says Dr. Mona Gohara, a board-certified dermatologist at Dermatology Physicians of Connecticut.

However, certain OTC acne treatments are beneficial when used in conjunction with more powerful prescription treatments. You should cleanse your skin with a wash that contains salicylic acid or alpha hydroxy acids (AHAs) like lactic acid at least a couple of times a week and moisturize with an oil-free moisturizer that’s gentle on the skin, says Dr. Tracy Evans, a board-certified dermatologist and medical director of Pacific Skin and Cosmetic Dermatology. Those with acne-prone skin should stick to noncomedogenic lotions, makeup and any other face products in order to not clog pores, says Weiss.

How we picked the best cystic acne treatments

While OTC products can’t cure cystic acne, they can help improve your situation, dermatologists told us. When shopping for cystic acne treatments, our experts recommend considering the following factors:

  • Ingredients: Look for acne-fighting active ingredients like salicylic acid, benzoyl peroxide and adapalene. Since people with moderate to severe cystic acne tend to have sensitive and inflamed skin, you should also consider a gentle formula that’s free of alcohol, fragrance or abrasive scrubs to prevent irritation.
  • Formulation: All of the products we recommend are noncomedogenic, meaning they’re less likely to clog pores and help prevent new breakouts from forming.
  • Product type: Consider what type of OTC product fits into your skin care routine, especially when pairing them with prescription medications. Types of products that can help treat cystic acne include face cleansers, gentle moisturizers and gel spot treatments.
Best cystic acne treatments

Below, we rounded up a few expert-recommended OTC products that can help treat cystic acne when used with oral medications and in-office treatments.

Best face washes for cystic acne

CeraVe Acne Foaming Cream Face Cleanser

This foaming cleanser with 4% benzoyl peroxide is a great option if you have cystic acne on your face and around the body, says Weiss. It has added ingredients like hyaluronic acid and niacinamide that can be good for those dealing with acne due to their moisturizing and anti-inflammatory effects, she says. This wash gently removes dirt, excess oil and makeup, and it helps prevent new acne from forming, according to CeraVe. The noncomedogenic wash is also fragrance-free for those with sensitive skin.

Neutrogena Oil-Free Salicylic Acid Acne Wash

What we like

  • Oil-free
  • Removes dead skin
  • Unclogs pores

Something to note

  • Can irritate sensitive skin

This foaming cleanser comes recommended by Dr. Eileen Deignan, a board-certified dermatologist and chief of dermatology at Emerson Hospital, because it helps unclog pores and calm irritation from acne. The face wash has 2% salicylic acid, which helps remove dead skin cells and unclog pores, says Weiss. It’s suitable for most skin types because it’s free of oils, fragrances and parabens, according to the brand.

Panoxyl Acne Foaming Wash

What we like

  • Can use on body
  • High level of benzoyl peroxide
  • Reduces dark spots

Something to note

  • Not for very sensitive skin
  • Can bleach towels
  • Strong scent

If you have oily or non-sensitive skin, you can use Panoxyl’s foaming wash to tame cystic acne on both your face and body. Its formula is 10% benzoyl peroxide, the highest concentration of the acne-fighting ingredient on this list. However, such a high concentration of benzoyl peroxide can be irritating to some people, especially those with sensitive skin, so you should introduce the product gradually into your skin care routine, according to Weiss.

Best exfoliants and spot treatments for cystic acne

Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant

What we like

  • Gently exfoliates
  • Unclogs pores
  • Oil control

Something to note

  • Not for very sensitive skin

This liquid, leave-on exfoliant, a favorite among our NBC Select staff, has 2% salicylic acid to help fight acne, unclog pores and remove dead skin. It’s also formulated with green tea to help soothe irritation, according to the brand. You can use this exfoliant up to twice daily, as long as your skin tolerates it.

Neutrogena Rapid Clear Stubborn Acne Spot Gel

What we like

  • Prevents future breakouts
  • Can use daily

Something to note

  • Can bleach fabrics

This spot treatment gel contains 10% benzoyl peroxide, and you can apply it directly on top of acne to reduce its size and redness, as well as actively fight future breakouts, says Gohara, who usually recommends this product for her patients with cystic acne. Neutrogena recommends applying a thin layer of the acne gel one to three times daily.

Best OTC retinoids for cystic acne

Differin Adapalene Gel 0.1% Acne Treatment

What we like

  • Prevents new pimples
  • Pump packaging
  • Cures inflammation

Something to note

  • Takes some time to work
  • Not for very sensitive skin

Products that contain adapalene — the only topical retinoid available over-the-counter — can be helpful when used in conjunction with other prescription treatments, and can cure inflammation, deep clean pores and prevent new pimples from forming, says Weiss. The brand recommends applying a thin layer of Differin Gel to the affected areas of the skin after cleansing and before moisturizing.

La Roche-Posay Effaclar Adapalene Gel

What we like

  • Oil-free
  • Prevents new pimples

Something to note

  • Not for sensitive skin

Another adapalene product Weiss recommends is La Roche-Posay’s Effaclar Adapalene Gel, which contains 0.1% adapalene to help unclog pores and fight acne. The gel is fragrance- and oil–free, and it’s noncomedogenic.

Best moisturizers for cystic acne

CeraVe Daily Moisturizing Lotion

What we like

  • Good for sensitive skin
  • Thick yet lightweight
  • Gentle formula

Something to note

  • Nothing to note at this time

“For my acne prone patients, I recommend moisturizing with a gentle, noncomedogenic moisturizer to keep their skin barrier intact,” says Weiss. This daily moisturizing lotion from expert-favorite brand CeraVe is good for sensitive skin because it’s fragrance-free and accepted by the National Eczema Association. The lotion has hyaluronic acid and ceramides to help retain the skin’s natural moisture for up to 24 hours, according to CeraVe.

La Roche-Posay Toleriane Double Repair Face Moisturizer

What we like

  • Reduces redness
  • Good for sensitive skin
  • Lightweight

Something to note

  • Thinner consistency

One of our favorite expert-recommended face moisturizers for acne-prone skin and rosacea, this La Roche-Posay moisturizer is both gentle enough for sensitive skin and has ingredients like niacinamide and ceramides to keep it hydrated, according to the brand. I use this moisturizer both day and night on my sensitive, acne- and rosacea-prone skin because it helps soothe my constant redness and inflammation. The moisturizer offers 48-hour hydration and can be used on the face, neck and hands, according to La Roche-Posay.

What causes cystic acne?

Cystic acne is a type of inflammatory acne that causes deep, painful lesions underneath the skin due to the accumulation of oil, bacteria and dead skin cells. Much like regular acne, cysts can range from mild (you might develop one or two cysts on your chin around your menstrual cycle, for example) to severe, which can affect the entire face and even the chest and upper back, says Weiss.

Hormonal changes or triggers related to puberty, menopause and pregnancy, underlying medical conditions like polycystic ovary syndrome (PCOS), stress and genetics can all cause cystic acne, according to Weiss. Certain people may also have an increased risk of developing cystic acne, including those with a family history of cystic acne and teenagers going through puberty, she says.

What active ingredients can help treat cystic acne?

There are three common active ingredients in OTC products that can help reduce inflammation caused by cystic acne: salicylic acid, benzoyl peroxide and adapalene. Though they likely won’t completely treat cystic acne on their own, these active ingredients can be helpful if you use them with in-office treatments and prescription medications. Keep in mind, however, that all of these ingredients can cause irritation, so they may not be suitable for sensitive skin, and you should introduce them gradually into your skin care routine.

Salicylic acid

Salicylic acid is a chemical exfoliant and beta hydroxy acid (BHA) that helps fight acne by targeting excess oil production, unclogging pores and removing dead skin cells, says Weiss. You can typically find 2% salicylic acid in creams, washes and lotions.

Benzoyl peroxide

Benzoyl peroxide specifically fights acne-causing bacteria to help reduce inflammation and the appearance of acne lesions, according to Weiss. You’ll often see products with very high concentrations of benzoyl peroxide (usually around 10%), but there isn’t much evidence to suggest that higher strengths are more effective at treating acne.

“There are actually some studies that show that 2.5% benzoyl peroxide and 10% benzoyl peroxide have a minimal difference in terms of their efficacy in acne treatments,” says Gohara. People with cystic acne that experience sensitivity or dryness may be able to tolerate the lower strength ingredients better, says Weiss.

Adapalene

Retinoids are more powerful acne treatments that can be effective at reducing inflammation. Topical retinoids help increase skin cell turnover and clear out clogged pores, which may be contributing to the initial cause of cystic acne, says Weiss. While prescription retinoid gels and creams are the most effective at treating cystic acne, adapalene — a topical OTC retinoid treatment — works well to regulate the turnover of cells lining the pores to reduce clogging.

Keep in mind that adapalene can be very drying, so you should introduce this ingredient gradually into your skin care routine, using a small amount and moisturizing afterward, according to Gohara. “Your skin is already irritated with the cystic acne, the last thing you want to do is stoke the fire,” she says.

Frequently asked questions

One of the biggest concerns with cystic acne is the potential for severe and even permanent scarring, which is why you’ll want to get on a treatment that will take care of cystic acne sooner rather than later, says Evans. “People who have very severe cystic acne can scar very quickly,” she says.

Scarring is always hard to treat, and cystic acne scars may require more intensive treatments like laser resurfacing of the skin, microneedling, hydrafacials and injectables that can break up the scar tissue using small needles, says Evans.

Here’s some advice from our experts on what to keep in mind — and some common misconceptions to avoid — when crafting your cystic acne skin care routine.

  • Simplify your routine. Don’t go overboard with the number of active ingredients you’re introducing into your routine. “If you’re experiencing irritation or dryness, consider only using one or two active ingredients at a time or using the lowest percentage of salicylic acid or benzoyl peroxide so that it’s not too irritating,” says Weiss.
  • Gradually introduce products. “I always recommend to my patients that they should be using products in a really slow and incremental way,” says Gohara. When using more irritating ingredients like benzoyl peroxide and adapalene, start with a pea-sized amount once or twice a week, and then gradually increase it to three times a week while monitoring any irritation, says Gohara.
  • Avoid harsh scrubs. There’s a common misconception that you should dry out acne, so people often use too many strong, irritating products, says Evans. “This is a condition that needs to be treated from the inside out, so you have to be more gentle with your skin care,” she says. Because cystic acne can cause very sensitive, inflamed skin, you should avoid using irritating products that contain alcohol or abrasive scrubs with small beads, which can cause microtears on the skin and lead to a damaged skin barrier , experts say.
Meet our experts

At NBC Select, we work with experts who have specialized knowledge and authority based on relevant training and/or experience. We also take steps to ensure that all expert advice and recommendations are made independently and with no undisclosed financial conflicts of interest.

  • Dr. Emma Weiss is a board-certified dermatologist and assistant professor of dermatology at the University of Colorado Anschutz Medical Campus.
  • Dr. Tracy Evans is a board-certified dermatologist and medical director of Pacific Skin and Cosmetic Dermatology.
  • Dr. Mona Gohara is board-certified dermatologist at Dermatology Physicians of Connecticut.
  • Dr. Eileen Deignan is a board-certified dermatologist and chief of dermatology at Emerson Hospital.
Why trust NBC Select?

Mili Godio is an updates editor at NBC Select who has covered a wide range of skin care topics, including face sunscreens, rosacea and keratosis pilaris treatments. For this article, Godio spoke to four dermatologists about how to treat cystic acne and highlighted their recommendations for the best over-the-counter products to consider.

Catch up on NBC Select’s in-depth coverage of personal finance, tech and tools, wellness and more, and follow us on Facebook, Instagram, Twitter and TikTok to stay up to date.

Mili Godio

Mili Godio is an updates editor for Select on NBC News.

How to treat the most stubborn acne, according to dermatologists (2024)

FAQs

How to treat the most stubborn acne, according to dermatologists? ›

Regular cleansing, twice a day, is ideal for removing those layers of old oil and makeup. I often recommend a topical retinoid cream to unclog pores and exfoliate the skin. Retinoids also have some anti-inflammatory effects, and they increase the rate at which our skin cells divide. This helps to heal the skin faster.

How do you treat stubborn acne? ›

Too much washing and scrubbing also can irritate the skin. Try over-the-counter acne products to dry excess oil and promote peeling. Look for products containing benzoyl peroxide and adapalene as the active ingredients. You might also try products containing salicylic acid, glycolic acid or alpha hydroxy acids.

What is the best dermatologist recommended acne treatment? ›

Adapalene: A retinoid, this active ingredient helps to clear blackheads, whiteheads, and pimples. Azelaic acid: It fights acne and can also fade the dark spots that appear when an acne spot clears. Benzoyl peroxide: This acne-fighter is especially effective at treating mild pimples.

What do dermatologists say about acne? ›

In short, very very small pimples will often clear quickly with topical agents such as antibiotics or retinoids, but only if they are superficial. Normally a dermatologist will also add in an antibiotic but this can take a few days rather than having an overnight effect.

What is the hardest acne to get rid of? ›

Acne conglobata is one of the most severe forms of acne. It involves many inflamed nodules that are connected under the skin to other nodules. It can affect the neck, chest, arms, and buttocks. It often leaves scars.

Why won't my acne go away no matter how hard I try? ›

There are a few reasons a pimple might not be going away. It's normal for some types of acne—especially deep, large pimples—to take some time to clear up. You might also have persistent pimples if you're not taking care of your skin, taking certain medications, or have certain health conditions.

How do you get rid of a hard pimple that won't go away? ›

Treatment for hard pimples
  1. Creams and ointments: The American Academy of Dermatology (AAD) recommends over-the-counter creams that contain benzoyl peroxide, retinoids, salicylic acid, and azelaic acid.
  2. Warm compress: A warm compress can soften the spot, allowing pus to come to the surface.

What is the most powerful acne treatment? ›

Isotretinoin: This is a potent medicine that attacks all four causes of acne—bacteria, clogged pores, excess oil, and inflammation (redness and swelling). About 85% of patients see permanent clearing after one course of isotretinoin.

Why isn't my acne clearing up? ›

Using only some of the acne treatment that your dermatologist prescribes could be the reason you still have acne. Wash your face twice a day and after sweating. Acne-prone skin is sensitive. Washing more than twice a day can irritate your skin, making acne worse.

What is the number 1 product for acne? ›

Rankings: Acne Treatments and Creams
RankBrandSample Product
#1 Score: 100DifferinBuy on CVS.com
#2 Score: 60NeutrogenaBuy on CVS.com
#3 Score: 56ClearasilBuy on Amazon
#4 Score: 56CeraVeBuy on Amazon
2 more rows

What is the new treatment for acne? ›

The new sebum-targeting AviClear laser doesn't have those potential side effects and appears to produce long-lasting results in individuals with moderate to severe acne. The prescription-free AviClear laser has the potential to significantly shift the treatment paradigm for acne.

Is there a permanent cure for acne? ›

Clearing severe acne greatly improves many people's lives. Most acne treatments, however, have little effect on severe acne. Isotretinoin can clear severe acne when other treatments fail. With just one treatment, isotretinoin can permanently clear the skin.

How to clear acne quickly? ›

  1. Apply Ice to the Pimple: ...
  2. Apply a Paste of Crushed Aspirin to the Pimple. ...
  3. Use An Over-the-Counter Acne Spot Treatment. ...
  4. Use Makeup with Salicylic Acid to Conceal Pimples. ...
  5. Apply a Face Mask for Acne. ...
  6. Get a Cortisone Injection to Quickly Get Rid of a Pimple.
Jul 25, 2024

How I cleared my severe acne? ›

Many over-the-counter treatments contain retinoids. Topical anti-inflammatories, like dapsone gel, can also reduce acne. An oral prescription medication called spironolactone can reduce the effects of male hormones. Chemical peels and blue light therapies also help if you want to clear up acne more quickly.

What age is acne the worst? ›

Acne effects around 90% of adolescents with the prime age across all genders being the teenage years of 14-19 years old. For people who have widespread acne that is classed as moderate to severe, more intervention in the form of acne treatments is often required.

What is the pill for clear skin? ›

For more severe forms of acne, your doctor may prescribe isotretinoin, a retinoid that is taken by mouth. Retinoids clear clogged pores by reducing the amount of oil that skin glands produce and killing the bacteria that reside there.

How do you treat acne that won't heal? ›

Home care and treatments
  1. Washing the face twice a day. ...
  2. Using ice for deep, painful pimples. ...
  3. Avoiding aggravating the skin. ...
  4. Trying a warm compress. ...
  5. Washing sheets and pillowcases regularly. ...
  6. Trying OTC creams. ...
  7. Using prescription medications. ...
  8. Changing the diet and lifestyle.
Mar 24, 2020

Why my acne is so stubborn? ›

The basics of Acne Development:

Stress, poor hygiene, hormone imbalances, and heredity are among the many variables that might bring on acne. Too much sebum, or oil, from the sebaceous glands, combines with surface germs and dead skin cells, clogging the pores.

Is there acne that won't go away? ›

If you have acne that just won't go away, you may want to take a closer look at your skin. It's possible that you don't have acne. Other skin conditions can look a lot like acne. Stubborn acne can also be a sign of something serious going on inside your body.

Why my acne is never ending? ›

There could be several reasons behind this skin issue. But stress, smoking, unhealthy eating habits, and alcohol could play a major role in such breakouts. During teen years, acne was a sign of approaching puberty. But if you are experiencing repeated breakouts in your adulthood, then it could be a cause of worry.

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