If you’ve got tender, inflamed pimples rooted deep underneath the surface of your skin, chances are you have cystic acne. This type of inflammatory pimple is one of the most severe, with the potential to cause long term scarring. Acne cysts can be chronic or infrequent, and may or may not eventually emerge at the skin’s surface.

In order to learn more about why cystic acne develops — and exactly how to treat it — we talked to the expert: Dr. Sandra Lee, aka Dr. Pimple Popper.

What’s the difference between a pimple and cystic acne?

Figuring out what type of acne you’re experiencing is important for tailoring the most effective treatment. Cysts are a type of inflammatory acne — pimples that start out as clogged pores (aka non-inflammatory acne) but become infected with P. acnes bacteria. There are four types of inflammatory acne:

• Papules
• Pustules
• Nodules
• Cysts

Papules and pustules are more superficial, originating in skin's outermost layer (aka the epidermis). Nodules and cysts are deeper areas of inflammation located in the dermis.

What does cystic acne look like?

Acne cysts resemble papules and pustules, though as we mentioned they’re deeper beneath the skin’s surface. They’re also much less common than papules and pustules. Here are the main characteristics of cystic acne:

• Deep, pus-filled bump beneath skin
• Pea to dime-sized or even larger
• Painful to the touch
• Skin may be red or discolored
• May or may not have a white head

What causes cystic acne?

All acne begins when pores clog with excess oil and dead skin cells. This provides a breeding ground for acne bacteria that's normally present on the skin’s surface. Though scientists aren’t sure why, some people seem more susceptible to this bacterial infection than others.

How severe your inflammatory acne is likely depends on a combination of factors, including:

• Hormones
• Genetics
• Immune response
• Lifestyle
• Environment

An acne cyst forms when the infection spreads outside the pore wall, leading to an immune response deep inside the skin.

What’s the best way to treat acne cysts?

According to Dr. Lee, there are a variety of treatments for cystic acne, depending on your individual circumstances. Though everyone’s skin is unique, here’s a rough guide. If you're experiencing frequent cystic breakouts, or any type of scarring, see your dermatologist.

Occasional acne cysts

Once-in-a-while painful, deep pimples are typically hormonal in nature and tend to pop up in similar spots along the jawline and/or T-zone. Keep breakouts in check by maintaining a consistent skincare routine that includes:

• Beta hydroxy acid: exfoliate and clear pores with SLMD Salicylic Acid Cleanser
• Retinol: reduce skin cell buildup with SLMD Retinol Resurfacing Serum
• Benzoyl peroxide: keep this antibacterial ingredient found in SLMD BP Acne Spot Treatment on hand

Mild inflammatory acne with infrequent cysts

Managing inflammatory pimples requires a comprehensive approach that addresses each stage of acne. Keep consistent with salicylic acid and retinol (plus a spot treatment when needed), but add one of these antimicrobial acne-fighters to your routine:

• Benzoyl peroxide: use SLMD Benzoyl Peroxide Acne Lotion after cleansing to kill bacteria and help calm inflammation
• Sulfur: try this sensitive-skin antimicrobial found in SLMD Sulfur Lotion

To take the guesswork out of managing acne, Dr. Lee created easy-to-follow skincare regimens formulated for all skin types. SLMD Acne System is a 3-step, twice-a-day routine that uses proven ingredients like salicylic acid, benzoyl peroxide, and retinol. If you’ve got sensitive skin, try sulfur instead, as part of SLMD Sensitive Skin Acne System.

Moderate to severe cystic acne

If you’ve been diligently following a regimen like Acne System for at least 12 weeks and haven’t seen improvement (or if you're worried about scarring), it’s time to consult with a dermatologist. Inflammatory acne left unchecked can have long term repercussions — causing permanent scarring and psychological damage. Your doctor can prescribe more potent treatments, including:

• Antibiotics: topical (like erythromycin or clindamycin) and oral (like doxycycline)
• Retinoids: topical (tretinoin, aka Retin-A) and oral (isotretinoin, aka Accutane)

How to get rid of an acne cyst

News flash: you should never pick or pop an acne cyst — even when they have that oh-so-tempting white head on them. These types of pimples are full of fluid, including bacteria and pus, that will just spread and create more acne. Irritating a pimple also encourages hyperpigmentation or even permanent scarring.

Instead, try one of these methods to speed up the healing process:

• Spot treatment: look for maximum-strength ingredients like benzoyl peroxide (find it in SLMD BP Acne Spot Treatment) or salicylic acid (like SLMD Salicylic Acid Spot Treatment). Acne patches like ultra-translucent SLMD Salicylic Acid Pimple Patches are a great option because they help prevent picking or popping.
• Warm compress: apply a warm (not hot!) washcloth to the cyst for about 10 minutes, several times a day. The theory is that gentle heat helps loosen the pus inside the cyst so that it can be better expelled by the lymphatic system.
• Cortisone shot: If you’ve got access to a dermatologist, this is perhaps the quickest and most effective way to shrink an acne cyst. The medication is injected directly into the pimple to reduce inflammation. It’s ideal for treating pimples that pop up right before big events.

Dr. Lee’s last word

Cystic acne can be a source of frustration and discomfort for patients. Not only can it damage skin and leave permanent scars — it can also contribute to low self-esteem and depression. But there are solutions, from targeted spot treatments to over-the-counter regimens like my SLMD Acne System that uses potent dermatological ingredients. And if your acne persists, your dermatologist can help you with prescription options. Remember, be kind to yourself and know that your acne doesn’t define you.

—Dr. Sandra Lee