[Acne] The Ultimate Guide to Dealing With Cystic Acne

*disclaimer: All of this is just my own experience and your mileage may vary. By cystic acne I mean the deep, painful bumps ("blind" pimples) that never come to a head

When I turned 25 I started getting deep, painful cysts on my chin, and I’ve probably read every single post on this subreddit related to cystic acne. I have finally found a solution that works for me.

The Method:

Do this as soon as you feel a “blind”, deep zit forming under the skin (even if you can’t see it or it doesn’t hurt yet). Before bed, prepare and drink a cup of chamomile tea (I use Bigelow Sweet Dreams tea). After you are done with the warm tea bag, press and hold it to the zit for about 30 seconds to a minute. Repeat nightly as needed.

That’s it! Without fail this makes the zit noticeably smaller and less painful within 1-2 nights. Typically within 3-4 nights I stop treating it altogether because I don't need to anymore! And this is for cysts that would typically be painful and inflamed for weeks.

Tips:

  • Warm compresses weren’t working for me initially, and I figured out it was because I wasn’t being gentle enough. The tea bag should be comfortably warm but not too hot, otherwise it will just irritate things more.
  • Similarly, hold the tea bag gently against the skin but do not press too hard. This will just make it worse.
  • I’ve tried this for whiteheads too and it can be useful for drawing them to a head, but this method is much more effective for cystic acne
  • Using chamomile tea as opposed to a different tea is important and doing it before bed is most effective for me. Sometimes I also do a morning round of this treatment or try ginger green tea, but it doesn’t seem to work as well
  • Do not touch the zit at all the rest of the day.
  • This can be drying to the skin, especially after multiple nights in a row, so it’s important to moisturize. I like La Roche-Posay Cicaplast Baume B5 for when skin gets flaky
  • Usually some pigmentation is left behind for weeks even after the cyst has flattened out, but that’s very easy to cover up with makeup. I like Clinique Redness Solutions Makeup

My experience with other solutions I have tried:

Hydrocolloid bandages

  • This is the one other semi-useful treatment I’ve tried. These are supposed to be for white heads but some people swear they are useful for cysts, too. It might just be that having one on keeps you from touching/picking. Note: Zit stickers with “spikes” to penetrate deeper, like Zisticka, have not been useful and have just made my zits even more irritated.

Cold compresses/ice

  • This has never worked for me at all, and the cold seems to “firm up” the cyst even more for some reason. It seems to be heat that does the trick.

Cortisone Shot from a dermatologist

  • I did this once for a particularly bad cyst and had good results, but this is in no way a long term solution for something that happens regularly. I would recommend this in an emergency- like if it’s right before your wedding- but the tea bag method makes it so my cysts don’t ever get big enough for this to be necessary!

Tretinoin

  • I had already been on Tret .05% for a year when I started getting these cysts, so this hasn’t been a solution. Maybe my cystic acne would have been worse if I wasn't on Tret, though.

Azelaic acid

  • I have been using prescription azelaic acid (finacea) for about a year (which is also supposed to be more effective combined with tret). I can’t really say whether or not it helps with the cysts. I definitely still get them.

Rosehip Oil

  • Is supposed to reduce redness and help with cystic acne. This wasn’t particularly useful for me, and I’m in fact wary of this making my oily T-Zone even worse by putting an oil on it. I do put rosehip oil on my cheeks every night because I don’t get acne there, and it’s very moisturizing.

Diet

  • I had been eating a whole food plant based (vegan) diet for about a year when I started getting these cysts, so a healthy diet unfortunately did not protect me. I tried a completely oil free/fat free vegan diet for a few weeks when my cystic acne was particularly bad (look up Nina and Randa Nelson) but this didn’t noticeably help, and also wasn’t sustainable long term for me. I do recommend eating a whole food plant based diet for skin and general health (dairy is supposed to be particularly bad for acne), but it’s not a cure all. I definitely treat myself occasionally to dessert/fast food, and my skin is overall very clear, so I think for most people it’s really not necessary to eat perfectly.

Spearmint tea/spearmint capsules

  • Spearmint is supposed to have an anti-androgen effect that prevents cysts. I tried this for several weeks and I’m not sure this was helping at all, and even if it was I don’t like spearmint tea enough to commit to drinking it every single day long term. I similarly don’t want to commit to buying spearmint pills for the rest of my life. This does seem to work for some people, though.

Red Light therapy

  • I have a red light that I sit in front of sometimes because it’s supposed to reduce inflammation. I have no idea if it helps or not, and is definitely not a solution for my `cystic acne.

Dermatologist

  • My experience going to a dermatologist about my cystic acne wasn’t good. He recommended I go on antibiotics (amoxycyllin), but I didn’t view this as a long term solution because I expected the acne would just come back after the antibiotics were over. He also prescribed me a topical antibiotic (clindamycin), which would probably help with white heads but isn’t useful for the deep cysts I was regularly getting.

Pillowcases/Laundry

  • I switched to satin pillowcases and I wash them every single week using a hypoallergenic laundry detergent (seventh generation free and clear). I dry them using dryer balls instead of dryer sheets so that they don’t get coated in wax. I can’t say whether this is making a difference or not, but I’d recommend giving it a try.

Things I’ve tried for cystic acne that were totally ineffective:

  • Sulfur ointment
  • Tea tree oil
  • Salicylic acid (does’t work for deep cysts)
  • Benzoyl peroxide (doesn’t work for deep cysts)
  • Aztec healing clay
  • Hemorrhoid cream
  • Diaper rash cream
  • Both prescription strength and drugstore hydrocortisone
  • Basically I recommend just not bothering with anything topical for deep cysts. None of these things made any difference