Blind Pimples: How To Get Rid Of Cystic Acne & Get Clear Skin

Acne can significantly impact your mental health—whether you're struggling with whiteheads, hormonal breakouts, or any other form. In fact, some experts suggest acne can even be classified as a traumatic experience, especially in more severe cases.

However, one form of acne tends to be more intense than the rest, due to its difficulty to treat and the additional discomfort that comes along.

We're talking about blind pimples. You know, those large, inflamed, painful pimples under the skin? These can be particularly uncomfortable and oftentimes more difficult to treat than their more low-key cousins like blackheads, for example. There are many nuances to these breakouts that derms need you to know, so here we go.

The first step to treating cystic acne is determining the possible cause—and yes, there can be more than one. Here's a quick summary of the main triggers for cystic acne.

A sign your cystic acne is hormonal is, in part, the placement of the majority of your pimples. If they run along the chin and jawline, they're most likely to be hormonal; meaning, they typically form in the same areas due to your oil production patterns. While plenty of face-mapping acne claims haven't been borne out through studies, this one is backed by research1.

If you're someone who menstruates, breaking out around your cycle might be another sign. According to a survey, almost two-thirds of acne-prone women report having flares before or on their menses2 (more specifically in the "late luteal phase of the menstrual cycle" or after ovulation and right before you start bleeding). 

Or, if you've recently started to feel the effects of menopause, your breakouts may be hormonal as well—yes, menopause acne is a real thing, and you can read more about it here if you're curious.

This is a very, very brief overview of hormonal breakouts—read more about causes, signs, and treatments here.

Genetics do play a role in your likelihood of getting cystic acne3 as well, research shows. "Some patients who are already predisposed to acne with more oily skin or family history of acne can be more sensitive to hormones in the body," Kobets says.

This can include sex hormones like androgens, testosterone, and dihydrotestosterone (DHT) or stress hormones like cortisol. "Many of these hormones increase oil production and inflammation in the skin," Kobets explains.

If you know you're more prone to developing cystic acne (i.e., a close family member had or has acne), then it's best to let your dermatologist know early on—this may influence their next steps or at the very least give them important context.

Certain hormones released when we’re stressed can trigger the body to produce more sebum—aka the waxy, sticky stuff that keeps your skin moisturized. “CRH (corticotropin releasing hormone) is produced in the brain and is responsible for telling your adrenal glands to increase cortisol production during stressful times,” notes board-certified dermatologist Joshua Zeichner, M.D. “CRH also has an impact on sebaceous glands in increases oil production.” Too much sebum production has been linked to acne4, which is why you might break out when you're stressed, too.

A lack of sleep (which may be triggered by stress or, in turn, cause stress) also impacts your likelihood of experiencing breakouts. A lack of high-quality sleep creates stress in the body, which, as you now know, can manifest into more sebum production and more breakouts.

Even if you don't typically have acne-prone skin, a lack of sleep can contribute to what dermatologists refer to as "occasional acne."

What you eat can have an impact on your skin as well, but it may differ from person to person. What we do know is that, according to the American Academy of Dermatology (AAD), a low glycemic index diet may lead to fewer pimples. Your glycemic index, essentially, is how much and how quickly glucose (sugar) will be released into your bloodstream in response to digesting different carbohydrates.

What's more, "Studies have shown that consuming low-fat or skim milk has been associated with a higher incidence of acne as compared to consuming whole milk or no milk at all," board-certified dermatologist Ramya Garlapati, M.D., previously told mbg.

The link is so strong, as demonstrated in this AAD study5—researchers found that women who drank two or more glasses of skim milk a day were 44% more likely to have acne than others. 

Sugar and dairy have a way of sneaking into your diet. Even if you aren't deliberately drinking two glasses of dairy milk or consuming loads of sugar, these ingredients can be found in plenty of beverages (we're looking at you, lattes), as well as premade foods.

"About 7 to 11% of people with inflammatory bowel disease (IBD), for instance, have psoriasis, a noncontagious disease whose main symptom is flaky patches on the skin which are red and inflamed underneath when scratched. Gut inflammation eventually can become systemic inflammation. And that, along with oxidative stress, blood sugar imbalances, and other problems, can all show up on your skin—especially if you are genetically predisposed to these conditions," board-certified internist Vincent Pedre, M.D., once told mbg.

As you can tell, the gut and skin are incredibly connected. If you are predisposed to inflammatory skin conditions—whether it be acne, psoriasis, eczema, or something else, it's important to take this connection even more seriously. This is why it's so important to tend to the gut and treat acne from the inside as well as the outside—more on that to follow.

RELATED: Digestion & Acne: How To Get Clear Skin By Healing Your Gut

If you want to prevent scarring, seeing a dermatologist is a must. Cystic acne can lead to post-inflammatory hyperpigmentation and indentation scars—both of which can be hard to treat and may impact your mental health and self-esteem even after the breakouts have cleared.

Large, inflamed, painful pimples most often call for, "The big guns," as Kobets puts it. This means prescription-grade products and treatments—here are a few worth noting.

While isotretinoin (formerly called Accutane) may be controversial in the beauty space, there's nothing wrong with taking it—especially if you've tried everything else and want to finally clear up cystic breakouts.

In fact, there's been a decent amount of debate over the years when it comes to isotretinoin. As Kobets says, "Many male and female patients with moderate to severe cystic acne tolerate oral isotretinoin without major effects." 

However, a few drawbacks of taking isotretinoin include frequent doctor visits, strict contraceptive measures for those who could become pregnant while taking isotretinoin, and a long treatment course (typically around five to six months). 

There are some controversial side effects as well, "Skin dryness, cholesterol elevation, liver abnormalities, depression, and inflammatory bowel disease—the latter two are controversial on how much of increased risk there really is," Kobets notes.

Given all of the above, it only makes sense that isotretinoin is prescription-only. If you're curious about isotretinoin, ask your doctor about eligibility, risks, and current formulations and research—as they're up to date on all of the current medications and information.

"For female patients with hormonal or cystic acne, especially when it is located on the lower part of the face, I believe oral hormonal blockers (anti-androgens), like spironolactone, are a great option if the patient is not planning to become pregnant any time soon," Kobets notes.

While spironolactone was originally used for heart failure and high blood pressure, it has proven to be an effective treatment for hormonal acne in women6, with minimal bothersome side effects.

For men, a new form of hormonal acne treatment has hit the market in the past few years–referred to as Winlevi, or Clascoterone 1% cream. "While it has shown in vitro (which means in the lab) to be superior to blocking DHT7 (hormones that cause excess oil production and inflammation) in oil cells in the skin compared to spironolactone, we still have to see how it compares to oral spironolactone in the real practice," Kobets says.

To sum up, spironolactone may be the best oral medication available to treat female hormonal acne. However, Winlevi is another great option for men and for those looking to stick to topical treatment.

Cortisone shots can be administered by your dermatologist if a particular cyst is giving you trouble—whether the motive is to prevent scarring, clear up a pesky cyst before a big event, or just bring you some mental peace—these shots can be extremely helpful.

"Cortisone shots are one of my favorite 'emergency' treatments for active acne, especially for the pain and deep-seated cysts," Kobets notes. It's important to view cortisone shots as an emergency, and temporary treatment that can go alongside something more permanent and preventive like oral or topical medications.

Acne facials (also called 'decongestion facials' or 'deep cleansing facials') will often include extractions and high-frequency devices to kill acne-causing bacteria on site.

Cystic acne will not benefit from extractions on active cysts (as it is a blind pimple without a head), but your esthetician may be able to prevent some breakouts by clearing out dead skin cells and excess sebum before acne forms.

Do be sure to let your esthetician know if you are on prescription medications or topicals beforehand, as that will change the sensitivity of your skin and thus the best facial practices and products for you.

"Any patient, male or nonpregnant females, should be using some type of topical retinol, preferably prescription," Kobets says. Popular prescription-grade retinoids include Tretinoin and Tazorac, and there is even one over-the-counter option that is approved for treating acne specifically, adapalene gel. 

"It has anti-inflammatory, anti-pore clogging, and anti-scarring properties, and it helps heal up acne quicker, as well as helping the pigmentation," Kobets says about the prescription-strength formulas.

These formulas are strong, so it's best to use them every few nights (or as directed by your derm).

For non-prescriptions, there are many retinol serums and formulas out there. These aren’t FDA-approved to treat acne specifically, however using them will likely benefit the skin and heal clear up breakouts. (More on them in a second.) Plus, they have plenty of other healthy aging benefits. 

It's also important to note that topical retinoids can be used alongside spironolactone but not in conjunction with oral isotretinoin (as your dermatologist will tell you). 

RELATED: 11 Must-Try Tips On How To Use Retinol From Derms

As we mentioned, cystic acne is very difficult to treat from home. This might make you feel discouraged, but it may also bring you peace knowing that it's not entirely your at-home routine contributing to your cystic breakouts.

However, a proper at-home routine can still work wonders, especially for acne in its early stages. Here, a few ingredients that work best for inflammatory acne like blind pimples. Think of this as a launchpad for your acne journey, not the end-all-be-all.

Retinol can speed up cell turnover8. This, in turn, will help decrease the risk of breakouts and brighten the complexion. In addition, retinoids block the activity of enzymes9 behind melanin synthesis, resulting in a more even skin tone. Adapalene gel is the only over-the-counter option that’s FDA-approved as an acne treatment specifically, but other formulas can help the overall appearance of the skin should you want to experiment with various brands.

Using exfoliants in your skin care routine is a must, especially for acne-prone skin. BHAs, or beta-hydroxy acids (like salicylic acid), are typically most popular for acne-prone skin—for good reason. As Zeichner notes, salicylic acid is the only acid FDA-approved to treat acne. He recommends finding a formula with a 2% concentration, such as the Paula’s Choice 2% BHA Liquid Exfoliant.

However, using a blend of AHAs and BHAs can tend to the skin from all angles. Don't mix your AHA serum with a separate BHA serum. "Don't DIY your acid combination," board-certified dermatologist Whitney Bowe, M.D., FAAD, previously warned. "The acids need to be formulated in a way that makes them stable together." Read: Don't layer an AHA over a BHA—look for a product that has them both (like Bowe's new Exfoliation Night serum). 

Here, a full guide to exfoliation and best products if you want to dive a bit deeper into this step.

An increase in sebum, the oily substance that protects your skin from drying out, generally leads to an increase in shine—which isn't what everyone wants. Using skin care products with tea tree oil can help to minimize the oil thanks to its astringent properties. This may help mattify the skin and regulate oil, thus preventing more sebum buildup.

Tea tree has been shown to be an effective treatment for mild to moderate acne10 but likely will not clear cystic acne. It can be used in your face cleanser or a mild toner to help minimize oil on the surface, though.

Once you're on the path to clearing your cystic acne, it's important to take preventive measures as well. In general, remember the following:

RELATED: Stress Acne Is Real & What To Do About It, From Derms

Your gut is a complex place, and how well it's tended to is going to impact your skin and your mental health (which, in turn, also affects your skin). But what does it mean to tend to your gut health? Here are a few general tips:

Do your best to consume anti-inflammatory foods and limit those with a high glycemic index—here's a good place to start.

As mentioned above, skim milk has been linked to breakouts. Avoid skim milk and instead opt for plant-based options. Rather than putting whey protein in your smoothies or daily shake, opt for a vegetarian blend or collagen powder.

A lack of sleep leads to increased cortisol levels in the body and therefore, more sebum production and breakouts. Get seven to nine hours of sleep every night that you can, and do your best to make sure it's high-quality sleep—here are a few expert tips to help you out.

Add a few stress-reducing techniques to your day—for not just the health of your skin but your mind as well, whether it be a daily stroll, yoga, meditation, listening to a podcast, or whatever makes you say ahhh. Here are our 10 favorites if you want some inspiration.

Research shows that the use of oral (and topical) probiotics may help reduce skin eruptions11. What's more, your gut and brain are also connected, and how healthy your gut flora is may impact your levels of stress and anxiety (which can lead to an increase in cortisol, and acne, as you know). 

Read more about the gut and brain connection here and our list of the best probiotic supplements on the market here.

You'll want to do your best to balance your hormones in your day-to-day life, starting with exercise.

Exercise produces endorphins12—chemicals in the brain that make you feel good—which help decrease tension, elevate mood, improve sleep, and boost self-esteem. Plus, it may double as a stress management technique.

Also, prioritize healthy hormone habits when it comes to your food consumption—here's how.

Blind pimples, aka cystic acne, is one of the hardest forms of acne to treat and prevent, which is why you should visit a dermatologist if you suspect this is the form of acne you have. Especially if it is impacting your mental health, it's better to seek professional help ASAP. If you suspect you may have a different form of inflammatory acne (yes, there are a few more out there), check out this guide to learn more.