The 15 Very Best Cystic-Acne Treatments
Photo-Illustration: Courtesy of the retailer.
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 dermatologists approach cystic acne with 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 can benefit from topical over-the-counter treatments, but dermatologist Noelani Gonzalez, 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 out which OTC options are actually worthwhile, we asked Gonzalez and other dermatologists about the most effective cystic-acne treatments to use at home, and we're sharing their suggestions below.
It's important to note that none of the derms we spoke to recommended using all of the items on this list because many contain potent active ingredients such as retinoids, acids, and benzoyl peroxide. Rather, they suggest pairing products that contain stronger actives with gentler, nonirritating ones.
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.
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.
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.
Active ingredients: Adapalene (0.1 percent)Consistency: GelPrice: 0.5 ounces (Approx. $28 per ounce)
Four of the dermatologists we spoke to say that integrating a retinoid into your skin-care routine is essential to preventing cysts. Retinoids, which we've written about many times before, are beneficial for exfoliating the skin and purging your pores of dirt and oil, which is why Dr. Joshua Zeichner, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital, says they're helpful for treating cysts. He 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. Zeichner says you can use a pea-size amount and start applying it every other night as your skin gets adjusted to it. Dr. Debra Jaliman, an assistant professor of dermatology at Mount Sinai's Icahn School of Medicine, also recommends Differin but stresses that, since 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.
Active ingredients: Benzoyl peroxide (2.6 percent), zinc, licorice rootConsistency: CreamPrice: 4.2 ounces (Approx. $2/ounce)
One of dermatologist Karan Lal's favorite ways to address cystic acne is with cleansers that include anti-inflammatory, acne-fighting ingredients like benzoyl peroxide, which helps to reduce the amount of bacteria on the skin. His top pick is 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."
Active ingredients: Sulfur (3%)Consistency: FoamPrice: 4 ounces (Approx. $8.5/ounce)
If you'd rather skip benzoyl peroxide, Lal also recommends this cleanser from M-61, which contains a host of acne-fighting actives like sulfur, salicylic acid, glycolic acid, witch hazel, and tea tree. "Sulfur is a powerful anti-inflammatory and antibacterial, and when combined with salicylic acid, it penetrates even better," he says. "It's excellent for those with red and inflamed acne cysts."
Active ingredients: ZincConsistency: FoamPrice: 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, according to Dr. Marisa Garshick, a clinical assistant professor of dermatology at NYP-Cornell. "For those who suffer from oily skin but can't tolerate salicylic acid, this foaming wash helps to reduce excess oil without drying out the skin," she says, because of it's noncomedogenic, non-acnegenic, and oil-free formula that has ingredients including oil-reducing zinc oxide.
Active ingredients: ZincConsistency: SerumPrice: 8 ounces (Approx. $1 per ounce)
Garshick told us that, regardless of skin type, it's good to have a potent antioxidant serum in your routine to protect your skin from free-radical damage. "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. 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. 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.
Active ingredients: ZincConsistency: Gel creamPrice: 1.7 ounces (Approx. $13 per ounce)
When it comes to hydrating the skin, Jaliman says 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 contains hyaluronic acid to keep skin supple and moisturized. It also made our list of the best moisturizers for oily skin, and it's dye and fragrance free.
Active ingredients: Zinc oxide, lactic acid, niacinamide, vitamin B3, hyaluronic acidConsistency: Lightweight creamPrice: 1.7 ounces (Approx. $13 per ounce)
Speaking of sunscreen, Jaliman loves Elta MD UV Clear SPF 46 — a longtime Strategist favorite — because "it's lightweight, oil free, and suitable for those who are prone to acne." Not only does it protect from UV damage, it is also specifically formulated to treat acne simultaneously. It contains niacinamide and B3, which will fade hyperpigmentation; hyaluronic acid, which will moisturize; and lactic acid, which will clear pores and reduce shine.
Active ingredients: Lactic acid, glycolic acid, citric acid, malic acid, salicylic acid, vitamin E, vitamin B5Consistency: Rich creamPrice: 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."
Active ingredients: Benzoyl peroxide (5 percent) and lactic acidConsistency: CreamPrice: 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.
Active ingredients: Benzoyl peroxide (2.5 percent)Consistency: CreamPrice: 0.75 ounces (Approx. $9 per ounce)
For a less expensive benzoyl-peroxide cream, Dr. Y. Claire Chang of Union Square Dermatology recommends Neutrogena's On the Spot Acne Treatment, which contains a milder dose of peroxide (lots of formulas contain 5 percent) and works by reducing inflammation of active lesions. The lower concentration lessens the chances of it irritating or drying out your skin.
Active ingredients: Red light
LED-light therapy has become a common popular acne treatment and can be particularly effective on cystic acne. When treating acne, experts recommend both blue and red light, each of which works to decrease inflammation and zap acne-causing bacteria. When we spoke to Hartman about the best skin-care devices, he told us red light has been shown to penetrate a bit deeper, which is ideal for deeply burrowed cystic acne. This nifty device is from Lightstim, and though it's designed to target wrinkles, the red light wavelengths would work well for cystic acne too.
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Active ingredients: Benzoyl peroxide (4 percent)Consistency: CreamPrice: 6 ounces (Approx. $2 per ounce)
If you are struggling with cystic acne on your chest or back, Jaber suggests using a wash like Panoxyl in the shower, which contains 4 percent benzoyl peroxide to kill acne-causing bacteria. 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.
Consistency: CreamPrice: 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 dark marks and scars over time.
Active ingredients: Salicylic acidConsistency: LiquidPrice: 8 ounces (Approx. $5 per ounce)
Garshick loves this salicylic-acid acne body spray, which she says is great for getting hard-to-reach, breakout-prone places, such as the back, chest, and shoulders. "The salicylic acid helps to unclog the pores and eliminate dead skin cells, leaving the skin looking clear," he explains. While you can use it anytime, he says it's particularly great to use post-workout.
Additional reporting by Lori Keong and Dominique Pariso.
• Dr. Brendan Camp, of New York–based MDCS: Medical Dermatology & Cosmetic Surgery• Dr. Y. Claire Chang, of Union Square Dermatology• Dr. Marisa Garshick, clinical assistant professor of dermatology at NYP-Cornel• Dr. Noelani Gonzalez, 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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The Opioid-Treatment Narcan Can Now Be Purchased Over-the-Counter, Without A Prescription
The U.S. Food and Drug Administration on Wednesday approved selling naloxone without a prescription, setting the overdose-reversing drug on course to become the first opioid treatment drug to be sold over the counter.
It's a move that some advocates have long sought as a way to improve access to a life-saving drug, though the exact impact will not be clear immediately.
Here's a look at the issues involved.
What is Narcan?The approved branded nasal spray from Gaithersburg, Maryland-based Emergent BioSolutions is the best-known form of naloxone.
It can reverse overdoses of opioids, including street drugs such as heroin and fentanyl and prescription versions including oxycodone.
Making naloxone available more widely is seen as a key strategy to control the nationwide overdose crisis, which has been linked to more than 100,000 U.S. Deaths a year. The majority of those deaths are tied to opioids, primarily potent synthetic versions such as fentanyl that can take multiple doses of naloxone to reverse.
Advocates believe it's important to get naloxone to the people who are most likely to be around overdoses, including people who use drugs and their relatives.
Police and other first responders also often carry it.
What does the FDA approval mean?Narcan will become available over-the-counter by late summer, the company said.
Other brands of naloxone and injectable forms will not yet be available over the counter, but they could be soon.
The nonprofit Harm Reduction Therapeutics Inc., which has funding from OxyContin maker Purdue Pharma, has an application before the FDA to distribute its version of spray naloxone without a prescription.
How is naloxone distributed now?Even before the FDA's action, pharmacies could sell naloxone without a prescription because officials in every state have allowed it.
But not every pharmacy carries it. And buyers have to pay for the medication — either with an insurance co-pay or for the full retail price. The cost varies, but two doses of Narcan often go for around $50.
The drug is also distributed by community organizations that serve people who use drugs, though it's not easily accessible to everyone who needs it.
Emergent has not announced its price and it's not clear yet whether insurers will continue to cover it as a prescription drug if it's available over the counter.
Does making naloxone over-the-counter improve access?It clears the way for Narcan to be made available in places without pharmacies — convenience stores, supermarkets and online retailers, for instance.
Jose Benitez, the lead executive officer at Prevention Point Philadelphia, an organization that tries to reduce risk for people who use drugs with services including handing out free naloxone, said it could help a lot for people who don't seek services — or who live in places where they're not available.
Now, he said, some people are concerned about getting naloxone at pharmacies because their insurers will know they're getting it.
"Putting it out of the shelves is going to allows people just to pick it up, not have stigma attached to it and readily access this life-saving drug," he said.
But it remains to be seen how many stores will carry it and what the prices will be. The U.S. Centers for Medicaid and Medicare Services, which now cover prescription naloxone for people on the government insurance programs, says that coverage of over-the-counter naloxone would depend on the insurance program. The centers have not given any official guidance.
Maya Doe-Simkins, a co-director of Remedy Alliance/For The People, which launched last year to provide low-cost — and sometimes free — naloxone to community organizations, said her group will continue to distribute injectable naloxone.
Are there drawbacks to over-the-counter sales?One concern is whether people who buy Narcan over-the-counter will know how to use it properly, said Keith Humphreys, a Stanford University addiction expert, though the manufacturer is responsible for clear directions and online videos on that.
One benefit of having pharmacists involved, he said, is that they can show buyers how to use it. One key thing people need to be reminded of: Call an ambulance for the person receiving naloxone after it's been administered.
He also said there are fears that if the drug isn't profitable as an over-the-counter option, the drugmaker could stop producing it.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group. The AP is solely responsible for all content.
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FDA Approves Over-the-counter Narcan. Here's What It Means
The U.S. Food and Drug Administration on Wednesday approved selling the leading version of naloxone without a prescription, setting the overdose-reversing drug on course to become the first opioid treatment drug to be sold over the counter.
It's a move that some advocates have long sought as a way to improve access to a life-saving drug, though the exact impact will not be clear immediately.
Here's a look at the issues involved.
WHAT IS NARCAN?
The approved nasal spray from Gaithersburg, Maryland-based Emergent BioSolutions is the best-known form of naloxone.
It can reverse overdoses of opioids, including street drugs such as heroin and fentanyl and prescription versions including oxycodone.
Making naloxone available more widely is seen as a key strategy to control the nationwide overdose crisis, which has been linked to more than 100,000 U.S. Deaths a year. The majority of those deaths are tied to opioids, primarily potent synthetic versions such as fentanyl that can take multiple doses of naloxone to reverse.
The drug has been distributed to police and other first responders nationwide.
Advocates believe it's important to get naloxone to the people who are most likely to be around overdoses, including people who use drugs and their relatives.
The decision "represents a decisive, practical and humane approach to help people and flatten the curve of overdose deaths," said Chuck Ingoglia of the National Council for Mental Wellbeing, in a statement.
___
WHAT DOES THE FDA APPROVAL MEAN?
Narcan will become available over-the-counter by late summer, the company said.
Other brands of naloxone and injectable forms will not yet be available over the counter, but they could be soon.
Several manufacturers of generic naloxone that's made similarly to Narcan will now be required to file applications to switch their drugs over the counter as part of a requirement by the FDA.
The nonprofit Harm Reduction Therapeutics Inc., which has funding from OxyContin maker Purdue Pharma, already has an application before the FDA to distribute its version of spray naloxone without a prescription.
___
HOW IS NALOXONE DISTRIBUTED NOW?
Even before the FDA's action, pharmacies could sell naloxone without a prescription because officials in every state have allowed it.
But not every pharmacy carries it. And buyers have to pay for the medication — either with an insurance co-pay or for the full retail price. The cost varies, but two doses of Narcan often go for around $50.
The drug is also distributed by community organizations that serve people who use drugs, though it's not easily accessible to everyone who needs it.
Emergent has not announced its price and it's not clear yet whether insurers will continue to cover it as a prescription drug if it's available over the counter.
FDA Commissioner Robert Califf in a statement encouraged Emergent to make the drug available "at an affordable price."
___
DOES MAKING NALOXONE OVER-THE-COUNTER IMPROVE ACCESS?
It clears the way for Narcan to be made available in places without pharmacies — convenience stores, supermarkets and online retailers, for instance.
Jose Benitez, the lead executive officer at Prevention Point Philadelphia, an organization that tries to reduce risk for people who use drugs with services including handing out free naloxone, said it could help a lot for people who don't seek services — or who live in places where they're not available.
Now, he said, some people are concerned about getting naloxone at pharmacies because their insurers will know they're getting it.
"Putting it out on the shelves is going to allow people just to pick it up, not have stigma attached to it," he said.
But it remains to be seen how many stores will carry it and what the prices will be. The U.S. Centers for Medicare and Medicaid Services, which now cover prescription naloxone for people on the government insurance programs, says that coverage of over-the-counter naloxone would depend on the insurance program. The centers have not given any official guidance.
Maya Doe-Simkins, a co-director of Remedy Alliance/For The People, which launched last year to provide low-cost — and sometimes free — naloxone to community organizations, said her group will continue to distribute injectable naloxone.
___
HOW WILL PEOPLE LEARN TO USE NARCAN?
Emergent had to conduct a study examining whether untrained people could follow directions for using Narcan.
Last month, an FDA expert panel voted to make the drug available over the counter, despite numerous errors in using the device reported in the company study. The FDA suggested Emergent make several changes to how the directions will be displayed on the packaging and said the device can be safely used "without the supervision" of a health care worker.
Keith Humphreys, a Stanford University addiction expert, said one benefit of currently having pharmacists involved in dispending the drug is that they can show buyers how to use it. One key thing people need to be reminded of: Call an ambulance for the person receiving naloxone after it's been administered.
He also said there are fears that if the drug isn't profitable as an over-the-counter option, the drugmaker could stop producing it.
___
AP Health Writer Matthew Perrone contributed to this story
___
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group. The AP is solely responsible for all content.
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