Home remedies, such as cleansing the skin, applying ice, and using benzoyl peroxide, can help shrink a cystic pimple. However, in some cases, cystic acne may require dermatological help.

Cystic acne is a severe form of acne that causes large bumps to form under the skin. These bumps can be painful and take a longer time to heal compared to milder forms of acne.

This article looks at what cystic pimples are, how to reduce their appearance, and what not to do. It also discusses more long-term treatments for cystic acne that could help prevent pimples from coming back.

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Cystic pimples are the result of pores in the skin becoming blocked, inflamed, and colonized by bacteria. Bringing down swelling and keeping the area clean may help to reduce the pimple’s size.

To do this at home, the American Academy of Dermatology (AAD) recommends:

  1. Cleansing the area: Wash the face up to twice daily and after sweating. Choose a product that is gentle and non-abrasive. Be sure to use gentle skin care products that say “alcohol-free” on the label.
  2. Applying a topical treatment: Topical treatments are most effective when the pimple is nearer the surface of the skin. Choose products that contain active ingredients to treat acne, such as benzoyl peroxide, salicylic acid, and azelaic acid.
  3. Using a warm compress: Once a white spot, or whitehead, forms in the center of the cyst, apply a warm compress. People can make a warm compress by soaking a clean cloth in hot water and gently pressing it to the pimple for 10–15 minutes. Repeat this step 3–4 times per day until the pimple heals.

Following these steps will reduce pain and swelling, which may shrink the pimple and help it heal more quickly. However, preventing cystic pimples is often the best approach, as they are harder to treat once they develop.

While a cystic pimple heals, it is important to be gentle with the skin.

Do not try to pop, pick, or squeeze a cystic pimple. It may be tempting, but popping a pimple can introduce more bacteria to the pore, slow healing, drive the infection deeper into the skin, and increase the chance of scarring.

In addition to not popping a pimple, the AAD advises that people avoid:

  • touching the face unnecessarily
  • scrubbing the skin
  • using harsh skin care products, particularly those that contain alcohol
  • tanning, either outside or on tanning beds
  • applying toothpaste or other home remedies found online

Many home remedies for acne are not based on strong evidence. Some may be ineffective, while others may do more harm than good. As a result, it is best to follow advice from trusted sources or a board certified dermatologist.

Cystic acne is a severe type of acne. Doctors sometimes call it nodulocystic acne. It occurs when large acne cysts or nodules form, penetrating deep into the skin.

The symptoms of cystic acne include:

  • large, painful pimples
  • lumps under the skin that may not come to a head, or that may take weeks to come to a head
  • inflammation and swelling on the skin

This type of acne can take longer to heal than other types. It is also more likely to cause scars than less severe types.

Rarely, people can develop acne conglobata, a severe form of acne that causes deep acne cysts to join together under the skin’s surface. This type of acne includes lesions that contain an unpleasant-smelling fluid.

Acne forms when a pore becomes blocked. This may happen when the natural oil the skin produces blocks the pore. Once the pore is clogged, inflammation and swelling occur. Sometimes, bacteria can then colonize the blocked pore.

There are a variety of factors that can contribute to this, including:

  • hormonal fluctuations, such as those caused by puberty, pregnancy, or menopause
  • medical conditions that affect the hormones, such as polycystic ovary syndrome (PCOS)
  • medications such as oral contraception, steroids, or lithium
  • the skin’s microbiome, as some species of bacteria can cause inflammation and are associated with acne
  • stress, as this causes a release of androgens, hormones that lead to acne development
  • genetics, which may make some people more likely to develop acne than others

Some people also find that certain foods aggravate acne, such as foods with a high glycemic index (GI) and dairy products.

In isolation, these factors may not lead to cystic acne. However, in combination, or in certain people, they may lead to occasional or persistent breakouts.

While any type of severe acne can be difficult to cope with, the AAD states that dermatologists can successfully treat almost any case.

Cystic acne treatment may involve a combination of medications and topical treatments in order to create long-term improvements.

Topical treatments

The topical products dermatologists recommend for cystic acne include:

  • Topical antibiotics: Topical antibiotic products can kill the types of bacteria that may cause or worsen severe acne. They can also help to prevent more pimples from forming.
  • Benzoyl peroxide: This ingredient helps to kill bacteria and prevent pores from becoming blocked.
  • Retinoids: This includes topical products that contain retinol, tretinoin, or adapelene. These are forms of vitamin A, and a common component of acne treatment. Dermatologists sometimes recommend that people use topical retinoids alongside topical antibiotics or benzoyl peroxide. However, retinoids are not suitable for everyone.

Many acne treatments increase the skin’s sensitivity to UV light. Additionally, exposure to the sun can worsen acne. As a result, it is important to wear facial sunscreen every day, particularly while undergoing acne treatment.

Systemic medications

Systemic treatments work by addressing acne via oral medication, which has a more widespread effect on the body than topical treatment. Some options include:

  • Antibiotics: A number of oral antibiotics can help decrease the severity of acne. A doctor may prescribe doxycycline or minocycline, or another type if these are not effective.
  • Retinoid medications: Potent retinoid medications, such as isotretinoin, can provide significant improvements for severe acne. According to the AAD, 85% of people find one course of isotretinoin leads to permanent clearing. It is not suitable for use during pregnancy or nursing.
  • Spironolactone: This treatment decreases the amount of androgen hormones in the body, such as testosterone. It is only suitable for people who are not pregnant.
  • Oral contraceptives: Females may find that a contraceptive containing a small amount of estrogen helps improve cystic acne. Some healthcare professionals may combine this with a course of spironolactone.

Dermatologists can also inject acute cystic acne with steroid medications.

Like any medication, these options have their own side effects and risks. People can discuss various approaches with a dermatologist to find the best treatment for them.

Cystic acne can lead to acne scars, particularly if the acne is advanced and has continued for a long time.

After a successful course of acne treatment, a dermatologist may talk through options to reduce the appearance of scarring. Scar treatments can vary depending on the type and severity of the scars, but may include:

  • microneedling or dermarolling, which involves the use of tiny needles to stimulate collagen production
  • chemical exfoliants and peels, which remove damaged and uneven skin cells, allowing new ones to grow
  • laser resurfacing, which may make scars flatter and less noticeable
  • incision or subcision, where the scars are physically removed

The following are answers to some questions people frequently ask about cystic pimples.

How do you get rid of a cystic pimple with no head?

Using a warm compress on the pimple for 10-15 minutes, three times daily can help to bring it closer to the surface. This allows it to heal. It is important to use a clean cloth each time when applying a warm compress to the area.

How long does it take for a cystic pimple to shrink?

Shrinking a cystic pimple can take time. Treatment from a dermatologist can take 2-3 months to show improvement in cystic acne.

It is possible to help shrink a cystic pimple at home by following some basic self-care tips. Using a warm compress can help draw the pimple to the surface of the skin, which can promote healing. Using topical products and cleansing the face regularly can also help clear pimples and prevent them from coming back.

However, numerous or recurring cystic pimples are a sign of cystic acne, which usually requires professional treatment. As a result, it is best to consult a healthcare professional or dermatologist for recurring cystic pimples.