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.
What are blind pimples?
Blind pimple is just another term for cystic acne—the nickname refers to the inability to see the head of the pimple. Cystic acne tends to be red, inflamed, and larger than other breakouts. The giveaway that you've got a cystic breakout? You can feel it below the skin, but the only evidence on the surface is a red mark and raised bump.
You can get cystic pimples on every area of the face, neck, back, and perhaps other parts of the body too—but they're most common on the face. Cysts can be soft to the touch as well.
"Pimples that arise deeper in the skin and do not always come to a head, lasting days, weeks, or months have a more inflammatory component and have the potential to scar more," board-certified dermatologist Kseniya Kobets, M.D., MHS, FAAD, tells mbg. This is why this form of acne is taken so seriously.
Causes of blind pimples & cystic acne
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.
Stress & sleep
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.
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.
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.
How can you treat cystic acne?
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.
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 found in the Differin Acne Treatment 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).
At-home solutions for acne
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.
Tea tree oil
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.
Acne prevention tips
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:
- Keep your pores unclogged: Get acne facials, use topical retinoids, invest in acne-safe products, and try not to sleep in your makeup if you can.
- Be consistent with your at-home skin care: Consistency is key—figure out what skin care schedule works for you and commit to it. May we suggest skin cycling? Everything you need to know here.
- Evaluate your lifestyle habits: As mentioned above, there are so many more factors to consider than topical care. How much you sleep, how much you stress, and what you eat all impact your skin, so remember to work from the inside and the outside.
Mind the connection between the gut, the brain, and the skin.
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:
Eat an anti-inflammatory diet.
Do your best to consume anti-inflammatory foods and limit those with a high glycemic index—here's a good place to start.
Skip skim milk and whey.
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.
Try your best to manage stress.
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.
Take probiotics for your gut flora.
Be mindful of hormone fluctuations.
You'll want to do your best to balance your hormones in your day-to-day life, starting with exercise.
Also, prioritize healthy hormone habits when it comes to your food consumption—here's how.
How long do cystic zits last untreated?
Cystic zits can last a long time—like months. This is why it's so important to seek out professional treatment. Lasting pimples like this can impact your mental health and lead to scarring, so see a dermatologist if you suspect you have cystic acne.
Can blind pimples go away on their own?
If left untreated, blind or cystic pimples will eventually pass—but there will likely be more to follow. It's essential to let these cysts run their course (even if it's frustrating) rather than try to pop or pick at them.
Why are blind pimples so painful?
Blind pimples cause inflammation under the skin, which, when combined with the depth and size of the pimple, leads to pain and tenderness. When a pimple is larger, it gets closer to the nerve and can be more sensitive than those of a smaller size.
Can you get rid of blind pimples overnight?
Sadly, no—you cannot get rid of blind or cystic pimples overnight. If you are in an emergency situation and need your cyst to go down, you should see a dermatologist for a cortisone shot rather than try to pop the pimple.
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.
Hannah Frye is the Assistant Beauty & Health Editor at mindbodygreen. She has a B.S. in journalism and a minor in women’s, gender, and queer studies from California Polytechnic State University, San Luis Obispo. Hannah has written across lifestyle sections including skin care, women’s health, mental health, sustainability, social media trends, and more. She previously interned for Almost 30, a top-rated health and wellness podcast. In her current role, Hannah reports on the latest beauty trends and innovations, women’s health research, brain health news, and plenty more.