look closely at my chin and you can see where the spots used to be (especially because I am a hypocritical monster who picks)

Cystic acne is a bitch. I don't love swearing but there is no other word for those deep, painful, mountainous creatures. Cystic acne in older people (especially women) is not the juicy, sebumy pops of our youth. NO, these mountains of pain that live deep below the surface and lasts for week are hot little kernels of infected cells surrounded by layer upon layer of painful, inflamed tissue that has basically been damaged by the pressure. Like a bruise. Picking is not even an option. Hot compresses can soothe the pain, but they don't do anything in terms of treatment. They are palliative.

So what does work?

Cortisone injections work like magic, banishing the offending form in as quickly as a few hours but no longer than 2-3 days. They must be administered by a dermatologist, and potential side effects include "pits" which can be worse than the zit. If yours are painful enough (and your insurance is good enough) they may cover part or all of the cost of injection. If not expect to pay around $200. Woof. This is really the best option if 1) your insurance will cover it 2) you are in enough pain to justify it 3) you have a big, heavily photographed event coming up.

Retinol can prevent them (after regular use, and if you can survive the purge) but that's long term and if you're reading this you probably want instant gratification. My advice to you if you have just started Retinol and are experiencing bad cystic acne is TO JUST STICK WITH IT. It will suck for a few weeks but long term it will be so worth it. That gunk was already in your face anyways waiting for it's chance to rear it's ugly head.

VIGILANT TECHY OPTION:  High Frequency Device
First and foremost, if you catch them early enough I have found a lot of relief from high frequency machines, or as I like to call them "the $25 acne banisher you should know about". Even if you don't catch them early they can still help with the pain because they "oxygenate" helping heal the inflammation and increase circulation.

 THE INGREDIENT TRIFECTA: Hydrocortisone | Benzoyl Peroxide | Sulfur
If you've got a spot, and you're doing everything else, and it still feels like a throbbing spotlight has imbedded itself under your skin, this trifecta of ingredients (links to my favorite version of each) can be applied up to 4 times per day on the offending spot in that order. You will feel instant relief (thank goodness!) and should see a decrease in size within a few days to a week. I like to apply the pink stuff and then when it's mostly dry buff it away with the cue tip until it forms a sort of "concealer" that can be worn during the daytime.

THE CULT FAVORITE SUPER HERO: Renee Rouleau Anti- Cyst Treatment
I resisted this one for so long but I finally caved and it's TOTALLY WORTH IT. I guess I should not be surprised given that I'd read glowing, almost unbelievable reviews on Refinery 29, Into the Gloss and about 15 other trusted blogs. The package is tiny (and expensive) but not nearly as bad as the cortisone injections, and also, you can use it more than once. A tiny dot on an early cyst can make it banish overnight. On a big daddy (I had to wait 4 days to get it shipped to me, stupid weekends) it was all but gone in 3 days. That's right, it took less time to heal that big ol'sucker than it did to ship to me. If this is a chronic problem for you, you can apply a thin layer everyday. So far my tri-weekly pre chemo visitor has yet to real it's ugly head (I hope I didn't jinx myself by writing this!) and I have started hoarding the tiny bottles of non-sticky, scentless gel.