Treating Cysts Is Actually Pretty Easy

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Welcome to Ask A Derm, a monthly feature where board-certified dermatologist Shereene Idriss is on hand to answer your most pressing skin-related questions. Though nothing can substitute a visit to Dr. Idriss’ practice at Union Square Dermatology, think of this as your skincare primer before your appointment date arrives. Get to know Dr. Idriss a bit better through her Top Shelf here, and through her Instagram account, @shereeneidriss. Got a question you’d like Dr. Idriss to answer? Ask away at [email protected]er.com.

Dear Dr. Idriss,

I’ll get straight to it: I’m pregnant! I’m excited, nervous, flustered...all of the feelings, and in between attempting to read every single pregnancy guide written in the English language, I’m also trying to figure out my maternity beauty routine. I’m a huge beauty nerd, and I’ve been told that there are certain ingredients I need to eliminate for the next several months. This has really thrown me for a loop! I’ve dealt with acne-prone skin for most of my life, and the post-acne scars that come with them. I know I’m supposed to be all glowy and beautiful now, with unbelievably long hair and clear skin, but so far, the pimples keep coming for me. The morning sickness I can take, but no retinol? No salicylic acid? What’s a mom-to-be to do?

Sincerely,
Baby Before Beauty

Dear BBB,

First of all, congratulations! It was only a few months ago when I was in your shoes. While pregnancy is truly one of the most beautiful experiences in life, it is also a lot to deal with, so it’s just plain unfair that during this time you also have to reconfigure your a lot on your Top Shelf. But don’t worry! I’m here to help.

You’re right about salicylic acid—unfortunately, even if you're prone to breakouts, salicylic acid is not your friend right now. You can rely on alternatives like glycolic acid and lactic acid instead. I used L’Oréal’s Revitalift 10-percent glycolic acid serum throughout my pregnancy to great success. Try it! I think you’ll like it. It’s also good that you know retinols are also a big no-no right now. If you are concerned about giving up everything they do, namely minimizing fine lines (as well as preventing them from forming in the first place), you can look for products with an ingredient called bakuchiol. It's a natural alternative to retinol that's pregnancy-safe. During my pregnancy, I found the Bakuchiol Reface Pads from Indeed Labs to be quite effective, and if you prefer it in a moisturizer, Olé Henriksen’s Goodnight Glow is formulated with bakuchiol, lactic and glycolic acids. 

Another ingredient to avoid is hydroquinone, which may or may not have been what you were using to treat your dark spots. Swap it for topical vitamin C, which does a really good job of brightening skin. Tranexamic acid is newer to the market, but I really like that ingredient as a hyperpigmentation-fighter, too. I love SkinMedica’s Lytera, which has tranexamic acid in it. Of course, you should talk with your doctor before you introduce anything new to your routine. And the same goes for when to introduce your old standby ingredients post-pregnancy—hydroquinone and retinol will remain on the bad list while you’re nursing, but it’s OK to bring salicylic acid back into the fold as soon as the baby arrives. Though something tells me that, when the time comes, sleep (and not salicylic) will be top of mind.

Dear Dr. Idriss,

I don’t get normal zits, I get cysts. Big, huge, impossible-to-shrink cysts. Nothing, I repeat NOTHING seems to speed up their demise. I’ve tried benzoyl peroxide spot treatments, salicylic acid, clay masks and even popping (please forgive me for popping but I was really desperate). Lately I’ve been reading about cortisone shots but I don’t know, that seems excessive? Do those even work? And if they do, is that the only solution?

Sincerely,
Sick Of My Cysts

Dear Sick,

Don’t worry! There’s more than one way to get rid of a cyst. But first, here’s a little background: a cyst is a firm nodule filled with (the very technically termed) “crud.” That crud is made up of keratin materials, bacteria, and maybe an ingrown hair follicle that's causing inflammation. I use cortisone shots on patients to make cysts "disappear faster," but the reality is that the cyst—the pocket itself—will never fully disappear unless you surgically remove it. That's why you often get cysts in the same place multiple times.

Does your cyst hurt? Is it excreting a weird pus? Is it discolored? Those are all signs of an infected cyst. If your cyst is infected, you want to be sure you're dealing with it medically, which means taking time to visit a doctor. The infection can be treated with oral antibiotics, topical antibiotics, or both. Once that’s addressed, there are a couple of ways to make a cyst go down. A cortisone shot is really like a Band-Aid—it’s only purpose is to minimize the symptoms of a cyst, AKA inflammation.

Even after a cortisone shot, it still takes days for a cyst to go down. People have this misconception that a celebrity will come in for a cortisone shot and the next day the cyst will be completely gone. This is not true for a lot of people! I should also note that you don't want to overdo the cortisone shots because cortisone is a steroid, and if you use too much at once you can trigger a thinning of the skin—worse yet, you can even end up with a divot. So you want to be very careful and judicious as to how you use the cortisone and how much you use. If you have a small cyst, like the size of a pencil head eraser, and it's kind of coming to a head, at-home treatments can work. I love hydrocolloid patches, like the ones from Cosrx and Starface, to help suck out the material inside the cyst and flatten it without the use of steroids. Please, start there!

Dear Dr. Idriss,

Once again, I’m drawn to a treatment I saw on Instagram. This time it’s thread lifting. It sort of sounds like it’s too good to be true. If I’m understanding correctly, it fakes a mini facelift for a certain amount of time, but it’s cheaper than a face lift and not nearly as invasive. This is extremely intriguing to me, but I’m worried I’m being bamboozled by clever marketing and not realistic results. What’s your position on thread lifting? Does it really work? How can I manage my expectations if I give it a try?

Sincerely,
Sew Curious

Dear Sew,

The good news is that thread lifting really does work! The simplest explanation is that it’s a procedure that uses absorbable sutures placed under the skin to slightly lift the skin on top. It can tighten the skin as well. But I have a question for you: How does your skin look? People who have started to notice some sagging, particularly on the lower two-thirds of the face, are usually good candidates for thread lifts. However, don’t think of it as a substitute to other in-office treatments, like Botox and fillers. It’s more like a beautiful adjunct to fillers (in particular) because with the addition of the sutures, you can use less filler for a more natural effect. The fillers do the work of contouring or adding facial definition, while the threads do the lifting work. But there’s a big but to all of this. If you're someone who has a tendency to create hypertrophic scars or keloids, I would approach thread lifting with caution. Have your doctor insert a thread in a discreet area to test it out first. Once you’re in the clear with your derm, you can expect the threads to disintegrate in two to three months. If you like what you saw, you’ll ready to go back in for more.

Shereene Idriss

Photo via ITG.