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How to tell if your zit is an acne cyst or a pimple that will heal itself

Here’s yet another not-so-fun fact about getting older — although you’re not a teenager anymore, acne doesn’t always go away. Sometimes, it can even get worse.

Working as an esthetician for over five years, I saw my share of blemishes, both on my own face and on the faces of my clients. The funny thing was that I wasn’t performing extractions on teens, in most cases. The majority of clients who came to me were adults with the same complaint: Why am I still getting acne when I’m not in high school?

More: What exactly is happening under your skin when you pop a pimple

The fact that acne has an age limit is a big myth. Acne may be most common in the teenage years, associated with fluctuating hormones and puberty. But the unfortunate news is that skin eruptions can continue on through adulthood, also related to hormones, stress, genetics and diet. The International Dermal Institute confirms that this rise in adult acne isn’t just our imagination — adults are experiencing more acne than ever before. Up to 54 percent of women over age 25 have some facial acne.

It’s times like these when having the right information about adult acne can help tremendously. For most of us, we’re still working with the same pimple knowledge that we gleaned from Seventeen magazine in middle school. But understanding the type of acne that you struggle with as an adult can equip you to better care for your skin and let you know when you should seek professional help.

What is a pimple exactly?

Everyone’s had one, and you’re probably going to get a few more in your lifetime. As Dr. Tony Yuan, a physician with Doctor On Demand, explains, a pimple is that basic blemish you see pop up when you’re stressed or during that time of the month — created by a superficial infection of the pores in the skin. “A pimple is a little sack that is filled with oil, debris and bacteria. When it comes to a head and erupts to the surface, you may notice a firm white head, which means the pus is close to the surface,” he explains.

More: 5 Natural acne remedies that actually work

Since acne is a common disease caused by many different factors, even run-of-the-mill acne can take on many different forms, says Dr. Omar Ibrahimi, founding medical director of the Connecticut Skin Institute in Stamford, Connecticut. He continues, “Generally speaking, acne can occur in a few different forms, blackheads, whiteheads, larger pustules or cysts. These are all different variants of a follicle that has been plugged to different degrees. Generally, if you don’t pick at blackheads or whiteheads, they tend to eventually settle down. These types of acne lesions tend to do better with topical treatments that can be easily prescribed by your dermatologist such as a retinoid and other topical medications. If you pick at these, you can cause them to become more red and irritated.”

As Dr. Ibrahimi explains, most pimples that magically appear in the mirror at exactly the wrong moment (like before a big presentation or a first date) are easy to manage when you resist the urge to pick and let them run their course. A pimple may respond to topical treatment, but a deep and painful cyst is another matter altogether.

What is an acne cyst?

The easiest way to tell the difference between a pimple and a cyst is with a little bit of watching and waiting. Dr. Elizabeth Tanzi, founder and director of Capital Laser & Skin Care and Clinical Professor of Dermatology at the George Washington Medical Center, says that a pimple with pus in the center can normally be drawn out with a warm compress, although popping and squeezing are not advised. On the contrary, a large, painful and deep acne cyst in the skin often won’t come to a “head” by itself. For a cyst like this, Dr. Tanzi advises, “A large acne cyst is best treated with an in-office cortisone injection.”

More: Here’s what your dermatologist isn’t telling you about your acne

The reason cystic acne is so painful and so hard to treat at home is because it results from an infection that goes deep into the skin. This deep, internal infection can create an acne cyst filled with pus that looks like a red, painful bump, tender to the touch. And compared to a pimple that most of us are tempted to pop, an acne cyst is definitely one you should not pick — cysts can be made worse by picking and could result in scarring.

Once acne becomes cystic, over-the-counter treatments just aren’t going to cut it. In fact, you may feel like you are beating your head against a wall for this very reason. Trying to control cystic adult acne without professional guidance is often a waste of time and money.

Fortunately, Dr. Ibrahimi says there are countless ways a professional can help to manage cystic acne, “There is a whole toolkit of options, ranging from topicals to oral medications. There are also devices that can be used to help better control the acne.” He adds, “Larger bumps such as pustules or cysts tend to not resolve by themselves. It is a sign that your acne needs to be under better control and a visit to the dermatologist would be advised.”

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