How can I treat cystic acne and large scars at 19?

Question

Hello doctor,

I am 19 and have been dealing with acne for about a year. I never had pimples before last year, but I think they started after I used sunscreen, and since then, they have been ongoing.

Right now, I have:

Three deep, blind pimples on my nose.
One pimple under my lower lip is filled with pus.
One between my nose and upper lip, also filled with pus.
One deep pimple between my eyebrows (usually cystic).

I also have big, almost pea-sized acne marks on my cheeks. My routine is:

Face wash with mandelic acid and salicylic acid.
Moisturizer with ceramides, non-comedogenic.
Hybrid sunscreen, non-comedogenic.

I used to spot-treat with Benzoyl peroxide, but it left marks, so I stopped. I am now using TRIAC cream (Mandelic and Salicylic acid).

I am worried because my acne marks are very noticeable, and I still have deep pimples, some filled with pus. I think hormones might be playing a role, but I am not sure.

Could you please advise me on:

How to treat my active acne, especially the deep or cystic ones?
How to prevent or reduce these big acne marks?
Are my current skincare and TRIAC cream okay for my skin?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

At 19, acne is really common and usually linked to hormones, though things like certain skincare products, stress, or diet can make it worse. From what you have described, you are dealing with both active pimples, some deep or cystic, some filled with pus, and leftover acne marks.

It makes sense that you stopped using Benzoyl peroxide because it left marks. The good news is that most marks fade with time and daily sun protection. Your current routine, a gentle cleanser, non-comedogenic moisturizer with ceramides, and sunscreen, is a solid base.

Since you still have inflamed and cystic pimples, you might need a bit more support. Treatments that often help include:

Using Benzoyl peroxide or a retinoid like Adapalene gel carefully, as a thin layer over your acne-prone areas at night, not just on individual spots.
Continue using sunscreen every morning to protect your marks.
Being patient with acne marks, they may fade slowly, but gentle exfoliants like Mandelic acid in your cream can help if used lightly.

Use a retinoid (like Adapalene 0.1 percent gel) at night to prevent clogged pores and help fade marks. Avoid picking or squeezing pimples, as that can make scars worse.

If cystic or pus-filled pimples keep coming back, seeing a dermatologist is the safest move. They might recommend a short course of oral antibiotics or check if hormones are contributing. With a consistent routine and proper guidance, your acne can improve, and your marks can gradually fade.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.