What Is Cystic Acne & How Can You Treat It Effectively?

Cystic acne is the most severe type of acne. It forms deep beneath the skin’s surface, causing extensive, inflamed breakouts that are often painful and can leave acne scars if left untreated. 

Unlike typical pimples, acne cysts don’t always come to a head immediately and can persist for weeks or months. 

While cystic acne is most common among teenagers and young adults, hormonal changes, genetics, and other factors can cause it to appear. This article will explore what causes cystic acne, how to recognize it, and the most effective ways to treat and prevent it.

What Is Cystic Acne?

Cystic acne is a severe inflammatory skin condition characterized by deep, pus-filled cysts buried under the skin. 

Sebaceous glands in the skin produce sebum, an oily substance important for protecting and moisturizing our skin and hair. If you’ve ever had an oily face or hair, it’s due to an excess production of sebum. 

Too much sebum can also lead to acne when dead skin cells and excess oil clog skin pores and hair follicles. 

In cases of cystic acne, bacteria can also clog the sebaceous glands, leading to painful cysts that often result in scarring if left untreated. 

Are cystic acne and nodular acne the same?

You might confuse acne cysts with nodules, another severe form of inflammatory acne. While they share some similarities, such as being deep, painful, and potentially leading to scarring, there are some distinctions. 

The key difference is that acne cysts contain pus, while acne nodules do not. As a result, nodular acne is more solid and firm because it is not filled with fluid.

Symptoms & Development of Cystic Acne

Since many types of acne exist, some telltale cystic acne symptoms exist. These cystic pimples often form on the cheeks, jaw, neck, back, shoulders, upper arms, and chest. 

• Red, swollen bumps deep in the skin

• No visible whitehead or blackhead

• Pain in the affected area

• Skin discoloration or dark marks

• Breakout clusters (especially along the jawline) 

• Crusty, pus-filled bumps

Cystic acne typically develops in five stages, beginning with clogged oil glands that lead to inflammation. This is followed by the formation of painful cysts or acne nodules underneath the skin, and it often ends in prolonged healing that may result in dark marks or permanent scarring. 

What Causes Cystic Acne? 

The exact cause of acne cysts remains unknown. However, research shows that the androgen hormone plays a key role. 

During the teenage years, levels of androgen hormones increase, leading to higher production of sebum, the oily substance that can clog pores. When this sebum mixes with dead skin cells and bacteria, it can result in infection and inflammation, often manifesting as an acne cyst.   

While teenagers are the most likely to get it, other factors that can lead to cystic acne include: 

• The menstrual cycle

• Pregnancy 

• Polycystic ovarian syndrome (PCOS)

• Stress

• Greasy, comedogenic (pore-clogging) cosmetics, such as skin care and makeup products 

• Tight, restrictive clothing

• Hot, humid weather

• Family history of acne

• Skin type (oily skin is more acne-prone)

What doesn’t cause acne

There are many myths floating around about what causes acne, including cystic acne. The following do not  cause cysts or make acne worse:

• Chocolate 

• Nuts

• Greasy food

• Dairy 

• Gluten

• Poor hygiene 

• Sex or masturbation

Save Up to 80% on Your Acne Treatments

Get Started With Your Free BuzzRx Discount Card Today

How Do You Treat Cystic Acne?

Unlike other types of acne, cystic acne can’t go away alone or quickly overnight. Additionally, typical over-the-counter (OTC) acne medications are usually ineffective. There are many cystic acne treatment methods for these severe breakouts. Your dermatologist will develop a treatment plan for your specific skin type.

Isotretinoin 

One of the most common treatments for cystic acne is isotretinoin (formerly Accutane, now Absorica). This medication comes from vitamin A and is delivered as a tablet. 

According to the American Academy of Dermatology, isotretinoin works for 85% of people. While this medication is excellent for acne, it comes with some serious side effects. Talk to your doctor if you’re experiencing:

• New or worsening mood disorders

• Bruising 

• Inflammatory bowel disease (IBD)

• Muscle and joint pain

• Persistent headaches

• Nosebleeds

Topical retinoids

Like isotretinoin, topical retinol is derived from vitamin A and works by unclogging hair follicles. However, they usually aren’t as strong as isotretinoin. 

Retinoids are often used alongside other acne treatments, like oral antibiotics. Tretinoin comes in tablets, creams, gels, and lotions. While adapalene is the only current retinoid available OTC, you’ll likely need a stronger formulation for acne cysts. Some prescription-strength brands include:

• Differin (adapalene)

• Retin-A (tretinoin)

• Avita (tretinoin)

• Avage (tazarotene)

• Tazorac (tazarotene)

Retinoids can leave your skin vulnerable to sun damage and peeling. Make sure to apply plenty of sunscreen and wear protective clothing when you’re outside. 

Other exfoliants

While these exfoliants won’t directly treat acne cysts, they can treat other problems that might lead to cystic acne. Some effective acids include: 

• Benzoyl peroxide to kill skin bacteria

• Salicylic acid or azelaic acid to kill bacteria and shed away dead skin cells

Spironolactone

Spironolactone (Aldactone) is another popular prescription medication for cystic acne. This medication regulates androgen levels and is usually prescribed for high blood pressure and edema (swelling). It’s most effective for acne cysts on the jaw and chin. 

Don’t take spironolactone if you’re pregnant or planning on getting pregnant, as it can cause congenital disorders. Research shows that spironolactone is effective and well-tolerated in adult women with acne when used for an extended duration. 

A 2021 study conducted at the University of Pennsylvania suggested starting with a daily dose of 100 to 150 milligrams (mg) of spironolactone. This dose can be reduced later if side effects occur or if the acne improves. Like other hormonal treatments, spironolactone may take longer to produce results, so it is recommended to use it for 4 to 6 months to achieve optimal outcomes.

. Some side effects associated with spironolactone include:

• Fatigue

• Dizziness

• Breast tenderness

• Irregular periods 

• High blood potassium (hyperkalemia)

Oral antibiotics

These antibiotics are the most effective cystic acne treatment when spread across a large skin area. They work by decreasing bacteria and inflammation from cysts. However, antibiotics don’t reduce oil or remove dead skin cells. 

Like antibiotics for other illnesses, cystic acne antibiotics should only be used for a short time. If your dermatologist decides the antibiotics aren’t working, they’ll likely put you on isotretinoin. Possible side effects include:

• Diarrhea

• Pain

• Sun sensitivity 

• Nausea

Birth control 

Oral contraceptives are effective at treating cystic acne for some women. They work best when taken during peak hormone periods during your menstrual cycle. 

Birth control pills contain another hormone called estrogen. It helps regulate overall hormone levels and possibly reduce acne cysts.

Still, estrogen birth control pills aren’t for everyone. These medications may not be appropriate for you if you smoke frequently, are prone to blood clots, or are trying to get pregnant.

Steroids/cyst draining

If no other treatments work, a dermatologist might inject a corticosteroid called triamcinolone directly into large, painful cysts to shrink them. These steroid injections help prevent long-lasting acne scars. 

Dermatologists might incise and drain large cysts. Do not attempt this at home since it can worsen the skin problem, cause severe scarring, and deepen the infection.

Does Cystic Acne Leave Scars? 

Scars happen if acne doesn’t heal properly. There are two significant types of acne scars: atrophic and hypertrophic. 90% of acne scars are classified as atrophic scars. 

Long-term cystic acne is the most likely acne type to scar. These scars can look like: 

• Small, deep pits (or icepicks) 

• Red, raised scars

• Large pits (or boxcars)

• Shallow holes in the skin

Don’t pick or pop acne cysts to prevent scars. If you do, they can spread skin infections.  

Though it’s best to prevent scarring in the first place, there are some dermatological treatments you can try to reduce the appearance of acne scars. 

• Chemical peels

• Dermabrasion 

• Laser resurfacing

Can You Prevent Cystic Acne? 

While cystic acne is not 100% preventable, there are ways to reduce your risk. The best way to avoid it is to take care of your skin and overall health. 

1. Wash your face with a gentle cleanser once daily to remove dirt and excess oil. Avoid harsh, drying scrubs, as they can irritate your skin. 

2. Avoid skin picking, scraping, or pulling, as it can introduce more bacteria and other harm into inflamed skin. 

3. Wear sunscreen daily. Using an oil-free sunscreen daily helps prevent sensitive, treated skin from sunburn and skin cancer. 

4. Limit high-glycemic index (GI) foods. High GI foods, like heavily processed carbs and sugary drinks, can spike blood sugar and lead to more inflammation. 

5. Clean your skin after working out, sweating, or before bed. Sweating can lead to more oil clinging to skin. Shower or wash your face soon after exercising to remove oil, dirt, and other debris. 

6. Reduce stress. Stress is closely linked to acne. Try mindfulness, practice yoga, or discover other ways to alleviate stress for better skin health. 

7. Invest in “non-comedogenic” and “oil-free” makeup or skincare. When purchasing makeup or skincare products, ensure the label says “noncomedogenic.” These products are less likely to clog your pores. 

When to See a Dermatologist

For most cases of cystic acne, you’ll need to see a dermatologist to clear it up. Your dermatologist is the best resource, whether it’s a prescription medication or medical drainage. 

Acne cysts are almost impossible to treat at home. Severe cystic acne can also lead to significant scarring.

Besides medical treatments, your dermatologist can work with you to prevent chronic acne. Remember, acne treatments don’t work overnight. Be patient, and leave the cysts alone to keep them from returning.