Cystic Acne: Identification, Causes, and More

Written by Resurchify | Updated on: April 05, 2023

Cystic Acne: Identification, Causes, and More

Brian Clough once said, “Acne is a bigger problem than injury.” Once in a lifetime, everyone faces issues with acne. Teenagers are the most affected with acne, but it can trouble any age group regardless of gender. Acne can be so stubborn that it may take you years to eradicate it from your body. The primary key to a successful journey against acne is patience. Some treatments take several months to show visible results and years to acne-free skin.

Identifying the cause of acne can be easier to treat acne. Different types of acne require different treatments. Some acne can be treated easily at home, while others require medical attention. Some cases may even require surgical removal. All acne is not the same. Finding out the type of acne you are suffering from will make it easier to treat.

Acne can be inflammatory or non-inflammatory. The non-inflammatory acne is the mildest. These are blackheads and whiteheads and are easy to cure. The inflammatory acne can be moderate or severe. The moderate acne, papules and pustules can be fixed at home with proper medication. The severe acne, nodules and cysts require adequate medication and treatment, depending on your skin.

The most severe acne is cystic acne. When a cyst develops deep beneath your skin, cystic acne appears. A combination of sebum, dry skin cells, and bacteria get trapped in the pores, resulting in cystic acne. Generally, someone having oily skin is more likely to have cystic acne. Also, teens, women and older adults with hormonal balance can suffer from cystic acne.

In most cases, cystic acne improves with age. However, the bumps and marks are stubborn and painful and would not disappear easily. If you suspect you have cystic acne, going to your dermatologist will help you best. He will prescribe you medication to clear your skin and cure the acne completely. Let us learn more about cystic acne, its causes, identification, remedy and prevention.


Not only the most severe, but cystic acne is also the largest. This acne also goes deep beneath the skin, while the other acne remains on the skin's top surface. Symptoms of acne are familiar to all. Cystic acne is even more evident due to the severity and production of cysts besides inflammatory papules and pustules. These are likely to cause scarring.

Cystic acne has a more significant impact on facial appearance, increasing the risk of causing psychological distress and affecting socially sensitive young adults. Generally, people with cystic acne do not experience physical symptoms, but the skin's appearance may give you emotional distress. However, there may be greater distress and painful cysts for cystic acne.

What treatment to be given is decided by the risk of scarring by long-term cystic acne. Long-term and permanent damage can happen in the form of:

  • Small, deep pits, known as “ice-pick scars.”
  • Larger pits
  • Red raised scars
  • Shallow depressions in the skin

Generally, cystic acne appears like boils on the skin. Other identifying factors may be:

  • Redness
  • Large white bump
  • Tender and painful to touch
  • Large pus-filled cyst

Acne cysts happen to be the most noticeable on the face. But they can also affect the neck, chest, back and arms. These can also appear on the shoulders and behind the ears.


The severity of cystic acne makes it difficult to be cured by over the counter medicines. You should see your dermatologist for prescription medication. Some treatments would not show visible results for up to eight weeks. A dermatologist may prescribe you one or a combination of the following for cystic acne.

  • Oral antibiotics
  • Benzoyl peroxide
  • Topical antibiotics
  • Topical retinoids

You can try the treatments below but consult your dermatologist beforehand. Some medicines may require combination therapies.


Isotretinoin or Accutane is a potent prescription medicine. It is made from a powerful Vitamin A source and taken every day in the form of a tablet. It is considered to be the most effective treatment for cystic acne. About 85% of people who try isotretinoin for cystic acne experience improvement in four to six months. Although efficient, this medicine comes with some serious risks. Consult your doctor if you experience:

  • Blood in urine
  • Bruising
  • Inflammatory bowel disease
  • New or worsening mood disorders
  • Persistent headaches or nosebleeds
  • Muscle and joint pain
  • Skin inflammation  

Oral Antibiotics

If the area of skin covered by acne is large, you may use oral antibiotics. Oral antibiotics decrease bacteria and inflammation, the factors contributing to the formation of cystic acne. However, these antibiotics do not work on reducing excess oil and dead skin cells. Antibiotics should be used only for the short term, over the concerns about bacterial resistance. If these do not work, the dermatologist may recommend taking isotretinoin. There are side effects of using antibiotics too. Possible in this case are:

  • Diarrhoea
  • Sun sensitivity
  • Nausea
  • Abdominal pain
  • Vomiting  

Topical Retinoids

Also derived from vitamin A, topical retinoids do not have the strength of isotretinoin. The topical retinoids remove and prevent cystic acne by unplugging the hair follicles. Sometimes retinoids and topical antibiotics are used conjunctively to be more effective. You can use topical retinoids daily, and they come in the form of creams, gels and lotions. Although there is an over the counter retinoid, adapalene, that is now available, cystic acne responds to only prescription-strength formulas. These include:

  • Retin-A
  • Avage
  • Differin
  • Tazorac
  • Avita

Do not forget to wear sunscreen while taking topical retinoid medication, as they make your skin susceptible to sunburn. Your skin may turn red and peel while on topical retinoid medication, but these side effects disappear as your skin gets habitual to the medication.


Spironolactone (Aldactone) is one more prescription treatment that can cure cystic acne. Generally, it is used to treat oedema and high blood pressure as a diuretic. In terms of acne, this helps cure inflammatory acne by managing access androgen levels contributing to acne formation. Typically, spironolactone is only effective in women having acne on the jawline or lower face. If you are planning a pregnancy, you should not use Spironolactone, as these may cause congenital disabilities. Kidney patients should also avoid using these. Researchers found that 50 to 100 milligrams (mg) doses per day work best, according to a 2012 study. However, to go high up to 200 mg daily is also not uncommon. The risk of some side effects is also reduced by this; such as:

  • Dizziness
  • Fatigue
  • Menstrual irregularities
  • Breast tenderness
  • Headaches
  • High blood potassium (hyperkalemia)  

Oral Contraceptives

In some women, oral contraceptives are feasible for cystic acne. If you developed cystic acne due to hormonal fluctuations related to the menstrual cycle, this method is very effective for treatment. Contraceptive pills with estrogen help regulate overall hormone levels and possibly decrease acne. Not everyone can use oral contraceptives. These may not be appropriate if you are trying to get pregnant, smoke, or have blood clots.

Risk of Scarring

Scarring is most common with cystic acne. You should never pick or poke this acne. Picking or poking may also spread infections. The best option is to prevent the acne scars in the first place, but if not, some treatments may work in reducing the scars. However, first, you should treat the active acne and then concentrate on scars after the acne is clear or under control.

The treatments are:

  • Chemical peels
  • Laser resurfacing from a dermatologist
  • Dermabrasion from a dermatologist

General Skin Care Tips

The best way to prevent cystic acne is to take care of your skin and keep it healthy. Some things you should incorporate in your skincare routine are:

  • In the evening, wash your face. Use a gentle cleanser that is not excessively harsh or drying but removes the excess oil and dirt from the face. Avoid scrubs, as they can irritate the existing inflammatory acne and worsen it.
  • Do not pick on your skin. Even the mild forms of acne can lead to cystic buildup if picked or poked.
  • Start using “noncomedogenic” and “oil-free” makeup products. These will not clog the pores.
  • Never sleep with makeup on your face. Always clean your face before sleeping to let the skin breathe.
  • Apply sunscreen daily. You can use an oil-free sunscreen to avoid clogging of pores. Sunscreen will help protect you from sunburn. Your skin becomes sensitive from acne medication and is at a high risk of sunburn.

Some lifestyle changes can also help you make your skin healthy and avoid cystic acne, like:

  • Try finding ways to alleviate stress in life. Stress leads to acne breakouts.
  • Refrain from having foods with high glycemic levels like pasta, white bread, rice and sugary treats.
  • Always wash your body and face after a workout to remove bacteria and oil.

When To See A Dermatologist?

Treating acne cysts at home is very difficult. The best treatment for cystic acne, in most cases, can be recommended by your dermatologist. Prescription medicine or surgery, your dermatologist will suggest you the best. Treating acne cysts at home is very difficult. Cystic acne can also cause significant scarring.

Visiting a dermatologist at the starting stage of cystic acne may make it easier to cure, and the acne will be less painful to deal with. The way is to find out the severity of acne you are suffering from. With medical treatments, your dermatologist may also prescribe you medication to prevent the acne from coming back. Remember, it may take several months to see a significant result of any new skincare regime. If you leave the cysts alone, that may also prevent them from recurring.

Some facts about cystic acne:

  • Acne is quite common, but cystic acne is comparatively uncommon and severe.
  • Hormonal changes during puberty is the main factor causing cystic acne, but older individuals may suffer too.
  • Chocolates, nuts, or greasy food do not cause cystic acne or poor hygiene or masturbation.
  • Cystic acne affects facial appearance so much that, for some people, it may be emotionally distressing. These can be painful too.

Severe, moderate or mild, the key to acne-free skin is patience and commitment. It will be easier to cure if you efficiently detect what type of acne you are suffering from. Consult your dermatologist if you have signs of cystic acne. If you do not see visible medication results, continue and be patient. Sometimes it may take four to six weeks for the treatment to show visible results.

A problem that seems so big may be easy to solve if you know the root cause. Khalil Gibran said, “Beauty is not in the face; beauty is a light in the heart”. So, next time you feel insecure, look at the beautiful person in the mirror; these marks are not your identity; your personality is. Be patient and be consistent with your journey to clear skin, and the result will be stunning! Be happy, be wild, be yourself. Because Coco Chanel beautifully quoted, “Beauty begins the moment you decide to be yourself.” All the best for a beautiful journey. :)

Frequently Asked Questions (FAQs)

What causes cystic acne?


The most extensive form of acne is the cyst, and it usually happens due to a severe infection beneath the skin surface. Cysts occur when sebum, dead skin cells, and bacteria clog the pores. The clogs are deep beneath the skin and further below the surface than nodules. These are large, red or white and are often painful to touch. These are the ones most likely to scar. Commonly the prescription medication isotretinoin (Sotret) is used for the treatment of cysts, but in severe cases, the doctor can surgically remove the acne. 

Does touching the face lead to more acne?

It is seen that a person touches their face hundreds of times every day. The touching transfers the bacteria or faecal matter from your hands to your face. These bacteria clog the pores on your face, which traps the sebum inside and cause acne. Picking or poking at acne can also lead to acne scars, which can be difficult to remove.  

Can acne be treated entirely?

The main thing is to be patient with acne treatments. While the treatment may start to work immediately, you may not see the visible results for several months. Be cautious in using too many acne products at once, as they may dry the skin. The body can respond to this dryness by producing more sebum leading to more acne issues. The only way to get a complete and accurate diagnosis of your skin problem is to visit a dermatologist. Some cases require expert treatment to cure and clear your acne completely. If you are patient and committed, you are not far from having acne-free skin.  

What causes acne?

When our skin renews itself, the old cells die and slough off to make room for new cells. This process is different for different skin types. When the dead cells shed unevenly, they become sticky and form a clump on the skin. This clump traps bacteria and oil inside the follicle. This clump swells as the sebaceous gland keeps producing oil and transforms into a pimple.  

Why is my skin sensitive after I started acne treatment?

The topical retinoids remove and prevent cystic acne by unplugging the hair follicles. Sometimes retinoids and topical antibiotics are used conjunctively to be more effective. Topical retinoid medication makes your skin susceptible to sunburn. Your skin may turn red and peel while on topical retinoid medication, but these side effects disappear as your skin gets habitual to the medication. Always use sunscreen while taking acne treatment. You can use oil-free sunscreen to prevent the pores from clogging. Avoid dirt and bacteria on your face as it may worsen the acne and cause rashes to the sensitive skin.  

What parts of the body can cystic acne affect?

Acne cysts happen to be the most noticeable on the face. But they can also affect the neck, chest, back and arms. These can also appear on the shoulders and behind the ears.  

What can be confused with cystic acne?

The most common skin disease that can be confused with cystic acne is Rosacea. This disease causes small red or pus-filled bumps to appear on your skin, the face is left with a chronic flush appearance, and redness persists across the nose, cheeks, forehead and chin. Rosacea also causes a burning sensation in the bumps and redness and swelling in the eyes and eyelids.



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