Cystic acne: Maybe you’ve heard of it—or, better (er, worse) yet, maybe you’ve come face to face with it yourself. The below-the-surface breakouts are renowned for being so deep that they’re virtually impossible to pop. Instead, these breakouts leave us with dull, pulsing sensations that are rather hard to ignore (despite being hard to reach)—especially when they’re paired with a bright red facade.
Since ignoring cystic breakouts is too much of a task, we decided to chat with a couple of the industry’s leading dermatologists about how to approach these pesky pimples head-on. Below, they share what cystic acne is, what causes it, and—what we’ve all been waiting for—the best cystic acne treatments. In other words, get ready to kick your breakouts to the curb with this complexion-saving guide. Ahead, dermatologists share exactly how to spot, prevent, and treat cystic acne.
What Is Cystic Acne?
If you’ve ever experienced deep, painful bumps that won’t pop as much as you may squeeze them (which, BTW, you should never do, but hey, we’ve all been there), then there’s a good chance that you’ve encountered cystic acne. According to NYC-based board-certified dermatologist Dr. Dendy Engelman, cystic bumps are first filled with blood, then with pus, which is why they often appear redder and don’t feature a noticeable white head.
“It is the most severe type of acne—cystic breakouts often throb and are painful to the touch—and it occurs deep within the skin,” Engelman says. Only a dermatologist can accurately diagnose you with cystic acne, but the #cysticacne hashtag on Instagram has 96k+ posts to help you gauge whether or not your acne is cystic.
Causes and Prevention of Cystic Acne
Clogged pores: Since cystic acne occurs when pores get clogged with dead skin cells, excess sebum, and p. Acnes bacteria, it’s essential to wash your face regularly.
- Hormones: Have you ever noticed cystic bumps popping up around the time of your period? Ding, ding, ding —there’s a reason why. According to research, while many things can play into the formation of acne, all acne is hormonally mediated. Though, the authors of the article point out that it’s more accurate to call hormonal breakouts “cyclical” or “pre-menstrual” breakouts, as it’s the hormones during these time frames that often lead to adult breakouts.
- Lifestyle: Everything from smoking and drinking to stress and your work environment can meddle with your hormones and lead to deep cystic breakouts. Causes can be fairly subjective, though, so just because you and your BFF are stressed doesn’t necessarily mean that both of you will breakout. Regardless, a great way to ensure your lifestyle doesn’t negatively impact your complexion is to focus on stress management, not smoking, drinking less, and ensure your diet is balanced.
- Diet: According to Engelman, food contains nutrients that we need to fight and kill bad bacteria. “Without them, the skin feels threatened and becomes inflamed,” she explains, noting that opting for foods high in fat and unhealthy oils can trigger inflammation in your skin, which can lead to clogged pores. As such, it’s best to eat a clean diet with few processed fatty foods when attempting to stop cystic breakouts in their tracks.
- Genetics: Some studies have found that there’s a link between acne and genetics, though more research need to be conducted to determine conclusively whether genetics guarantee cystic breakouts.4 Nevertheless, it is still a possibility that Engelman says to be aware of. After all, even if you’re aware of all the causes and ways to prevent breakouts, if it’s in your genetics, you may still experience the painful bumps.
What are the signs and symptoms of cystic acne?
Cystic acne feels like a lump deep within your skin, unlike other forms of acne, which tend to feel like they’re only on the skin surface. It appears on the face and neck, as well as the back, chest, and arms.
Symptoms of cystic acne include:
- Large red cysts filled with pus
- Pain around the cysts
- Dark scars or “pits” in the skin
- Large oozing abscesses
The large abscesses are formed when individual cysts merge. These generally don’t look good, resulting in self-esteem issues.
Treatments For Cystic Acne
Gentle cleanser: Often people with acne think they need a strong cleanser or exfoliant to cut through the gunk that clogs their pores. But the truth is, a gentle cleanser is your best bet. “We don't need to put scrubs or tools on our faces that will break down the skin barrier,” says Engelman. “Cystic acne is too deep within the skin to be buffed out or scrubbed. Instead, use a cleanser containing salicylic acid or benzoyl peroxide.
If you're not sure where to start, you can't go wrong with Revamin Acne Cream, which aims to hydrate and treat acne-prone skin from the outside in.
Topical treatments: These targeted treatments such as Nonacne provide a powerful combination of active ingredients, which promise to start reducing the blemish immediately. "The one thing to stress about spot treatments is that you're treating acne after it's already reared its ugly head, and you're not preventing pimples from forming: So in essence, you're always playing catch-up with your skin," Engelman explains. “I recommend using topical treatment as needed but always with a continuous regimen.”
Prescriptions: According to Engelman, “The rule of thumb according to dermatologists is that if a drugstore treatment doesn't clear up your acne after two weeks, you need to see a dermatologist for a prescription treatment. Cystic acne does not involve skin involvement. If you are experiencing the symptoms described, it is time to see your dermatologist.
Retinoids: Retinoids are the umbrella under which retinol and Retin-A exist. Although you can start with an over-the-counter retinol treatment and see how it affects your breakouts, Engelman says you may be better off using a prescription-strength topical retinol treatment. “They work to control cell turnover, allowing old, clogged cells to get rid of and normalizing the turnover of new cells to prevent them from getting clogged, targeting acne before it starts,” she explains.
Oral supplements: “Oral supplements work to kill Propionibacterium acnes (the pathogen that causes acne),” Engelman explains, noting that some supplements like Zinamax
It is also anti-inflammatory, which helps improve acne. McLean, Virginia-certified dermatologist Dr. Lily Talakoub weighs in on this, noting, “Cystic acne is difficult to treat with over-the-counter medications. Because acne starts in multiple layers beneath the skin's surface, topical medications often don't help. Oral medications are often needed.
What are the signs and symptoms of cystic acne?
Cystic acne feels like a lump deep within your skin, unlike other forms of acne, which tend to feel like they’re only on the skin surface. It appears on the face and neck, as well as the back, chest, and arms.
- Symptoms of cystic acne include:
- Large red cysts filled with pus
- Pain around the cysts
- Dark scars or “pits” in the skin
- Large oozing abscesses
The large abscesses are formed when individual cysts merge. These generally don’t look good, resulting in self-esteem issues.
What are the risk factors for developing cystic acne?
Puberty and hormonal changes
The biggest factor in whether cystic acne develops is puberty. This is because the body is going through some big hormonal changes. It is producing more androgens, the male sex hormones. These sex hormones stimulate the glands in the skin to produce more sebum, increasing the risk of developing acne.
Young men tend to be affected more by severe acne than young women.³ This may be due to the higher levels of androgen in men than women. However, cystic acne does affect both sexes.
Many young women find that cystic acne develops or worsens around the time they get their period or when they become pregnant. This is also due to changes in hormones. If you think your acne is worse around the time you get your period, tell your doctor about it.
Genetics
Family history is a risk factor for developing cystic acne. If your parents or other members of your family have cystic acne, you have a higher risk of developing it yourself.
If you have naturally higher sebum levels, you are also more likely to develop acne.
Stress
Stress can cause an increase in androgen production. Because androgens increase sebum production, this causes your skin to be more oily when you are stressed, increasing your chances of developing or worsening your acne.
Medications
Some medications cause or worsen cystic acne. Drugs such as oral contraceptive pills and other hormone-altering medications can affect the severity of acne.
If you think a medication you are taking may be causing or contributing to your cystic acne, consult your doctor. It’s important to emphasize that you should not just stop taking your medication without talking to your healthcare provider.
How is cystic acne diagnosed?
A dermatologist will examine your skin to see if your symptoms match those of cystic acne. They will rule out any other skin conditions, such as rosacea, which, unlike cystic acne, cannot be cured.
How to treat cystic acne
Often the first treatment a doctor will prescribe for cystic acne is a combination of an oral antibiotic and a cream to apply to the acne.
The antibiotic helps reduce the inflammation—redness and swelling—while the medicine unblocks pores and kills the bacteria in the cysts. If this doesn’t work, other methods can be tried.
Here are some medications your doctor may use to treat cystic acne.
Topical retinoids
Topical retinoids are helpful acne treatments as they can reduce inflammation and prevent new cysts from forming.⁴ Topical treatment alone is usually not enough to resolve the cysts. However, topical retinoids can be used in combination with other medications when recommended by your doctor.
Here are the secrets to getting rid of acne:
- For the first secret method, click here
- For the second secret method, click here
- For the third secret method, click here
Isotretinoin
Oral isotretinoin, known as Accutane, can be prescribed for cystic acne, usually for periods of about 16 to 20 weeks. However, it can be used for longer if recommended by a doctor or dermatologist. This medication is effective in reducing inflammation, killing bacteria, unclogging pores, and removing excess oil to clear acne.
Isotretinoin does have some negative side effects, such as dry skin, nose bleeds, dry mouth, and more sun-sensitive skin.⁵ Isotretinoin cannot be taken when pregnant⁶ as it is highly teratogenic, which means it can cause severe birth defects and miscarriages.
If you can become pregnant, using two forms of contraceptives to ensure you do not conceive when on isotretinoin is recommended. It is vital to discuss taking isotretinoin with your doctor before deciding if it is right for you.
Remember, you should only obtain isotretinoin from your drugstore with a prescription from your doctor. Never buy isotretinoin online. If you do take isotretinoin, apply sunblock and moisturizer daily to take care of your skin.
Spironolactone
Spironolactone is an oral medication, either in tablet or liquid form, that is approved by the U.S. Food and Drug Administration (FDA) for treating many conditions, including heart failure.
Although spironolactone is not approved for acne treatment,⁷ it has been shown to reduce androgen, lessening the production of oil in the skin, helping to reduce cystic acne. However, this medication can only be taken by women, and not when pregnant.
Side effects of this medication include headaches, irregular periods, breast tenderness, and fatigue.
Birth control
Oral birth control can be an effective form of acne treatment for those who have worsening acne around menstruation. It reduces sebum production by reducing the amount of androgen circulating in the body.
Four birth control pills have been approved by the FDA for the treatment of moderate acne only, so they should be taken in combination with antibiotics or spironolactone. Birth control pills should only be used if the contraceptive effects of the medication are also wanted.
The approved birth control pills are:
- Yaz
- Ortho tri-cyclen
- Beyaz
- Estrostep FE
- Corticosteroid injection
Injecting a corticosteroid into a cyst can help reduce the cyst’s size and scarring, as well as the associated pain. Triamcinolone acetonide is the most common corticosteroid used for cystic acne treatment.
Unfortunately, the treatment itself can be quite painful and result in some redness. These effects, as well as the cyst, should go away in about 24 to 48 hours.
Incision and drainage
Large, painful cysts can be removed by making an incision in the cyst and draining the pus from it. This should only be done by a doctor as there is a high risk of infection when done incorrectly.
Natural treatments
Natural treatment options can help reduce acne; however, they are unlikely to be sufficient for clearing severe cystic acne.
Some natural options include:
- Zinc (oral) to reduce inflammation and promotes wound healing
- Brewer’s yeast, specifically Hansen CBS (oral)
- Tea tree oil (topical) for its antiseptic properties
- Bovine cartilage (topical) for promotion of wound healing
- Lavender oil (topical) to kill bacteria and reduce inflammation
- Peppermint oil (topical) for suppressing the growth of P. acnes
- Chamomile oil (topical) to aid wound healing and reduce skin redness
For treating cystic acne, these should be used in addition to, not instead of, any other treatment prescribed by a doctor. It is important to tell your doctor if you intend to try these options as sometimes interactions can occur between medications, particularly with zinc.
Basic skincare to treat acne
How to prevent cystic acne
When to see a doctor for cystic acne
- Salicylic acid peel: This liquid treatment is applied to the skin to remove or exfoliate the surface layers of the skin. Salicylic acid breaks the bonds that hold the skin's cells together, causing them to shed away or peel. It also helps unclog pores and reduce the amount of oil on the skin.
- Pyruvic acid peel: This liquid treatment is applied to the skin to remove dead and damaged skin cells. It also improves skin brightness, fades discolored areas and reduces excess oil in the skin.
- Photodynamic therapy: After applying a topical photosensitizer, a medical light source is focused on the skin to activate it. Combined with the photosensitizer and the presence of oxygen, the light helps destroy acne cysts, nodules and bacteria. This treatment also reduces the size and activity of oil-producing glands on the skin.
- Dermabrasion: This procedure removes acne scars and gives skin a smoother look. During the process, your provider uses a special surgical scraping tool to remove the layers of skin that cover the collagen layer.
- Laser resurfacing: This procedure uses a wand-like laser instrument to remove the upper layers of skin from acne scarring. It is sometimes referred to as laser peeling because it removes old skin cells in order to reveal new, more youthful-looking cells.
- Radiofrequency resurfacing: The treatment uses tiny pins that safely deliver energy through the skin's surface. This creates tiny wounds that initiate a natural healing process and accelerate the formation of new, healthy tissue. The result is an improved skin tone and texture and smoothing of acne scars.
Summary
When on a quest to get rid of or prevent cystic acne from forming, there are a few ingredients and processes you should steer clear of. “Exfoliation is not always your friend,” Engelman emphasizes. “Since cystic acne happens underneath the skin’s surface, it is likely that you will be drying out the surrounding skin area before it gets to the cyst, thereby irritating the surrounding area and exacerbating the infection.” Instead, she recommends applying a fast-absorbing serum followed by an occlusive balm to help force the acne-fighting product into the pore.
What’s more, don’t forget to moisturize! Many people believe the acne is the result of overly-oily, hydrated skin, but oftentimes skin only looks oily because it has a compromised skin barrier and is over-producing oil in an attempt to actually stay hydrated.5 “We need to strengthen this barrier in order to keep bacteria out and prevent more breakouts,” Engelman says. “Hyaluronic acid does wonders for hydrating skin and improving texture. Even though it is an acid, it does not exfoliate but rather locks in water.”
Cystic acne is a severe form of acne, characterized by the presence of large pus-filled cysts that feel painful and deep within the skin. It is caused by the clogging of hair follicles by dead skin cells and dried sebum, which become infected by P. acnes.
Although there are many triggers for cystic acne, the most common are hormonal changes, such as those at puberty and menstruation.
The best way to deal with cystic acne is to see your doctor to discuss treatment, keep your skin clean, and avoid picking at your pimples, even though that can be difficult.
Remember that acne of any kind is not uncommon. When it comes to cystic acne, you don’t have to just live with it. There are many treatments available for it, as well as for acne scarring.
Last but not least, whatever you do, no matter how tempted you may be, do not pick a cystic zit. While whiteheads and blackheads can often be extracted with the utmost care (though, it’s still best to leave it to a derm or esthetician to do so), squeezing a cystic zit can lead to more inflammation, bleeding, and even scarring.
Here you will find the product you are looking for
Sources:
- Acne | American Academy of Family Physicians
- Acne | MSD Manual Consumer Version
- Adult acne versus adolescent acne (2018)
- Why topical retinoids are mainstay of therapy for acne (2017)
- Isotretinoin: The Truth About Side Effects | American Academy of Dermatology Association
- Is Any Acne Treatment Safe to Use During Pregnancy? | American Academy of Dermatology Association
- Highlights of Prescribing Information | U.S. Food & Drug Administration
- Oral spironolactone in post-teenage female patients with Acne vulgaris (2012)
- Natural Acne Treatment: What’s Most Effective? | Mayo Clinic
- Lasers and Lights: How Well Do They Treat Acne? | American Academy of Dermatology Association
- Microneedling for the treatment of scars: An update for clinicians (2020)
- Impact of sugar on the body, brain, and behavior (2018)
 yet, maybe you’ve come face to face with it yourself. The below-the-surface …){kind=link}