Cystic Acne: Causes & Treatment Options

Kristin Hall

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 3/12/2021

Acne is an incredibly common skin condition that affects approximately 85 percent of all people between the ages of 12 and twenty-four. 

It’s also common in adulthood, with data suggesting that between 10 percent and 50+ percent of women continue to experience acne breakouts as adults.

While acne affects just about everyone at some point in life, it can vary hugely in severity from a few small pimples to painful breakouts of cystic acne. 

Cystic acne is a severe form of acne that can develop deep within your skin. It causes inflamed, painful breakouts and is often challenging to get rid of using over-the-counter creams, cleansers and other acne products.

If you have cystic acne, you may have tried a variety of treatments to get rid of your breakouts, usually without much in the way of success. 

While cystic acne can be frustrating to deal with, it is treatable. Below, we’ve explained how and why cystic acne develops, as well as the factors that may increase your risk of developing cystic acne breakouts.

We’ve also explained what you can do to get rid of cystic acne and prevent it from coming back, from science-based medications to habits, lifestyle changes and more. 

What Is Cystic Acne?

Cystic acne, or nodulocystic acne, is a severe form of acne. Like other types of acne, it usually affects the face, although it may also develop on your chest and back.

Unlike whiteheads, blackheads and small inflammatory acne lesions, which form on the surface layer of your skin, cystic acne lesions develop deeper inside your skin. Cystic acne lesions are filled with fluid and are often large, tender and painful to the touch. 

Breakouts of cystic acne can occur either on their own or with other, milder forms of acne such as whiteheads and blackheads. 

Because cystic acne is so severe, it’s often challenging to treat. While over-the-counter products available at your local drugstore may clear away mild acne lesions on your face and body, they’ll often do little to the cystic acne. 

Worse yet, when cystic acne does clear, it often leaves behind an unsightly, frustrating reminder of your breakouts in the form of acne scarring.

The effects of cystic acne can be both physical and psychological. Physically, it can affect your appearance, and when left untreated or improperly treated, can even cause lasting damage to your skin. 

From a psychological perspective, cystic acne can cause everything from mild discomfort about your appearance to poor self-esteem, anxiety or depression.

How Does Cystic Acne Develop?

Cystic acne develops the same way as other forms of acne — when sebum and dead skin cells build up inside your hair follicles, or pores, and cause a blockage to develop. 

Sebum is a type of oil-like substance that’s produced by your sebaceous glands. It plays a key role in keeping your skin hydrated, lubricated and protected from bacteria and other potentially harmful substances in the environment.

When your sebaceous glands secrete too much sebum, it can build up inside your hair follicles and contribute to blockages.

Dead skin cells are produced as part of your body’s process of renewing and replacing its skin, which is referred to as epidermal turnover. 

Every 40 to 56 days, the outermost layer of your skin replaces itself by creating new cells. As part of this process, the old, leftover cells gradually detach from your skin and are shed into the environment.

These dead skin cells can mix with the excess sebum on the surface of your skin and contribute to blocked hair follicles and acne breakouts.

Most types of acne only affect the outermost layer of your skin, causing minor inflammation and discomfort. 

Cystic acne, on the other hand, develops deeper inside your skin, causing large, tender bumps to form on your face or body. As bacteria multiply inside the acne lesion, it can become painful, tender and severely inflamed. 

Cystic Acne Causes & Risk Factors

Although anyone can get acne, certain factors may increase your risk of dealing with persistent or severe acne, including cystic acne. These include:

  • Hormones. Certain hormones, such as androgen hormones, play a role in your skin’s production of sebum. When levels of these hormones increase, you may experience more acne breakouts, including breakouts of cystic acne.

    We’ve talked more about the relationship between hormones and acne breakouts in our guide to hormonal acne.

  • Genetics. Research suggests that your genetics may play a role in your risk of dealing with acne breakouts. Some studies suggest that you may inherit a tendency to develop acne from your parents.

  • Cosmetics and skin care products. Cosmetics and skin care products that are made using oils and certain other ingredients may contribute to clogged pores and breakouts of inflamed and/or cystic acne.

  • Habits. Certain habits, such as smoking, popping your pimples, sleeping with makeup on or not keeping your skin clean may increase your risk of developing acne breakouts, including breakouts that cause cystic acne. 

How to Treat Cystic Acne

Cystic acne can be difficult to treat, especially with over-the-counter products designed for mild acne breakouts. 

However, even the most severe, persistent cystic acne can almost always be treated using the right combination of medications and changes to your skin care habits. 

If you have cystic acne, it’s important to talk to a licensed healthcare provider to find out more about what’s causing your breakouts and the prescription and over-the-counter acne treatment options that are available to get your acne under control. 

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Medications for Cystic Acne

Most cases of cystic acne are treated with medication. Your healthcare provider may prescribe one or several medications to reduce sebum levels, strip away dead skin cells or prevent acne causing bacteria from growing on your skin. 

Common medications for cystic acne include:

  • Tretinoin. Tretinoin is a topical retinoid that’s used to treat mild, moderate and severe acne. It works by encouraging your skin to shed dead skin cells that can cause acne breakouts.

    Tretinoin is one of several active ingredients in our Customized Rx Acne Cream, which has a tailored formula designed specifically for stubborn acne.

  • Isotretinoin. Isotretinoin is an oral medication that’s used to treat moderate to severe cystic acne breakouts. It works by reducing sebum levels on your skin and stopping dead skin cells from building up inside your hair follicles.

    Your healthcare provider may prescribe isotretinoin if you’ve tried other treatments for cystic acne without success.

    Isotretinoin is effective at treating acne, but it can cause side effects. It’s also unsafe for use during pregnancy. As such, you’ll need to use birth control and take precautions to minimize your risk of becoming pregnant while using this medication.

  • Clindamycin. Clindamycin is a topical antibiotic. It treats acne by stopping acne-causing bacteria from multiplying on your skin and inside your pores. It also helps to reduce the swelling that often accompanies cystic acne breakouts.

    Clindamycin is one of several active ingredients in our Customized Rx Acne Cream. You can learn more about how it works, its effects on acne and how you can use it in our full guide to clindamycin as an acne treatment.

  • Oral antibiotics. Your healthcare provider may prescribe an oral antibiotic, either for use by itself or in combination with topical antibiotics such as clindamycin.

    Like topical antibiotics, oral antibiotics work by preventing the bacteria that cause cystic acne from multiplying. Oral antibiotics for cystic acne include doxycycline, minocycline, azithromycin and several others.

  • Birth control pills. Several forms of the combined birth control pill have been approved by the FDA as acne treatments. These work by reducing sebum production and lowering your levels of acne-causing hormones such as testosterone.

    We offer several birth control pills online, following a consultation with a healthcare provider who will determine if a prescription is appropriate. Our guide to birth control and acne goes into more detail about the benefits of birth control for treating acne breakouts.

  • Spironolactone. Spironolactone is a medication for high blood pressure that’s also used off-label as a treatment for acne. It works by reducing the levels of androgenic hormones such as testosterone in your body.

    By lowering the amount of testosterone in your body, spironolactone reduces your skin’s sebum production, helping to treat and prevent acne.

    Our guide to spironolactone provides more information about how spironolactone works as a treatment for hormonal acne breakouts. 

Even with medication, cystic acne can take several months to fully disappear. Be consistent and keep taking your medication, even if you don’t see immediate results. Over time, you should see a significant reduction in acne lesions and improvements in your skin. 

Acne Removal Procedures

If you have very large acne cysts, you may need to visit a dermatologist to have them drained or removed. Several procedures are used for this:

  • Corticosteroid injection. A dermatologist may inject a corticosteroid (medication used to reduce inflammation) into a cyst to relieve pain and reduce its size.

  • Drainage. A dermatologist may surgically cut open a large cyst or nodule to remove its contents.

It may take several days for your acne to improve after treatment by a dermatologist. Make sure to closely follow the care instructions to help your skin recover. 

Habits & Lifestyle Changes

Because cystic acne is a severe, persistent form of acne, small changes to your skin care habits and lifestyle are unlikely to bring an end to your breakouts on their own.

However, in combination with science-based treatments such as those listed above, taking good care of your skin can help to stop cystic acne breakouts from coming back and ensure your skin looks its best as you recover.

Try the following skin care habits and lifestyle changes to improve your skin and prevent cystic acne from returning:

  • Continue using your medication, even after your breakouts stop. Make sure to keep using your medication for the entire treatment period, even if your acne goes away in the first few months.

    This helps to prevent recurrence. Your healthcare provider may recommend taking your medication for an extended period of time to keep your skin clear and acne-free.

  • Wash your skin twice a day and after exercising. Try to wash your skin twice a day — once in the morning, and once before you go to bed. You should also wash your skin as soon as possible after you exercise or do anything else that causes you to sweat.

    When you wash your face, stick to alcohol-free, gentle products and apply cleanser with your fingertips, not a washcloth. Make sure to avoid any skin care products that contain alcohol or other ingredients that can cause dryness or irritation.

  • Avoid picking or popping acne. If you notice any acne lesions on your face, make sure not to pop them. This can force the contents of the acne deeper into your skin and make your breakouts worse. It can also spread bacteria and worsen infections.

    If you need to touch your face, make sure to wash your hands with soap and warm water first to remove any oil and/or bacteria.

  • If you smoke, quit. Although smoking doesn’t cause cystic acne specifically, numerous studies have found that smoking cigarettes and other tobacco products can contribute to acne breakouts.

    If you’re a smoker, try to quit smoking. Our guide to the benefits of quitting smoking goes into more detail about the health benefits you’ll experience after quitting, as well how you can take action to quit for good.

  • Take good all-round care of your skin. Other general skin care habits, such as using a high quality moisturizer and protecting your skin from the sun, can also help to stop acne breakouts from coming back.

    Our guide to dermatologist recommended skin care tips shares 14 additional tactics that you can use to keep your skin healthy while you treat cystic acne. 

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In Conclusion

Cystic acne can be severe, painful and persistent. When it’s particularly bad, it can affect both your physical appearance and your psychological well being.

Since over-the-counter products generally aren’t effective at treating cystic acne, it’s important to talk to a licensed healthcare provider if you often experience cystic acne breakouts. 

Depending on the severity of your acne, they may prescribe antibiotics, retinoids or other types of medication to get rid of your cystic acne breakouts, clear your skin and help you to stop your acne from making an unwanted comeback. 

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Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

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This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.