Painful Acne: Causes and Treatment

Vicky Davis, FNP

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 4/13/2021

Fact: not all acne is created equal — something people with acne can all attest to. 

First, there’s comedonal acne. That’s the clinical term for whiteheads and blackheads. And while those types of breakouts can be unsightly and annoying, they tend not to be overly painful. 

Then, there’s cystic acne, which comes with a major “ouch factor.” We won’t sugar-coat it, this type of acne can be a bit of a nightmare. It can get inflamed and irritated, can take a long time to heal, and can even leave behind scarring.  

But don’t worry! This painful, severe acne can be dealt with. You just need to know what to do — and, while we’re at it, what not to. First, read up on what causes these tender spots, then we’ll walk you through ways to treat them.

What Is Cystic Acne and Why Is It Painful?

Comedonal acne forms on the surface layer of your skin, whereas cystic acne forms deeper underneath the surface. This type of inflamed acne fills with fluid, creating large cysts and can be painful to the touch.

This severe form of acne can be difficult to treat — especially with over-the-counter products. When it does finally clear, it can leave behind lasting damage and scarring.

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What Causes Cystic Acne?

This painful acne is caused by the same thing that causes other types of acne: when a combination of sebum and dead skin cells build up and cause a blockage in your pores and hair follicles.

Sebum is an oil-like substance that is naturally produced by your sebaceous glands to lubricate your skin and hair. It also helps protect your skin from bacteria and other potentially harmful substances in your environment.

Unfortunately, sometimes an excess of sebum is produced, which can build up and cause blockages, and those blockages can lead to painful and severe acne.

Excess sebum can be caused by a variety of factors, including:  

  • Hormone imbalances — like the ones that occur during your period

  • Some people produce more sebum thanks to genetic factors

  • Environmental factors — like washing your skin excessively or working out a lot—also play a role

Dead skin cells also play a role in breakouts. Your body naturally sheds dead skin cells every 40 to 56 days as part of its process to renew and replace skin (also called epidermal turnover). 

When these dead skin cells mix with excess sebum, they can contribute to blocked pores and breakouts. 

While some types of acne are on the surface, cystic acne occurs deeper under the skin. As more bacteria grows, those under-the-skin lesions get bigger and become painful and inflamed.

If you use certain skincare or cosmetic products that contain oil, you may also be more prone to clogged pores and cystic acne. And there are other lifestyle choices that also contribute to an increased risk of acne — including the cystic kind — like smoking, sleeping with makeup on and more.

Treatment for Painful Acne

Painful cystic acne can be tricky to treat, but that doesn’t mean it’s untreatable!  Speaking with a licensed healthcare professional is the best way to determine exactly what could work for your specific case of acne. Here are a few treatment approaches you may wind up considering. 

Can Over-the-Counter Treatments Help At All?

The short answer is maybe. As mentioned above, over-the-counter products aren’t always the most effective when it comes to treating this type of acne because of how deep the cysts tend to be. 

That said, over-the-counter products that contain benzoyl peroxide or salicylic acid have been found to help some people who experience painful acne.Tea tree oil, which has anti-inflammatory properties and is available over the counter, has also been found to reduce swelling around painful acne.

Prescription Medications 

If the over-the-counter stuff doesn’t cut it, prescription medication can likely help. There are topical options which are applied directly to the infected area, as well as medications that can be taken orally.

Tretinoin and Clindamyacin are prescribed topicals. The first encourages your skin to shed dead skin cells that cause breakouts, the later stops bacteria from multiplying. Side effects for both include itching, dryness, and burning amongst other things. If these things persist or worsen, you should contact your healthcare provider.

Two oral options for treating painful cystic acne include birth control pills and Isotretinoin. The FDA has approved a handful of combined oral contraceptives for use in acne treatment, which work by lowering your levels of acne-causing hormones (like testosterone) and reducing sebum production. Isotretinoin also works by reducing sebum production, along with preventing dead skin cells from building up and clogging pores. Oral antibiotics are also sometimes prescribed, they also prevent bacteria from multiplying.

At-Home Treatments

If you’re looking to deal with the pain, applying ice may help.  Grab an ice cube from the freezer, wrap it in a paper towel and apply it to the area for five minutes to 10 minutes. Repeat this two more times with 10 minute breaks in between.

One thing you should never do? Try to pop a painful, cystic acne spot yourself. Doing so, can spread the bacteria and make them even worse. Only a dermatologist should attempt to remove or reduce an acne cyst. They can carefully cut a cyst open and drain it or inject it with a corticosteroid to reduce inflammation and ease pain.

Certain lifestyle changes may help some people reduce experiencing painful breakouts, too.  Keeping your hands off your face, washing with a  gentle cleanser twice a day and staying out of the sun are all habits that can help reduce acne.

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In Conclusion

Dealing with a painful bout of cystic acne can be frustrating. Hopefully, knowing both that you’re not alone in your fight against cystic acne and that there are science-backed treatments available is a silver lining.

To avoid suffering, skip the over-the-counter products that tend not to work and, instead, go straight to speaking with a licensed  provider. From there, you will be able to discuss treatments for acne (like topicals, oral medication, in-office procedures or lifestyle changes) will best alleviate your painful cystic acne.

14 Sources

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.

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