What is Cystic Acne? Causes, Symptoms and Treatments

    Acne breakouts aren’t fun. Luckily, they’re usually easy to treat. But when your acne transforms from minor whiteheads and blackheads into cystic acne, dealing with outbreaks can go from an easy process into a frustrating, stressful and painful ordeal.

    Cystic acne is the most severe form of acne. Unlike whiteheads and blackheads, which form on the surface of your skin, cystic acne forms deep below the surface. Cystic nodules can be large and painful, affecting both your face and your neck, shoulders and chest.

    Compared to regular hormonal acne, cystic acne is fairly uncommon. While 85% of people aged between 12 and 24 experience regular acne, statistics from the CDC indicate that two people in every 1,000 are affected by cystic acne.

    In short, cystic acne is a rare, serious form of acne. Unlike regular hormonal acne outbreaks, an outbreak of cystic acne usually involves large, inflamed lesions that can take far longer to clear up and disappear.

    Luckily, cystic acne isn’t immune to treatments. In fact, many of the same treatments that work for hormonal acne are also highly effective at eliminating cystic acne nodules and stopping new outbreaks from occurring.

    Worried your acne might be cystic? Below, we’ve covered everything you need to know about cystic acne, from the primary causes of cystic acne outbreaks to symptoms that differentiate an outbreak of cystic acne from regular hormonal acne.

    We’ve also listed the most effective treatments for cystic acne, from topical and oral retinoids to hormonal medication and more.

    What is Cystic Acne?

    Cystic acne is a severe form of acne that’s characterized by large, painful, red breakouts that occur beneath the surface of your skin. Because these cysts form deep below the surface of your skin, they don’t result in the typical pimples most people associate with acne.

    Compared to the whiteheads, blackheads and other lesions that develop during a hormonal acne outbreak, cystic acne has several differences. Cystic acne lesions are usually:

    • Bigger than whiteheads, blackheads and other pimples
    • Red, inflamed, tender and painful when touched
    • Beneath the skin, without an obvious opening

    Most of the time, outbreaks of cystic acne occur alongside hormonal fluctuations. Some people have more or less continuous cystic acne, with cysts affecting their facial skin almost non-stop throughout the year.

    Like most acne, cystic acne is most common in teenagers and people in their 20s, although it can affect all age groups. Most cystic acne outbreaks affect the face, however cystic acne can also develop on the shoulders, back, arms and chest.

    How and Why Does Cystic Acne Develop?

    Like most acne, cystic acne is the result of excess sebum and dead skin cells collecting inside your hair follicles. As sebum collects in the follicle, it can result in a blockage and the formation of a pimple.

    Most blocked hair follicles result in blackheads and whiteheads -- small, manageable types of acne that tend to go away within a week. But when bacteria gets trapped inside the follicle, it’s easy for the follicle to become inflamed, swollen and painful.

    Cystic acne occurs when a hair follicle becomes blocked and infected deep beneath the surface of your skin. The infection causes a large, pus-filled nodule to develop, creating a red, sensitive bump that’s visible on the surface of your skin.

    Because cystic acne forms beneath the surface of your skin, dealing with an outbreak can be a challenging process.

    Complicating things, cystic acne nodules can spread quite easily. If a cyst breaks open, the pus inside can spread the infection to the surrounding area, increasing the risk of another breakout developing.

    Androgens and Cystic Acne

    Like regular hormonal acne, the root cause of cystic acne is almost always an increase in your body’s production of androgens.

    Androgens are male sex hormones. The most common androgen in both women and men is testosterone. When your body produces higher amounts of testosterone, it can stimulate your sebaceous glands to create and secrete more sebum.

    Your body’s production of testosterone fluctuates over the course of your menstrual cycle. For most women, testosterone levels are at their highest just before and during your period. This is why acne outbreaks are particularly common in the days leading up to your period.

    Our guide to hormonal acne explains how androgen hormones like testosterone affect sebum production and acne in more detail, as well as the best ways to moderate your hormones for better skin.

    Because androgens like testosterone are such a major cause of acne, one of the most common treatments for cystic acne is the use of birth control. We’ve covered this, as well as several other cystic acne treatments, below.

    Can Cystic Acne Cause Scarring?

    Severe outbreaks of cystic acne can and often do leave lasting scars. Cystic acne scars are the result of cysts stretching and damaging skin tissue. There are several different forms of scarring from cystic acne, ranging from pit-shaped scars to lumpy, hypertrophic scarring.

    If you have cystic acne scarring, there are options available to reduce and potential remove your scars. Our guide to getting rid of cystic acne scarring goes into more detail on the different types of scars that can develop from cystic acne, as well as the most effective treatment options.

    Cystic Acne Treatments

    A variety of treatments are available for cystic acne, ranging from over-the-counter products to prescription medicines.

    Because cystic acne is the most severe form of acne, your best option is always to meet with an experienced, qualified dermatologist. They’ll be able to look at your acne and determine the best course of action.

    Below, we’ve listed and explained some of the most common treatments for cystic acne, ranging from hormonal medication to topical and oral retinoids.

    Hormonal Medication (Birth Control)

    Many women can limit the severity of their cystic acne by using a combined oral contraceptive, or simple birth control bill.

    Modern birth control pills contain a mix of estrogen and a progestin, allowing them to suppress androgens in the body. Since lower androgen levels contribute to lower sebum production, birth control is often enough to bring acne under control.

    For severe cystic acne, some dermatologists will combine birth control with a topical retinoid or oral medication such as isotretinoin. However, birth control on its own is sometimes enough to bring mild to moderate cases of cystic acne under control.

    Right now, the FDA has approved three birth control medications as treatments for acne. Our guide to birth control pills and acne lists these three brands and explains how birth control can help to limit your acne symptoms.

    As with any hormonal medication, you’ll need to talk to your doctor before you start using oral birth control. If you currently use birth control, you might also be able to bring your acne under control by switching from your current pill to a different type of oral contraceptive.

    Retinoids (Topical and Oral)

    Retinoids are vitamin A-based medications that function by speeding up your skin cell turnover cycle. This makes it more difficult for dead skin cells to collect inside your pores and contribute to the development of acne.

    The most widely used retinoids are tretinoin and isotretinoin. The first is a topical medication you can apply to your skin as a liquid or cream. It’s available by prescription and usually sold under the brand name “Retin-A.”

    Our guide to tretinoin and cystic acne covers how tretinoin can work as a cystic acne treatment, as well as the type of results you can expect from adding it to your acne prevention toolkit.

    The second is an oral medication that’s widely known as “Accutane.” More powerful than topical tretinoin, oral isotretinoin also has a wider range of side effects, meaning it’s typically only used by dermatologists for severe cases of cystic acne.

    Although retinoids start working almost immediately, it can take several months before you start to notice an improvement in your acne.

    Like with hormonal medication, it’s best to talk to your doctor before using retinoids. Your doctor will be able to choose the best topical or oral retinoid for your needs and explain the amount of time required before you’ll see results.

    Antibiotics

    Cystic acne is caused by a combination of a blocked pore and a bacterial infection, making an antibiotic a normal part of treatment.

    Antibiotics work by fighting back against the bacteria inside cystic acne nodules. Over time, this can help to reduce the bacterial side of cystic acne development and help to heal both deep and surface acne lesions.

    The most common antibiotics for treating cystic acne are tetracycline, doxycycline, erythromycin and minocycline. Topical antibiotics like clindamycin are occasionally used, although these tend to be better for typical hormonal acne.  

    Most of the time, antibiotics are used in combination with hormonal medication or a retinoid to target cystic acne from multiple angles.

    Just like the other two treatments we’ve listed above, you’ll need to talk to your doctor before you can use antibiotics to treat your cystic acne. Since several different antibiotics all work to treat acne, your doctor will assess your specific case and choose the best option for you.

    Other Treatments

    While facial creams, natural products and other over-the-counter treatments can be useful for treating and preventing normal hormonal acne, most just aren’t powerful enough to get rid of a severe cystic acne outbreak.

    Because of this, it’s best not to look at natural cures and over-the-counter acne treatments as your first line of attack against cystic acne. Instead, stick to proven, FDA-approved medicinal treatments, such as retinoids, antibiotics and hormonal medication.

    With this said, creams, balms and other over-the-counter treatments can be effective for helping your skin recover after a cystic acne outbreak. From dealing with scarring to providing relief from the pain and discomfort caused by cystic acne, these product do have their uses.

    Our guide to hormonal acne lists some of the most common over-the-counter and natural acne treatments, with detailed information on how you can use them to deal with acne outbreaks.

    Learn More About Treating Cystic Acne

    Dealing with cystic acne can be incredibly difficult. Luckily, it’s not something you need to live with forever. From retinoids and antibiotics to hormonal medication, a range of treatments are available to help you get rid of cystic acne for good.

    Our guide to tretinoin and cystic acne explains how you can use topical retinoids to bring your cystic acne under control, often in combination with other medications.

    You can also learn more about preventing, treating and removing cystic acne scars in our guide to cystic acne scar treatments.

    Finally, our guide to hormonal acne covers the hormonal side of acne breakouts, with detailed information on how androgens such as testosterone can affect your body’s sebum production, skin health and acne breakout risk.

    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.