Cystic Acne

Medically Reviewed By William C. Lloyd III, MD, FACS
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What is cystic acne?

Cystic acne is a form of nodular acne, which is a type of acne vulgaris. Acne has two broad categories: non-inflammatory and inflammatory. Blackheads and whiteheads fall under the non-inflammatory column. On the other hand, inflammatory acne consists of pimples, nodules and cysts. Nodules are large, hard, painful lumps that form deep in the skin. Cysts are tender pus-filled lesions that feel softer than nodules.

All acne begins in the skin’s pores. Pores are openings that contain a hair follicle and a sebaceous, or oil, gland in the bottom. Sebum is the name of the oil the gland secretes. Its purpose is to moisturize the skin. The oil also cleans the pore by carrying dead skin and debris up and out of the pore as it goes. In acne, oil and debris become trapped in the pore. They form a plug, which clogs the pore and blocks the opening. In inflammatory acne, Cutibacterium acnes bacteria also become trapped in the pore. This triggers the inflammation.

Cystic acne on chin, jaw, face and neck skin is common. It can also frequently affect the chest, shoulders, and upper back.

Acne is the most common skin condition in the United States. Almost everyone will experience an acne breakout at some point. Teenagers and young adults are most likely to have breakouts, but they can occur at any age. In the majority of cases, acne is minor. Cystic acne is the most severe form of acne, but it is also the least common. The risk of developing cystic acne is higher if you have a parent who had it.

Experts do not fully understand why acne happens. For cystic and nodular acne, there are four contributing factors: bacteria, clogged pores, excess oil production, and inflammation. But it remains unclear why some people develop cystic acne and others do not.

Acne, including cystic acne, appears to be hormonal to some extent. It tends to happen or worsen when hormone levels are changing, such as during adolescence and menstruation.

Both nodular and cystic acne treatment require a dermatologist’s expertise. Prescription treatments are necessary, including oral antibiotics, retinoids, and hormonal therapies. Sometimes, other doctors recommend procedures, such as injecting medications into the cysts or draining them.

Scarring and pitting are complications of cystic acne. There are treatments available to help improve the look and texture of scarred skin. Treating cystic acne and its scars can have mental and emotional benefits as well.

What are the symptoms of cystic acne?

Cystic acne tends to affect body parts with a high concentration of oil glands. This includes the face, neck, chest, upper back, and shoulders.

Acne cysts are the main symptom. These cysts are pus-filled lesions that are deep within the skin. They are not as hard as nodules, but are painful like nodules. They also trigger a strong inflammatory response. So, the skin over the cyst is usually red and swollen.

Cystic acne can resemble other skin conditions. Consulting a dermatologist can ensure you get an accurate diagnosis. Dermatologists are doctors with expertise on how to treat cystic acne. They can most effectively treat cystic acne. In general, the earlier you see this skin specialist, the better. But it is never too late to seek care for cystic acne.

What does cystic acne look like?

Cystic acne lesions are deep within the skin. They are filled with pus, a combination of bacteria, oil, and dead skin cells.

Acne cysts on a young woman's chest and jaw line:

acne on young woman's chest or decolletage
Getty


Close-up of cystic acne and other types of acne on a woman's cheek, chin and jaw line:

Close-Up Of Young Woman With Acne On Face
Getty

What causes cystic acne?

Acne vulgaris happens when skin pores clog with oil, dead skin and debris. The presence of bacteria in the blocked pore contributes to inflammation. Nodules can form when deep pimples surround a hair follicle. Sometimes, the nodule encompasses more than one hair follicle. Cysts occur when the nodule fills with pus.

The reason some people develop cystic acne and others do not remains unclear. Experts believe several factors likely play a role, including hormone levels and genetics. Androgen hormones, in particular, may be to blame. These hormone levels rise during adolescence, which increases oil production and skin cell turnover. Genetics may cause some people to overproduce oil or be unusually sensitive to normal skin bacteria.

What are the risk factors for cystic acne?

A number of factors increase the risk of developing cystic acne. Not all people with risk factors will get cystic acne. Risk factors for cystic acne include:

  • Age: Although you can develop acne at any age, cystic acne is most common in teenagers and young adults.

  • Certain medications: Examples include corticosteroids, lithium and phenytoin.

  • Diet: A high-carbohydrate or high-glycemic diet may contribute to acne breakouts, according to some research.

  • Heredity: People with a parent who had cystic acne are more likely to have problems with it as well. 

  • Skin environment: Greasy or oily skin products, tight or occlusive clothing, high humidity, excessive sweating, and friction or pressure on the skin can contribute to acne breakouts. 

  • Stress: Stress can be a trigger for breakouts or worsen existing breakouts in people who already have acne.

Reducing your risk of cystic acne

It is not possible to completely prevent or avoid acne, including cystic acne. However, there are steps you can take that may help control triggers and breakouts including:

  • Avoiding scrubbing your skin, abrasive or alcohol-based cleansers, and greasy or oily skin products

  • Keeping your hands off your face and not squeezing pimples. Picking at acne causes more irritation, which can worsen the breakout, and increases the risk of scarring.

  • Quitting smoking

  • Shampooing your hair daily if you have oily hair

  • Washing your face with a gentle cleanser and lukewarm water twice a day and after heavy sweating. Do not wash it excessively, as this can cause irritation and worsen a breakout.

If you are at risk of cystic acne or notice it developing, see a dermatologist early. There may be other ways to help control triggers and minimize breakouts.

What are the diet and nutrition tips for cystic acne?

There is no specific “acne diet” that will help clear pimples, nodules and cysts. However, some research seems to indicate that certain foods can trigger breakouts. The link to foods and acne is inflammation. Some kinds of foods can stimulate inflammation in the body. This, in turn, may lead to breakouts or worsening of breakouts.

Foods that researchers have studied and found a potential link to acne breakouts include:

  • Cow’s milk, including fat-free milk and milk that contains fat. Milk-based dairy products, such as yogurt, do not seem to lead to more breakouts.

  • High-glycemic foods and beverages, such as white bread, white rice, potatoes, fries, chips, sweets, and sugary beverages 

Small studies have also found that eating low-glycemic foods may reduce acne breakouts. This includes eating fresh vegetables, most fresh fruits, whole grains, beans and legumes.

If you think your diet may be contributing to your acne, talk with your doctor. You will need to try eliminating one food type at a time and keep a diary to track your breakouts. This can help you and your doctor identify a link if one is there. Be sure to give up the food for enough time to see a difference, perhaps up to a month.

How do doctors diagnose cystic acne?

A dermatologist can diagnose acne by examining your breakouts. Your doctor may also ask you several questions about your symptoms including:

  • When did you first start having breakouts?

  • Are the breakouts only on your face or are they on other parts of your body?

  • What, if any, breakout triggers have you noticed?

  • Is your acne affecting your social life or self-esteem?

  • What treatments have you tried?

  • What medications do you take?

  • What skin and hair care products do you use, including soaps, cleansers, lotions, moisturizers, sunscreens cosmetics, and shampoo and conditioner?

  • Do you have a family history of acne?

  • Do you take oral contraceptives or use another form of hormonal birth control?

  • Are your menstrual periods regular and is there any chance you could be pregnant?

What are the treatments for cystic acne?

You cannot treat cystic acne on your own. Over-the-counter treatments are not strong enough to clear it. Instead, you need to see a dermatologist for prescription treatments.

Prescribed treatment options

Potential treatment options for cystic acne include:

  • Oral antibiotics in combination with topical therapy. Common regimens include doxycycline, erythromycin, minocycline or tetracycline, with tretinoin (Retin-A) or tazarotene (Tazorac). It can take up to 12 weeks to see the full benefit of oral antibiotics. After acne is under control, doctors will gradually decrease the dose to the lowest effective dose. The goal of treatment is to maintain control with topical medicines alone and avoid long-term use of oral antibiotics.

  • Oral contraceptives. Women with cystic acne may benefit from this hormonal therapy. Oral contraceptives are effective in treating both inflammatory and non-inflammatory acne. An alternative is the antiandrogen spironolactone (Aldactone).

  • Oral isotretinoin (Amnesteem, Claravis, others). This retinoid vitamin A derivative is very effective at treating cystic acne. However, it can have serious side effects, such as depression and severe birth defects. Doctors usually prescribe it when other treatments do not produce results. People who take this medication must participate in a monitoring program. This includes a requirement for women of childbearing age to use two methods of contraception for one month before treatment, during treatment, and for one month after treatment is complete. The course of treatment lasts between 16 and 20 weeks.

  • Steroid injection with triamcinolone acetonide solution

Draining the cysts may be an option, but this approach can lead to scarring.

Home remedies for cystic acne

While cystic acne requires professional treatment, there are home remedies for acne, including cystic acne, that help in preventing or reducing breakouts. These include:

  • Avoiding scrubbing your skin, abrasive or alcohol-based cleansers, and greasy or oily skin products

  • Keeping your hands off your face and not squeezing pimples. Picking at acne causes more irritation, which can worsen the breakout, and increases the risk of scarring.

  • Quitting smoking

  • Shampooing your hair daily if you have oily hair

  • Washing your face with a gentle cleanser and lukewarm water twice a day and after heavy sweating. Do not wash it excessively, as this can cause irritation and worsen a breakout.

How does cystic acne affect quality of life?

Having acne can affect your quality of life. Research shows that even mild acne can decrease quality of life. These effects become more pronounced as the severity of the acne increases. Anxiety, depression, and low self-esteem all increase with more severe acne, such as cystic acne. Body image also suffers in proportion to the severity of the acne.

Studies also suggest that acne is more likely to have an impact on emotions and quality of life when it lasts a long time. This underscores the importance of seeking treatment early from an experienced dermatologist. Early treatment may also help prevent acne from worsening and causing scarring, which further impacts quality of life.

What are the potential complications of cystic acne?

In addition to the emotional issues that affect quality of life, physical complications can occur with cystic acne, namely, scarring and skin discoloration. When cystic acne scars, it can form deep pits in the skin. Keloid scars—thick, discolored scars—can also form.

Taking care of cystic acne scars

The best strategy for scars is prevention with effective treatment. But if scars develop, dermatologists have several options to improve their appearance. Options for scar treatment include:

  • Chemical peels
  • Dermabrasion
  • Laser resurfacing
  • Skin grafting, which involves removing the scar by taking a “punch” of skin and replacing it with donor skin from another area

If you have scarring from previous acne breakouts, talk with your dermatologist about your options. Find out which one is right for you based on the severity and discoloration of your scars.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Sep 1
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