Cystic Acne: What Is It, Causes, Treatment and Home Remedies

• Cystic acne is an inflammatory skin condition that occurs when debris and oil buildup  extends deep within pores
• Cystic acne presents as red, inflamed skin and pus-filled cysts
• Effective treatment typically involves a combination of prescribed oral and topical medications

Cystic acne is a severe form of acne that develops when blocked pores become inflamed and infected. This infection penetrates deep into the skin and causes pus-filled cysts to form. Cystic acne breakouts can develop on the face, neck, back, chest and buttocks. 

These cysts are tender and painful, and can cause extensive scarring if left untreated; the attention of a professional is necessary for effective treatment. 

What Is Cystic Acne?

Cystic acne results when pores become clogged with dead skin cells, sebum (an oily substance secreted by sebaceous glands in the skin) and Cutibacterium acnes (formerly Propionibacterium acnes) bacteria.

The resulting infection affects the tissue underneath and around the pores that are affected. Pus-filled cysts form in the deeper layers of skin and are painful to the touch. If they burst, the infection then spreads which causes greater inflammation.

Cystic acne is typically treated with combination therapy that includes topical and oral medications to target bacteria and reduce inflammation.

Where is cystic acne most likely to occur?

Cystic acne can develop anywhere on the body but typically forms on the face, neck, back, shoulders and chest. These are the areas that have greater concentrations of sebum-producing glands. 

What Causes Cystic Acne?

Cystic acne is a result of the same factors that cause milder forms of acne. The main differences are its severity and that the infection is beneath the skin, not at the surface level. 

Science believes that it is a combination of factors that cause cystic acne including hormonal fluctuations and genetics. Mild acne can also progress to cystic acne if left untreated.

Genetics

Genetics have a strong influence over whether or not you develop acne. Clinical studies support this theory; one study of twins found 81% of acne cases were due to a genetic component. These could include the tendency to have oily skin, to overproduce skin cells or to have a weak response from the immune system when C. acnes is present. All are leading causes of acne. 

Hormones

At various stages in life such as puberty, pregnancy and menopause, fluctuations in hormones can have a detrimental effect on skin. 

In particular, dysregulation of androgen production causes an increase in sebum production which increases the risk of acne developing. Decreases in estrogen levels can also produce the same result. 

Medications

Known as drug induced acne, some medications can have an adverse effect on hormone levels, resulting in acne breakouts. Corticosteroids which treat inflammation related to conditions such as asthma, allergies, and arthritis are one such example. 

Other medications that list acne among their side effects include lithium for bipolar disorder and bromides, which help treat epilepsy.

Skin hygiene

While most causes of acne lie beneath the skin’s surface, there are some behaviors that can increase the risk of developing cystic acne such as:

• Improper face washing techniques; overscrubbing, washing too often or not enough
• Using comedogenic products, which are more likely to cause blockage in pores
• Sharing makeup, makeup brushes and applicators, which spreads bacteria
• Touching your face, which also spreads bacteria

Best Cystic Acne Treatments

Cystic acne is a severe form of acne, and therefore requires prescription medications to be effectively treated. 

Combination therapy is a standard acne treatment when treating severe acne and typically includes an antibiotic alongside another medication for greater benefits. and to avoid antibiotic resistance. Some of the most commonly used oral and topical prescription medications are as follows.

Antibiotics

Antibiotics are required to kill acne-causing bacteria and reduce the accompanying inflammation. Commonly prescribed oral antibiotics include tetracycline, doxycycline, erythromycin, azithromycin and a combination of trimethoprim and sulfamethoxazole. 

Along with the antibiotic, a corticosteroid such as hydrocortisone may be prescribed to reduce the redness, pain and swelling of cystic acne.

Birth control pills

Regulating hormones with birth control pills will in turn reduce or eliminate acne breakouts.

Three types of oral contraceptives are FDA-approved for treating acne. Each type contains a low dose of the same form of estrogen but with different types of progestin. 

• Estrostep contains estrogen and norethindrone 
• Ortho Tri-Cyclen combines estrogen and norgestimate
• YAZ has estrogen and drospirenone

Isotretinoin

Isotretinoin is a retinoid that remains the cornerstone of acne treatment as it delivers significant results. Typically prescribed for moderate-to-severe acne and for treatment-resistant acne, it is prescribed for 4–6 months.

Patients on this medication are followed closely to monitor for short-term and long-term adverse physical, and psychological adverse events.

Steroid injections

While oral corticosteroids to treat autoimmune diseases can actually increase the risk of acne developing, injecting corticosteroids directly into large acne cysts are effective in reducing their size, and lowers inflammation and pain within several days.

Over-the-counter options

Over-the-counter (OTC) products are not effective on their own to treat cystic acne but can be used alongside prescription medications to soothe uncomfortable symptoms and provide a better outcome.

Benzoyl peroxide is a powerful antibacterial that is available in many forms including cleansers, gels, foams and spot treatments. It can help reduce acne-causing bacteria and clear pores of debris. It is very commonly used alongside prescription medications as combination therapy.  

Azelaic acid is another antibacterial that is very effective against C. acnes and is available in both foam and gel products. It can be an important component of a comprehensive cystic acne treatment program.

Home Remedies for Cystic Acne

While cystic acne requires professional attention, employing some home remedies and lifestyle adjustments can add an additional layer of support to your treatment plan.

Diet 

There is evidence that eating a high-glycemic diet that includes white rice, potatoes and flour can increase the incidence of acne. 

To avoid this, opt for a diet rich in fruits, vegetables, lean proteins and whole grains rich in vitamin A and omega-3 fatty acids which can all support healthy skin.

Tea tree oil

Tea tree oil contains antimicrobial and antibacterial properties that can treat mild-to-moderate acne. While it can’t eliminate the more severe cystic acne, it can still provide the same benefits as part of a broader treatment program.

Tea tree oil skin care products are available OTC and can also be purchased in its pure form; it must be first diluted before applying to the skin. 

Does popping cystic acne help?

As cystic acne is present below the skin, it is not possible to pop the cysts. That being said, touching or squeezing inflamed areas can spread the bacteria beneath the skin and worsen the condition.

Draining the pus and reducing the size of acne cysts should be addressed by a dermatologist.        

Can You Prevent Cystic Acne?

There are some steps you can take to reduce your risks of cystic acne.

• Use gentle, noncomedogenic skin care products to avoid clogging pores
• Use a chemical exfoliant, such as alpha hydroxy acid (AHA) to remove dead skin cells and reduce oiliness
• Wash your face of sunscreen once indoors and remove any residue with a gentle,  alcohol-free toner
• Don’t leave makeup on overnight
• See a specialist at the first signs of acne to receive treatment and prevent it from becoming more severe   

Cystic Acne Scars

Because acne cysts can be both deep and large, the risk of scarring is much greater with this form of severe acne than with mild. This is why it is important to start treatment as soon as possible in order to avoid extensive scarring.

Several effective treatments are available for cystic acne scars:

• Laser therapy: A highly focused laser light can reduce the appearance of deep scars by  stimulating collagen production to fill in depressed areas and create a smoother surface
• Microdermabrasion: A high-speed brush removes the upper layers of damaged skin, promotes collagen production and reveals new, healthy skin cells
• Chemical peel: The application of chemicals such as salicylic, glycolic or lactic acid can help reduce the appearance of mild-to-moderate scars

Takeaway                                 

Cystic acne is a severe form of acne that penetrates deep into the skin. This acne results from a buildup of dead skin cells, sebum and C. acnes bacteria that clogs pores and results in painful, inflamed cysts. 

Therapy focuses on treating existing breakouts and preventing future ones from developing. If left untreated, deep scars can form.

Treatment typically includes an antibiotic paired with another medication, based on your specific circumstances and your physician’s judgment. These include prescription topical treatments, birth control pills and injectable corticosteroids. 

In-office treatments such as laser therapy and chemical peels can be effective in addressing scarring that often accompanies cystic acne.