- Cystic acne is an inflammatory skin condition that usually requires treatment by a dermatologist
- It occurs when blockage in a pore extends deep into the skin
- Cystic acne breakouts include red, swollen skin and pus-filled cysts
- Treatment often requires a combination of oral and topical medications, as well as home remedies and good skin hygiene
Cystic acne is most visible and embarrassing when it appears on the face, but breakouts can form on your neck, back, chest and buttocks. Blemishes that look like boils can be painful, and they seldom go away on their own.
Anyone can have cystic acne, but is most common among teenagers. It usually forms on especially oily skin or on skin in which sweat and moisture become trapped by tight clothes. Seeking treatment from a dermatologist at the first signs of cystic acne give you the best chance of avoiding a prolonged and uncomfortable breakout.
What Is Cystic Acne?
Acne is simply the result of pores that become clogged with dead skin cells, oil and bacteria. A typical acne breakout of a few pimples and blackheads can usually be treated easily at home with over-the-counter products and medications. These blemishes lie primarily on the surface of the skin.
But, if the clog in a pore or hair follicle extends down through other layers of skin, the breakout becomes more serious. Cysts push their way to the surface of the skin. The acne-causing bacteria causes an infection, which makes the skin around the cysts swell and redden.
Where is cystic acne most likely to occur?
Cystic acne, like every other type of acne, usually forms on the face. Hormone-triggered acne is often found along the jawline. But the oil glands of the forehead, cheeks, and chin can also produce excess sebum (the oily substance that moisturizes the skin), putting those areas at risk of an outbreak.
Areas that sweat a lot, such as the neck, back and chest, are also vulnerable to cystic acne breakouts. It’s also because these areas are often covered, so oil and sweat can become trapped for long periods in between bathing.
What Causes Cystic Acne?
While the majority of the population experiences some acne in their lives, cystic acne is less common, affecting less than 10% of the people who have acne. It’s not always clear why some people develop this severe type of acne, but there are some established factors.
Changes in hormone levels, such as puberty, menstruation and menopause, can raise the risk of cystic acne flare-ups. Increased levels of certain hormones, such as androgens, cause an increase in your oil glands’ production of sebum, an oily substance that helps moisturize your skin.
Cystic acne is a heritable skin condition, as are other types of acne vulgaris—the clinical term for acne breakouts. If your parents were prone to cystic acne, you face a higher risk. This means a consistent skincare regimen is important, as is a willingness to work with a dermatologist to maintain healthy skin.
Just as naturally occurring hormonal changes can trigger cystic acne breakouts, so too can medications that affect your hormone levels. Acne breakouts are among the possible side effects of corticosteroids, for example, which treat inflammation related to asthma, arthritis, and many other health conditions. Corticosteroids are similar to cortisol, a hormone produced in the body that plays a role in metabolism, immunity, the stress response and other functions.
Other medications that list acne among their side effects include lithium for bipolar disorder and other psychiatric disorders, and bromides, which help treat epilepsy, among other conditions.
Leaving sunscreen and oil-based cosmetics on your skin for long periods can contribute to oil buildup on the surface of the skin and clogged pores.
While sweat can help keep cool your body in hot weather or during a vigorous workout, it can also contribute to clogged pores and bacteria buildup. And if sweat and moisture are trapped on the skin by tight clothing, the risk of an acne breakout is even higher.
Best Cystic Acne Treatments
Severe cystic acne breakouts will almost always require prescription medications for effective treatment. In some cases, antibiotics are needed to kill the bacteria clogging your pores. But dermatologists also have many non-antibiotic treatment options that are proven to be effective in managing severe acne, including prescription-strength medications that can reduce sebum production or speed up the turnover of cells on the surface of the skin.
In its early stages, cystic acne can sometimes be treated with over-the-counter medications, including skin cleansers and lotions containing retinoids, which are derivatives of vitamin A that promote skin cell turnover and even help smooth wrinkles. If you’re experiencing adult acne, retinoids may help you erase some fine lines while also help you achieve clear skin. Over-the-counter products are also helpful in maintaining clear skin after acne flare-ups.
Some commonly used prescription medications include:
A type of retinoid proven to keep cystic acne under control is isotretinoin. It’s available as an oral medication and as a topical spot treatment. A typical course of oral isotretinoin is 16 to 24 weeks, but that schedule can vary depending on your response to the medication. Skin irritation is the most common side effect of topical isotretinoin. Other retinoids, such as trifarotene, can also be effective in treating severe acne.
Acne-causing bacteria can sometimes trigger a bacterial infection that can only be treated with course of oral antibiotics, often then combined with topical acne treatment. Commonly prescribed oral antibiotics include tetracycline, doxycycline, erythromycin, azithromycin, and a combination of trimethoprim and sulfamethoxazole.
Birth control pills
Regulating your hormones with birth control pills can offer women more than effective contraceptive protection. It can help keep your skin clear, particularly if you are prone to hormone-triggered cystic acne, which usually forms along the jawline.
While oral corticosteroids to treat autoimmune diseases, such as lupus, and other inflammatory conditions, can actually raise your risk of acne flare-ups, injecting corticosteroids directly into acne cysts can help reduce them and make acne scars less visible.
Some over-the-counter (OTC) skincare products that are effective for mild-to-moderate acne may help with cystic acne, but usually as part of a broader treatment plan that includes prescription medications and in-office procedures.
Benzoyl peroxide is a microbial agent that helps clear pores and helps reduce the amount of bacteria on the surface of the skin. Along with benzoyl peroxide, salicylic acid, is one of the most widely used acne treatments. It comes in lotions that you use like a cleanser and wash off right after applying and in creams that you can leave on over night. Azelaic acid is available in both foam and gel products, and can be an effective part of a comprehensive cystic acne treatment program.
Home Remedies for Cystic Acne
In addition to following your dermatologist’s advice on medications and undergoing certain procedures to treat cystic acne, some home remedies and lifestyle adjustments may be helpful, too. Usually, cystic acne won’t disappear on its own. However, good skin hygiene practices and other healthy behaviors may go a long way in keeping your skin clear.
Many thoughts about diet’s role in all forms of acne are anecdotal and not well-proven by scientific research. It does appear that eating a high-glycemic diet, rich in white potatoes, white rice, enriched flour and added sugars may increase acne risks.
But whether increasing your intake of vitamin A, omega-3 fatty acids, and other key nutrients offer significant acne protection is still unclear. However, following a diet, such as the Mediterranean diet, which is packed with a variety of fruits and vegetables, whole grains, lean protein sources, and limited amounts of sugar, alcohol, and sodium is associated with overall good health.
Tea tree oil
Applying tea tree oil to acne outbreaks can often help treat moderate acne. But it may also be effective with more severe acne too, especially if it’s part of a broader treatment program. Tea tree oil products are available over the counter and may be used once or twice a day, depending on the concentration.
Does popping cystic acne help?
At the first sign of zits your first impulse may be to pop them and scrub your face. But popping acne cysts may do more harm than you realize. They are signs of a bacterial infection on the surface of the skin and popping them may cause the infection to spread.
Draining the pus and reducing the size of acne cysts can be done effectively by a dermatologist. That’s why it’s important to see a specialist as soon as you can when the first signs of cystic acne appear.
Can You Prevent Cystic Acne?
Certain risk factors for cystic acne are unmanageable. You can’t control your genes or exactly how your body will respond to puberty or menopause or in response to various medications. But there are some steps you can take to at least reduce your risks of cystic acne breakouts.
- Use a gentle cleanser and moisturizer daily to keep your skin clear and healthy.
- Wear clothes that wick away sweat from your skin.
- Rinse sunscreen off thoroughly once you’re out of the sun.
- Don’t leave makeup on overnight.
- See a dermatologist if your usual skin hygiene routine isn’t keeping acne away.
Cystic Acne Scars
Because acne cysts can be both deep and large, the risk of scarring is much higher with this form of acne than with a minor breakout of a few pimples and blackheads. However, several effective treatments for cystic acne scars exist.
- Laser therapy: Using a highly focused laser light, a dermatologist can heat the scar tissue, causing it to evaporate, while also promoting the production of collagen, a substance critical to healthy skin.
- Dermabrasion: A high-speed brush removes the upper layers of damaged skin to allow new, healthy skin cells to take their place.
- Chemical peel: The application of chemicals such as salicylic acid, glycolic acid or lactic acid can help reduce scars primarily on the surface. It is less effective with deeper acne scars.
Coping with cystic acne or even less severe forms of acne can be difficult, both physically and emotionally. Remember, though, that your risk for breakouts may be due to genetics or hormonal changes beyond your control. What you can control, however, is how your usual skin care routine and you respond to early signs of acne breakouts. By seeing a dermatologist before pustules and cysts appear, you may be able to prevent flare-ups and maintain clear skin during those years when cystic acne is most common.
- Tasoula, E., Gregoriou, S., Chalikias, J., Lazarou, D., Danopoulou, I., Katsambas, A., & Rigopoulos, D. (2012). The impact of acne vulgaris on quality of life and psychic health in young adolescents in Greece. Results of a population survey. Anais brasileiros de dermatologia, 87(6), 862–869. doi:10.1590/s0365-05962012000600007
- Tan, J., Thiboutot, D., Popp, G., Gooderham, M., Lynde, C., Del Rosso, J., Weiss, J., Blume-Peytavi, U., Weglovska, J., Johnson, S., Parish, L., Witkowska, D., Sanchez Colon, N., Alió Saenz, A., Ahmad, F., Graeber, M. and Stein Gold, L. (2019). Randomized phase 3 evaluation of trifarotene 50 μg/g cream treatment of moderate facial and truncal acne. Journal of the American Academy of Dermatology, 80(6), pp.1691-1699. jaad.org/article/S0190-9622(19)30335-4/fulltext
- Petridis, C., Navarini, A. A., Dand, N., Saklatvala, J., Baudry, D., Duckworth, M., … Simpson, M. A. (2018). Genome-wide meta-analysis implicates mediators of hair follicle development and morphogenesis in risk for severe acne. Nature communications, 9(1), 5075. doi:10.1038/s41467-018-07459-5
- Leyden, J. J., & Del Rosso, J. Q. (2011). Oral antibiotic therapy for acne vulgaris: pharmacokinetic and pharmacodynamic perspectives. The Journal of clinical and aesthetic dermatology, 4(2), 40–47. ncbi.nlm.nih.gov/pmc/articles/PMC3050614/
- Kucharska, A., Szmurło, A., & Sińska, B. (2016). Significance of diet in treated and untreated acne vulgaris. Postepy dermatologii i alergologii, 33(2), 81–86. doi:10.5114/ada.2016.59146
- Costa, C. S., Bagatin, E., Martimbianco, A., da Silva, E. M., Lúcio, M. M., Magin, P., & Riera, R. (2018). Oral isotretinoin for acne. The Cochrane database of systematic reviews, 11(11), CD009435. doi:10.1002/14651858.CD009435.pub2
- Tan, A. U., Schlosser, B. J., & Paller, A. S. (2017). A review of diagnosis and treatment of acne in adult female patients. International journal of women’s dermatology, 4(2), 56–71. doi:10.1016/j.ijwd.2017.10.006
- Del Rosso J. Q. (2017). Azelaic Acid Topical Formulations: Differentiation of 15% Gel and 15% Foam. The Journal of clinical and aesthetic dermatology,10(3), 37–40. ncbi.nlm.nih.gov/pmc/articles/PMC5367880/
- Malhi, H.K., Tu, J., Riley, T.V., Kumarasinghe, S.P. and Hammer, K.A. (2017), Tea tree oil gel for mild to moderate acne; a 12 week uncontrolled, open‐label phase II pilot study. Australas J Dermatol, 58: 205-210. doi:10.1111/ajd.12465
- Kraft, J., & Freiman, A. (2011). Management of acne. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne,183(7), E430–E435. doi:10.1503/cmaj.090374/
- Connolly, D., Vu, H. L., Mariwalla, K., & Saedi, N. (2017). Acne Scarring-Pathogenesis, Evaluation, and Treatment Options. The Journal of clinical and aesthetic dermatology, 10(9), 12–23. ncbi.nlm.nih.gov/pmc/articles/PMC5749614/