Cystic Acne

What is cystic acne?

Cystic acne is a type of inflammatory acne that causes painful, pus-filled pimples to form deep under the skin. Acne occurs when oil and dead skin cells clog skin pores.

With cystic acne, bacteria also gets into the pores, causing swelling or inflammation. Cystic acne is the most severe type of acne. Acne cysts are often painful and more likely to cause scarring.

What’s the difference between an acne cyst and an acne nodule?

Nodular acne and cystic acne are very similar. Both cause deep, painful bumps under the skin. And both can scar. Differences include:

• Acne cysts are filled with pus, a fluid.
• Acne nodules are more solid and harder than acne cysts because they don’t contain fluid.

What causes cystic acne?

Pores in the skin can clog with excess oil and dead skin cells, causing pimples. Bacteria can enter the skin pores and get trapped along with the oil and skin cells. The skin reaction causes swelling deep in the skin’s middle layer (the dermis). This infected, red, swollen lump is an acne cyst.

Cystic acne causes include:

• Age (teenagers are more prone to cystic acne).
• Family history of cystic acne.
• Hormone changes during the teenage years and sometimes during menopause, and stress.

What does cystic acne look like?

Acne cysts resemble boils, a type of skin infection. An acne cyst may be:

• A red lump under the skin.
• Painful or tender to touch.
• Small as a pea or big as a dime.
• Oozing pus from a whitish-yellow head.
• Crusty.

Where do acne cysts develop?

A cystic acne breakout may cover a large area of skin. Cystic acne tends to appear on the face, which has a lot of oil glands. But you can also get acne cysts on your:

• Back.
• Butt.
• Chest.
• Neck.
• Shoulders.
• Upper arms.

How is cystic acne diagnosed?

A dermatologist, a doctor who specializes in skin conditions, can examine your skin and make a cystic acne diagnosis.

How is cystic acne managed or treated?

Acne cysts can be difficult to treat. Because they can scar, you should seek help from a dermatologist instead of trying over-the-counter acne products. A dermatologist can teach you how to treat cystic acne.

It can take three months or more to clear up acne cysts. Treatment often involves taking oral antibiotics and applying prescription-strength topical gels or creams to the skin.

Cystic acne treatments include:

• Antibiotic creams, gels solutions and lotions to kill bacteria and decrease inflammation.
• Azelaic acid (Azelex®, Finacea®) or salicylic acid to kill bacteria and get rid of excess dead skin cells.
• Benzoyl peroxide to reduce the number of bacteria on the skin.
• Retinoids (adapalene, tretinoin, tazarotene among others), vitamin A derivatives that help slough dead skin cells.

What are other cystic acne treatments?

Other treatments for cystic acne include:

• Corticosteroid injections: Used to quickly shrink large, painful acne cysts.
• Incision and draining: Helps to open up an acne cyst and drain the pus.
• Birth control pill or spironolactone: Used by women to lower hormone levels that cause cystic acne.
• Isotretinoin: An oral retinoid (most commonly called Accutane).

What are the complications of cystic acne?

Opening up acne cysts — by popping or picking them — increases the risk of scarring and bacterial skin infections like cellulitis.

Some people develop pigment changes (light or dark) spots at the site of the acne cyst after the skin clears up. These spots may be pink, purple, red, black or brown. They eventually fade away, but it may take more than a year.

How can I prevent cystic acne?

You can lower your risk of getting acne by taking these steps:

• Use a mild foaming facial cleanser, lukewarm water and your fingers (not a washcloth or sponge) to wash your face after you wake up, before going to bed and after exercising or sweating.
• Apply oil-free moisturizer if you feel dry.
• Use noncomedogenic (water-based) makeup and facial products.
• Don’t sleep in makeup.
• Keep your hands away from your face during the day.
• Don’t pick at or pop pimples or scabs.
• Wash your hair regularly and keep hair (which can be oily) away from your face.
• Occasionally oily environments, such as working at a fast food restaurant, can contribute to acne flares.
• Diets high in simple sugars and dairy, also called a high glycemic index diet, may contribute to flares as well.

What is the prognosis (outlook) for people who have cystic acne?

Most people with cystic acne can prevent severe breakouts or quickly treat acne cysts to prevent scarring. Often, but not always, cystic acne clears up or diminishes with age, as hormones settle down.

Severe or untreated cystic acne can affect how you feel about your appearance, making you anxious or depressed. If cystic acne bothers you, talk with your healthcare provider about getting help with fostering a positive self-image.

When should I call the doctor?

You should call your healthcare provider if you experience:

• Swollen, red, painful pimples.
• Acne or scarring that makes you feel self-conscious.
• Signs of a skin infection.

What questions should I ask my doctor?

You may want to ask your healthcare provider:

• What causes cystic acne?
• What is the best cystic acne treatment?
• What are the treatment side effects?
• How can I lower my chances of getting acne cysts?
• How can I prevent scarring or other complications?

A note from Cleveland Clinic

It’s tempting to want to touch or pick at painful, swollen acne cysts. But cystic acne is more likely than other zits to scar or develop infections. A dermatologist can offer suggestions to prevent cystic acne. This doctor can also treat painful acne cysts, lowering the chances of scarring. Antibiotics and topical (skin) creams are effective cystic acne treatments.