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What causes cystic acne and how to treat it

Acne cysts are often large and painful. Discover what can cause them and what you can do to reduce the risk of scarring.

Curology Team Avatar
by Curology Team
Updated on Jan 26, 2024 • 9 min read
Medically reviewed by Kristen Jokela, NP-C
Cystic Acne
Curology Team Avatar
by Curology Team
Updated on Jan 26, 2024 • 9 min read
Medically reviewed by Kristen Jokela, NP-C
We’re here to share what we know — but don’t take it as medical advice. Talk to your medical provider if you have questions.

Whether you call them zits, blemishes, or pimples, at some point in life, they affect nearly every person. Cystic acne, however, is something different. It’s a more severe form of acne and is often painful, stubborn, and unpleasant.

While you may be tempted to treat these large painful cysts with home remedies, cystic acne responds best to prescription treatment. We asked Curology’s licensed dermatology providers to explain exactly what causes these pimples, some of the potential complications, and the treatments you can use.

What is cystic acne?

Acne vulgaris is the medical term that describes a common acne inflammatory disorder that manifests as pimples, primarily on the face. This is a common skin condition that 95% of people going through puberty experience.¹ Acne develops when oil and dead skin cells clog follicles.² When these lesions become inflamed and swell to at least 5 mm, they’re called cysts and nodules.³

Cystic acne is a type of acne that is associated with a high amount of inflammation.⁴ These more severe cysts and nodules typically occur deep in the skin and frequently cause pain.⁵ Acne occurs more commonly in the teen and adolescent years, but it can also appear in adulthood. However, treating adult acne may take a different approach to management than adolescent acne.⁶

What does cystic acne look like?

Cystic acne includes inflamed and swollen bumps that are at least 5 mm in diameter.⁷ Acne conglobata is a rare form of cystic acne. It presents with interconnecting cysts that are tender and disfiguring. These cysts can appear on the face and other parts of the body, including the shoulders, back, chest, upper arms, buttocks, and thighs.⁸

Why does cystic acne hurt?

The excess oil, dead skin, and bacteria associated with cystic acne can cause inflammation to occur deep within the skin, which can lead to pain and tenderness.⁹

What causes cystic acne?

When facial oil (sebum) and dead skin cells clog a hair follicle, it can rupture the thin wall of the follicle. This can cause bacteria and inflammation to spread to the surrounding area, leading to the formation of nodules and cysts. There are several factors that contribute to the development of acne including:¹⁰

  • Hormones

  • Wearing occlusive items such as headbands and backpacks

  • Oil-based cosmetics

  • Repetitive trauma from scrubbing

  • Genetics

Are there complications?

Cystic acne may lead to several other complications and skin conditions. For example, the severe form of inflammation and swelling can lead to post-inflammatory hyperpigmentation and acne scarring. Acne can also have quality of life and psychological complications, including lower self-esteem, depression, and anxiety.¹¹

How is cystic acne managed and treated?

Unfortunately, there are many misconceptions about what makes acne better and worse.¹² There is a lot of information on the internet, but it’s important to understand what to do and what not to do from skincare professionals so you don’t experience some of the complications that can happen from cystic acne.

Preventing cystic acne from worsening

There are several skincare practices that can be utilized to help prevent acne from getting worse. For example, frequently touching your face can sometimes make acne worse.¹³ It is a good idea to wash your hands before touching your face to ensure you aren’t spreading bacteria. 

It’s also important not to pop or squeeze any cystic pimples. When you squeeze or pop pimples, it’s easy to push some of the pus and bacteria deeper into the skin, which increases inflammation, pain, and the risk of developing scars.¹⁴

When you wash your face, avoid scrubbing your skin because this can irritate the area and cause a flare-up. Instead, use a mild non-comedogenic cleanser that’s formulated to help prevent and treat acne vulgaris, such as Curology Acne Cleanser.¹⁵

Although it may be tempting, do not share anything that you use on your face with your friends or family members, such as makeup. Even if the makeup is non-comedogenic, sharing products can transfer acne-causing bacteria from other people’s skin to yours, which can clog your pores and lead to breakouts.¹⁶

It is also important not to use products that dry out your skin. Acne may cause oily skin, so it might be tempting to reduce the oil until your face feels dry. However, that may irritate your skin and can make your acne worse.¹⁷

Finally, don’t use pore-clogging skincare or hair care products.¹⁸ Take the necessary steps to review the products that you use to be sure they don’t have ingredients that can clog your pores.

How to best treat cystic acne 

Before prescribing cystic acne treatment, your dermatology provider may evaluate the potential for an underlying medical condition, such as polycystic ovary syndrome (PCOS), which can trigger acne due to androgen excess.¹⁹

Your dermatology provider may also review your current skin care regimen. They may discuss the current condition of your skin and things that you have noticed trigger your cystic acne before setting up a treatment plan. 

The healing process and improvement of the skin generally takes at least two to three months after starting the right treatment. Sometimes you need to test several treatments before you begin to see noticeable improvement.²⁰

Your dermatology provider may consider several topical and/or systemic therapy options. The choice of treatment considers the severity of acne, response to prior treatments, and of course, your medical history.²¹

Some of these options include topical treatment that helps reduce skin inflammation and kill P. acnes. If topical antibiotics are prescribed, another topical ingredient may be used to help prevent bacterial resistance.²²

Combination treatment may also be considered, such as topical antibiotics and topical tretinoin.²³ Your dermatology provider may also prescribe oral medications such as oral antibiotics.²⁴ When cystic acne may be associated with hormonal changes, your provider may also recommend hormone therapies, such as oral contraceptives or spironolactone.²⁵

Maintenance therapy may also be considered to reduce the potential for future outbreaks.²⁶ Curology’s Custom Formulaᴿˣ for acne* can help support your skin with a prescription-strength formula that's customized with clinically proven ingredients to help clear acne.

Are there effective home remedies for cystic acne?

Although you can find several at-home remedies for cystic acne on the internet, many are not effective and sometimes can even worsen the condition. Cystic acne is best treated by a dermatology provider. 

However, there have been some studies that have shown that herbal medicines may be beneficial in treating acne. For example, natural substances that have anti-inflammatory activity may help reduce inflammation, such as tea tree oil and aloe vera.²⁷ Topical application of ice may help reduce inflammation and pain. 

It’s important to use mild facial cleansers and gentle moisturizers to prevent skin irritation. Another treatment option is Curology’s Emergency Spot Patch, which can help absorb pus and oil while also concealing blemishes.

The key takeaways

  • Cystic acne is a more severe form of acne that’s typically at least 5 mm in diameter, occurs deep within the skin, and frequently is painful.

  • Cystic acne can happen in adolescents or adults. Hormones and genetics may contribute to the formation of cystic acne.

  • Cystic acne occurs deep within the skin which can lead to pain and tenderness

  • Complications can include severe scarringpost-inflammatory hyperpigmentation, and emotional distress.

  • Cystic acne is best managed by a licensed dermatology provider who can choose either oral or topical prescription-strength products.

Don’t fight your acne alone: Curology can help

While cystic acne is more common during adolescence, it can occur throughout your life. Dermatology providers can offer effective prescription treatments that can reduce your outbreaks and lower the risk of severe scarring and hyperpigmentation. 

Get your personalized skincare routine with Curology

Get your personalized skincare routine with Curology

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Acne treatment is a process that can take several weeks to start seeing results. However, you can get treatment from the comfort of your own home. Don't fight your acne alone—get personalized help from licensed dermatology providers at Curology, who can offer you personalized formulas using evidence-based medications.** 

FAQs

What is the outlook for people with cystic acne?

Although cystic acne can be challenging to manage, there are treatment options available. It is important to remember that it often takes several weeks to months for the condition to respond to the right treatment, and it may require a combination approach.

When should I see a doctor for cystic acne?

Cystic acne is best treated by a medical professional. Your dermatologist or licensed dermatology provider can prescribe effective treatments, and the sooner you begin treatment, the sooner you see results!

Where does cystic acne commonly appear?

Acne commonly appears on the face, but can also appear on the back, shoulders, and chest area.²⁸

Is cystic acne a symptom of something?

In some cases, there is an underlying cause for the development of cystic acne. For example, polycystic ovary syndrome (PCOS) can trigger acne.²⁹ Hormonal changes that occur during puberty³⁰ and menopause³¹ can also be a trigger. It is best to work with your medical provider to explore underlying causes if this is a concern for you.

• • •

P.S. We did the homework so you don’t have to:

  1. Skroza, N., et. al. Adult Acne Versus Adolescent Acne. The Journal of Clinical and Aesthetic Dermatology. (2018, January 1).

  2. Sutaria, A.H., et al. Acne Vulgaris. StatPearls. (2023, August 17).

  3. Heng, A.H.S. and Chew, F.T. Systematic review of the epidemiology of acne vulgaris. Scientific Reports. (2020, April 1).

  4. Sutaria, A.H., et al. Acne Vulgaris. StatPearls. Ibid.

  5. American Academy of Dermatology Association. What Can Clear Severe Acne? (n.d.).

  6. Skroza, N., et al. Adult Acne Versus Adolescent Acne. The Journal of Clinical and Aesthetic Dermatology. Ibid.

  7. Heng, A.H.S. and Chew, F.T. Systematic review of the epidemiology of acne vulgaris. Scientific Reports. Ibid.

  8. Hafsi, W., et al. Acne Conglobata. StatPearls. (2023, June 1).

  9. American Academy of Dermatology Association. Acne: Signs and Symptoms. (n.d.).

  10. Sutaria, A.H., et al. Acne Vulgaris. StatPearls. Ibid.

  11. Sutaria, A.H., et al. Acne Vulgaris. StatPearls. Ibid.

  12. Ražnatović Đurović, M., et al. Adolescents’ beliefs and perceptions of acne vulgaris: A cross-sectional study in Montenegrin schoolchildren. PLOS One. (2021, June 16).

  13. Institute for Quality and Efficiency in Healthcare. Skin care for acne-prone skin. InformedHealth. (2019, September 26).

  14. American Academy of Dermatology Association. 10 Skin Care Habits That Can Worsen Acne. (n.d.).

  15. American Academy of Dermatology Association. 10 Skin Care Habits That Can Worsen Acne. Ibid.

  16. American Academy of Dermatology Association. 10 Skin Care Habits That Can Worsen Acne. Ibid.

  17. American Academy of Dermatology Association. 10 Skin Care Habits That Can Worsen Acne. Ibid.

  18. American Academy of Dermatology Association. 10 Skin Care Habits That Can Worsen Acne. Ibid.

  19. Carmina, E., et al. Female Adult Acne and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. Journal of the Endocrine Society. (2022, February 6).

  20. Sutaria, A.H., et al. Acne Vulgaris. StatPearls. Ibid.

  21. Kraft, J. and Freiman, A. Management of acne. CMAJ. (2011, April 19).

  22. Kraft, J. and Freiman, A. Management of acne. CMAJ. Ibid.

  23. Kraft, J. and Freiman, A. Management of acne. CMAJ. Ibid.

  24. Kraft, J. and Freiman, A. Management of acne. CMAJ. Ibid.

  25. Kraft, J. and Freiman, A. Management of acne. CMAJ. Ibid.

  26. Sutaria, A.H., et al. Acne Vulgaris. StatPearls. Ibid.

  27. Proença, A.C., et. al. The Role of Herbal Medicine in the Treatment of Acne Vulgaris: A Systematic Review of Clinical Trials. Evidence-Based Complementary and Alternative Medicine. (2022, June 15).

  28. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Acne. (July 2023).

  29. Carmina, E. et. al. Female Adult Acne and Androgen Excess: A Report From the Multidisciplinary Androgen Excess and PCOS Committee. Journal of the Endocrine Society. Ibid.

  30. Lynn, D.D., et al. The epidemiology of acne vulgaris in late adolescence. Adolescent Health, Medicine and Therapeutics. (2016, January 19).

  31. Khunger, N. and Mehrotra, K. Menopausal Acne-Challenges And Solutions. International Journal of Women's Health. (2019, October 29).

Kristen Jokela is a certified Family Nurse Practitioner at Curology. She obtained her Master of Science in Nursing at the University of South Florida in Tampa, FL.

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**Cancel anytime. Subject to consultation. Results may vary.

• • •
Our medical review process:We’re here to tell you what we know. That’s why our information is evidence-based and fact-checked by medical experts. Still, everyone’s skin is unique—the best way to get advice is to talk to your healthcare provider.
Curology Team Avatar

Curology Team

Kristen Jokela, NP-C

Kristen Jokela, NP-C

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