June 2022

Cystic Acne – Causes, Symptoms, Treatment Options

Teenage girl twisted her face

Of the millions of people around the world suffering from acne, those with cystic acne are the most likely to scar. The good news is that the condition isn’t as common as its other types. If you want to learn more about what causes cystic acne, what symptoms you can expect, and the treatment options that are made available to patients, stick around.

What Is Cystic Acne?

Cystic acne is a type of acne vulgaris (inflammatory acne) that causes painful bumps filled with pus, bacteria, excess oil, and dead, dry skin cells. According to the American Academy of Dermatology Association, the zits appear as red, crusty lumps under the skin. They can be as big as a dime and as small as a pea. It typically affects people with plenty of oil glands.

Aside from the face, people can get cystic acne on their back, neck, shoulders, chest, butt, and upper arms. The condition is usually diagnosed by a licensed dermatologist or wellness professional.

Cystic Acne Causes & Risk Factors

Cystic acne is associated with the presence of a microbe called Propionibacterium acnes on the skin surface. The breakouts occur when hair follicles, impurities, bacteria, oil, and dead skin cells clog pores.

Risk factors include:

Hormonal changes. Hormonal changes related to stress, menopause, pregnancy or puberty can trigger acne flare-ups of any kind, including cystic pimples. For example, androgen hormones such as testosterone affect oil glands in women.

Age. We all know that teenage boys and girls develop acne more easily than adults. But even though breakouts are supposed to end with puberty, this isn’t always the case. Adult acne is a thing.

Genetics and family history of acne. If one or both of your parents had cystic acne at some point in their lives (or are still dealing with it), your odds of developing cystic acne are greater.

Cystic Acne Complications

The most common complications from acne cysts are bacterial infections of the skin and scars.

Bacterial skin infections

When pimples get infected, this triggers an immune response leading to more inflammation and infection (cellulitis) to the skin. As a result of this, painful pimples form under the skin. They are referred to as blind pimples.

Cellulitis can occur in any part of the body. The term should not be confused with cellulite – a harmless condition that is a cosmetic rather than a medical concern.

Skin infection is likely to happen when the cystic (or nodular) zits are popped. It is more difficult to treat. The process takes a while and usually involves a course of antibiotics. To help with the symptoms, NSAIDs can be prescribed as well.


Woman with acne

Scarring is a common complication resulting from acne. Any pimple has the potential to turn into a scar when the right circumstances are met. However, it is more prevalent in people with cysts and nodules because these types of spots can cause damage to adjacent parts of the skin.

Three main types of acne scars are known:

  • Boxcar scars: depressions in the skin that come with an oval or round shape
  • Rolling scars: indentations in the skin with sloped sides that give it an undulating appearance
  • Ice pick scars: deep holes into the skin that have a sunken appearance

How to Treat Cystic Acne

Benzoyl peroxide. This is a topical skin ointment that works for all types of acne but is an excellent choice for acne cysts and other types of inflammatory pimples. It works by reducing the acne-causing bacteria, which also decreases bacterial resistance to antibiotics. The cystic acne treatment is most effective when combined with other medications.

Azelaic acid. This is a topical cream that offers anti-inflammatory and antibacterial properties. It penetrates the skin and unclogs existing blockages.

Topical antibiotics. They come in the form of saturated pads, gels, and lotions that are applied to the skin. The most used topical treatments of this kind are clindamycin and erythromycin. Peer-reviewed studies suggest their potency is limited to severe acne vulgaris and has no effects on non-inflammatory acne.

Topical retinoids. Retinoids come in the form of vitamin A-derivatives. They work by speeding up the shedding of dead skin cells, regulating sebum production, and clearing the skin’s surface. They may not be able to clear severe acne on their own and had better be paired with other acne treatments.

The only exception is isotretinoin. It’s used as a last resort when everything else has failed. Many patients experience a permanent clearing of their skin with this acne treatment; however, it can have certain side effects and should be employed with your doctor’s guidance.

Spironolactone. This treatment can work for comedones and cystic acne. It’s an oral medication that is prescribed to women of all ages, especially those in their 20s-30s, as well as menopausal women.

Oral contraceptives. Some, but not all, birth control pills can help fight acne outbreaks. Talk to your board-certified dermatologist and OB-GYN to find out which oral medications will work for you.

Salicylic acid, glycolic acid, and alpha-hydroxy acids are great as the first line of acne treatment. They all work in the same manner by freeing dead skin cells from the pores, allowing them to shed faster. That being said, salicylic acid, in particular, may not be the best option for acne cysts, let alone severe acne. It depends on the case.

Cystic Acne Home Remedies and Spot Treatment for Clear Skin

Cystic Acne Home Remedies

  • Probiotics. There is a well-known link between the gut and the skin’s health, which is why many folks believe you should step up your gut health game. Taking probiotic supplements can be beneficial for your whole body. Foods that are high in natural probiotics include kefir, miso, kimchi, sauerkraut, kombucha, etc.
  • Diet changes. Some people suggest eliminating dairy products from your diet for an entire month to see if there is an improvement in your acne flare-ups
  • Aspirin mask. Some people believe in crushing an aspirin tablet and mixing it with water to form a paste. The concoction is then applied directly to the pimples. This is supposed to reduce inflammation and pain. However, you should keep in mind that aspirin could irritate the skin; not to mention, it should not be used when an allergy to salicylates is present.
  • Turmeric mask. Turmeric is notorious for its antiseptic and anti-inflammatory properties. Some proponents of this method advise slathering a paste of turmeric and water onto the face and leaving it on for 45 minutes. Once the time is up, proceed to rinse your face with lukewarm water.
  • Ice. Rubbing ice on the pimples until you feel cold can help minimise cystic acne breakouts. It does not treat severe acne, though.
  • Tea tree oil. Other folks are proponents of tea tree oil due to its anti-inflammatory and antimicrobial properties. There is no medical evidence that this works.
  • Vinegar cleanser. Vinegar too has antibacterial properties, which is why cleansing your skin with diluted vinegar once or twice a day could help prevent future breakouts. Please note that it won’t treat acne, and it can make your skin red.
  • Address any health conditions that may be causing acne flare-ups

How to Prevent Cystic Acne

  • Always remove your makeup before going to bed
  • Opt for non-comedogenic facial products
  • Wash your face with a mild foaming cleanser; do not use any aggressive products or tools
  • Wash your face after excessive sweating and exercising
  • Do not touch or pop your pimples to prevent scarring; otherwise, you may push the infection deeper into the skin, helping it spread further
  • Try not to touch your face during the day
  • Use an oil-free moisturiser with hyaluronic acid, niacinamide, or ceramides because these ingredients work to restore the skin’s protective barrier and reduce inflammation and redness
  • Wash your hair regularly to avoid excess oils from finding their way onto the face
  • Avoid certain foods that trigger severe acne flare-ups, such as dairy products and sugars; stay away from fast food
  • Avoid sun overexposure as this can worsen acne; not to mention, it may harm your skin health, leading to skin cancer
  • Keep your hormone levels in check

Woman cleaning face with makeup remover


What triggers cystic acne breakouts?

There is a slew of factors that contribute to cystic acne breakouts, including the likes of pregnancy, menstruation, and menopause. In other words, hormonal fluctuations are to blame for pimples. Women with certain medical conditions – e.g. polycystic ovarian syndrome (PCOS) – are also more susceptible to getting cystic acne.

Can I pop cystic acne?

It’s not recommended that you pop your pimples. You should leave them alone, however tempting it is to squeeze them. Even touching the pimple can transfer more bacteria onto the area, making acne worse and slowing down the healing process. This could result in scarring.

Why do I keep getting cystic acne on my chin?

According to research, most of the time, acne on the chin is caused by hormones that stimulate excess oil production. If you have oily skin, this can exacerbate the situation further.

How do I get rid of a cystic pimple on my chin?

There are different tricks you can try to make a pimple go away, like dabbing 2% benzoyl peroxide on the spot to kill bacteria, applying ice to the area, or cleansing your face with a pH-balanced facial product. If this fails, you can consult a board-certified dermatologist on some effective acne treatments that the cosmetic industry has to offer.

How long does cystic acne on the chin last?

Cystic acne flare-ups can take one to four weeks to clear on their own.

Will scarring develop?

As they heal, severe acne cysts can leave permanent scars. This is more likely to happen if you tend to pick your pimples rather than leaving them alone. On that note, some people never develop scarring, so you may just be more predisposed to this.

Does severe acne vulgaris go away?

A severe type of acne can be successfully treated with a combination of methods, from diet changes to cosmetic procedures and products.

Does removing dead skin cells prevent acne?

Removing dead skin cells helps to keep your acne breakouts in check, but it will not cure your condition. It’s still recommended that you use mild cleansing agents that get rid of dead skin cells and impurities from the pores, as this will keep your skin clean.

Why do I get pimples during my menstrual cycle?

About a week before you get your period, there is an increase in your progesterone levels, which ups sebum production. This can result in clogged pores, and that’s how you get blemishes on your face.

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