What is Cystic Acne? Learn the Symptoms & Treatment Options

Cystic acne is a severe form of pustule that occurs when oil and dead skin cells build up deep within hair follicles, leading to infection and inflammation. This type of pustule is characterized by large, red, and painful breakouts deep in the skin. It can be particularly tough to treat and can lead to scarring if not managed properly.

Key Takeaways:

  • Cystic acne is characterized by large, painful, pus-filled cysts under the skin.
  • Symptoms include large, red, painful bumps deep in the skin, often with pus and significant swelling.
  • Treatments may include oral antibiotics, isotretinoin, hormonal therapy, and corticosteroid injections to reduce inflammation and bacteria.

Symptoms of Cystic Acne

Cystic Acne symptoms

Cystic acne stands out as a severe form of pustules, characterized by deep, inflamed, pus-filled cysts beneath the skin, distinguishing it from other pimple types through its depth, inflammation level, and potential for scarring.

It’s labeled severe due to its propensity to cause significant skin damage, intense pain, and a higher risk of scarring compared to more superficial forms like blackheads or whiteheads, making it a notably challenging condition to manage.

Interesting Fact: Acne affects up to 50 million people in the United States alone, making it the most common skin condition.

Most common causes:

Cystic acne results from a combination of factors, including hormonal fluctuations, excessive sebum production, bacteria presence, and skin inflammation.

Hormonal changes, especially during puberty, pregnancy, or menstrual cycles, can increase oil production in the skin, leading to clogged pores. When these clogged pores become infected with bacteria, particularly *Propionibacterium acnes*, it triggers an immune response, causing inflammation and the formation of deep, painful cysts.

Genetic predisposition plays a role, as individuals with a family history of severe pustules are more likely to experience cystic pustules.

Lifestyle and environmental factors, such as stress, diet, and certain cosmetics, can also exacerbate the condition, further complicating its management and treatment.

Certain medications and chemicals, including corticosteroids, lithium, androgens, can exacerbate or contribute to the development of cystic pustules

Diagnosis and When to See a Dermatologist

See a Dermatologist

When dealing with a persistent, painful, and deep-set pustule, consulting a dermatologist becomes crucial. Unlike milder forms of acne that might respond to over-the-counter treatments, cystic acne’s severity and potential for scarring necessitate professional medical advice.

If you’re experiencing large, painful bumps under your skin that don’t improve with general pimple treatments, or if you’re noticing significant scarring, it’s time to see a dermatologist.

What to expect during a dermatological examination

During a dermatological examination, the dermatologist will thoroughly assess your skin to understand the type and severity of acne you’re experiencing. This examination involves a visual inspection of the affected areas to identify the characteristic cysts of cystic pimples.

The dermatologist may also inquire about your medical history, including any previous treatments, medications you’re taking, and your family’s history of pimples, to gather a comprehensive understanding of your condition.

In some cases, if the diagnosis isn’t clear-cut or if there’s a concern about underlying conditions, further testing may be recommended. For the majority of cases, the physical signs of cystic pimples are sufficient to diagnose the condition and begin a targeted treatment plan.

Treatment Options for Cystic Acne

Treatment for cystic acne involves a multifaceted approach, ranging from over-the-counter (OTC) remedies to more intensive prescription-based interventions, depending on the severity and persistence.

Over-the-counter vs. Prescription Treatments:

OTC treatments, such as benzoyl peroxide and salicylic acid, can be effective for mild acne but often fall short in treating cystic pimples due to their depth and severity. Prescription treatments, tailored by a dermatologist, can more effectively target the underlying causes of cystic pustule with stronger medications that are not available over the counter.

Topical Treatments (Retinoids, Antibiotics):

Prescription topical treatments include retinoids and antibiotics. Topical retinoids, derived from vitamin A, help prevent clogged pores and reduce inflammation, making them a cornerstone in treatment. Topical antibiotics work by reducing the bacteria on the skin that contribute to pustule development, often used in combination with other treatments to enhance efficacy.

Oral Medications (Antibiotics, Isotretinoin):

For moderate to severe cystic acne, oral antibiotics may be prescribed to reduce bacteria and fight inflammation. Isotretinoin, a powerful medication known for its ability to treat severe pustules, is often considered when other treatments fail. It significantly reduces sebum production, but due to its potential side effects, it requires close monitoring by a dermatologist.

Hormonal Treatments (for Women):

Hormonal treatments, such as birth control pills and anti-androgen medications, can be effective for women whose cystic pustule is influenced by hormonal fluctuations. These treatments work by regulating hormones that can contribute to pustules, offering an effective solution for some women.

Procedures (Laser Therapy, Drainage, and Extraction):

Professional procedures can also play a role in treating cystic pustules. Laser therapy helps reduce the bacteria and inflammation associated with pustules, while drainage and extraction procedures can immediately reduce cyst size and alleviate pain, though they must be performed by a dermatologist to minimize the risk of scarring.

Emergency Treatments (Corticosteroid Injections):

For rapid relief of a painful cyst, corticosteroid injections can be administered by a dermatologist. These injections reduce inflammation and pain and significantly decrease the risk of scarring by rapidly shrinking the cyst, making them a valuable option for the immediate treatment of severe cystic lesions.

Potential Complications

acne scars

Cystic pustule, due to its severity, can lead to significant complications that extend beyond the physical symptoms and can lead to long-lasting consequences.

Scarring and Pigmentation Issues

One of the most common complications of cystic acne is scarring. The intense inflammation within the skin can destroy skin tissue, leading to atrophic scars, which appear as indentations in the skin.

Cystic acne can cause hyperpigmentation, leaving dark spots on the skin where the pustule lesions are located. These pigmentation issues and scars are often persistent and may require professional treatment to improve their appearance.

Emotional and Psychological Impacts

The effects of cystic acne aren’t just skin-deep. The condition can have a profound emotional and psychological toll on individuals, affecting self-esteem and confidence. The visibility of pustule and its scars can lead to social withdrawal, anxiety, and depression.

The chronic nature of the condition, along with the challenges of finding effective treatment, can exacerbate these emotional difficulties, highlighting the importance of addressing the psychological aspects of pimples alongside the physical symptoms.

Long-term Skin Damage

Beyond immediate scarring and pigmentation, cystic pustules can result in long-term skin damage. Repeated outbreaks can lead to thicker, coarser skin texture and enlarged pores. Over time, the skin may lose its elasticity and smoothness, leading to premature aging in the affected areas.

This long-term damage underscores the necessity of early and effective treatment to manage cystic pimples and minimize their impact on the skin’s health and appearance.

Prevention Tips for Cystic Acne

Prevention Tips for Cystic Acne

Preventing involves a combination of skincare practices, lifestyle adjustments, and, when necessary, medical intervention. While it’s challenging to prevent entirely due to its ties to hormonal fluctuations and genetic predisposition, these tips can help manage and reduce the risk of severe outbreaks:

Prevention Tip Description
Maintain a Consistent Skincare Routine Use gentle, non-comedogenic skincare products that don’t clog pores. Incorporate a mild cleanser and a moisturizer suitable for your skin type into your daily routine, and consider products with ingredients like salicylic acid or benzoyl peroxide to combat excess oil and bacteria.
Avoid Aggravating the Skin Resist the urge to pick at or pop cysts, as this can worsen the inflammation and lead to scarring. Also, avoid harsh scrubbing or over-exfoliating, which can irritate the skin and exacerbate pustules.
Manage Hormonal Fluctuations For those who notice a link between their pustule and hormonal changes, discussing hormonal treatments with a healthcare provider can be beneficial. Birth control pills or anti-androgens may help balance hormone levels and reduce pimple outbreaks in some women.
Adopt a Healthy Lifestyle A balanced diet low in sugar and dairy has been suggested to benefit some people with acne, though the evidence is mixed. Staying hydrated, getting enough sleep, and managing stress through exercise, meditation, or yoga can also help reduce the severity of pustule outbreaks.
Seek Early Treatment At the first sign of cystic acne, consulting with a dermatologist can prevent the condition from worsening. Early intervention with appropriate treatments can reduce the risk of scarring.
Avoid Certain Medications and Chemicals Be aware of medications and chemicals that may trigger pustule, such as corticosteroids and certain cosmetics. Discuss alternatives with your healthcare provider if you suspect a medication is contributing to your acne.



Can diet affect cystic acne?

Yes, certain foods, especially those high in sugar and dairy, may exacerbate cystic acne in some individuals.

Is it possible to completely cure cystic acne?

While there’s no guaranteed cure, consistent treatment and lifestyle adjustments can significantly manage and reduce symptoms.

Can stress cause cystic acne to flare up?

Yes, stress can trigger or worsen cystic pustules by increasing hormone levels that stimulate oil production.

Are there any natural remedies effective against cystic acne?

Some natural remedies, like tea tree oil, may reduce inflammation and bacteria, but professional treatments are often more effective for cystic pustules.

How long does it typically take for cystic acne treatments to work?

The response time varies, but many treatments may take 2 to 3 months to show significant improvement.


Tackling cystic acne demands a comprehensive approach that combines diligent skincare routines, mindful lifestyle choices, and, when necessary, medical intervention. By understanding the multifaceted nature of this condition—from its deep-seated cysts to the potential for emotional distress—it becomes clear that early action and persistence are key.

While managing cystic pustules might be fraught with challenges, the array of treatment options available today offers hope. Whether it’s through adopting dietary changes, seeking hormonal balance, or exploring advanced dermatological treatments, there is a path forward.

Remember, the goal is not just to treat cystic pustules but to restore confidence and improve quality of life. With patience, knowledge, and the right support, overcoming cystic acne is an achievable goal, paving the way to clearer skin and renewed self-assurance.