What is Cystic Acne – and What’s the Best Way to Treat It?

by | Updated: September 3rd, 2022 | Read time: 4 minutes

The only thing worse than getting a blemish is breaking out with repeat blemishes – in the same area. Recurrence is common with inflammatory acne, also known as cystic acne, which involves red, swollen, painful lumps deep below the skin’s surface. If you suffer from cystic acne, you’ve likely tried endless remedies to prevent it and treat it. Here, a dermatologist weighs in with effective and realistic help.

Woman Examining Face in Mirror to See if She Has Cystic Acne

What is cystic acne?

Cystic acne is characterized by lumps under the skin, known as nodules or sebaceous cysts, that can be incredibly difficult to treat.

Due to the size of the cysts and accompanying swelling and redness, cystic acne isn’t easily concealed with makeup. Nor is it possible to “pop” these blemishes manually (as you might do with a whitehead) to relieve swelling or pain. In fact, pressing on or squeezing cystic acne exacerbates the condition and increases risk of infection, which can spread to other areas of the face and result in more breakouts.

While cystic acne can be aggravating, patience and willpower are important, along with the right topical treatments to target inflammation and speed healing. Take note: cystic acne can last for weeks or even months, and if cysts do open, healing can be delayed and scarring may occur. Having a treatment plan in place is key to avoiding extended issues with this type of acne.

What causes cystic acne?

Oil and dead skin cells naturally accumulate on skin, and when you don’t cleanse or exfoliate enough, or when sebum or oil production is increased, excess buildup clogs hair follicles and can trigger cystic acne.

Cystic acne may present during puberty or adulthood, especially once you’ve reached the age of 30, when “adult acne” may form as a side effect of hormonal fluctuations or medications, like corticosteroids, testosterone or lithium. Environmental factors, such as stress, diet and lifestyle, also play a part.

“Cystic acne involves pus-filled cysts forming very deep in the middle layer of the skin, which leads to swelling and inflammation that tends to be severe,” says Dr. Nadir Qazi, DO, board-certified physician, cosmetic dermatology surgeon and owner of Qazi Cosmetic Clinic, based in Irvine, California.

Cystic acne is more common for those with oily skin. Breakouts can cover large areas of the face, specifically around the cheeks and jawline, but also on the back, buttocks, chest, neck, shoulders and upper arms.

How to prevent cystic acne and prevent future breakouts

It’s important to recognize a cystic acne flare up immediately. This type of acne, when left untreated, can be long-lasting and lead to severe acne scarring – which is hard to erase.

A good skincare routine is essential, including cleansing twice daily or more often if you exercise or sweat excessively. Gently cleanse skin with a foam or exfoliating, jelly-like cleanser, and remember to never pick at or try to squeeze breakouts.

“Picking at the cysts can push the infection deeper into the skin, causing it to spread,” Qazi says. Be wary of stress and find activities for relaxation and managing chronic levels. Stress triggers hormone release, which exacerbates cystic acne.

To fight cystic acne, Qazi recommends getting “plenty of sleep and exercise, eating more vegetables, and reducing intake of sugar and alcohol.”

Which topicals help with cystic acne?

Most over-the-counter acne medications are not strong enough to fully treat cystic acne. Products containing benzoyl peroxide and retinol (vitamin A) can be helpful.

Oral antibiotics and birth control are sometimes prescribed. Antibiotics fight bacteria and inflammation, while birth control regulates hormones and offers stability. Isotretinoin (Accutane) is considered to be the most effective treatment for cystic acne and is derived from vitamin A for daily use, but it’s also highly potent and agitating.

Prescription medications can be powerful and abrasive, so consider using over-the-counter options, like benzoyl peroxide and retinol, first.

“Benzoyl peroxide is an antibiotic and skin peeling agent that’s the most effective over-the-counter treatment for mild acne and killing bacteria,” Qazi says.

Still a strong treatment, it’s recommended to use benzoyl peroxide in small amounts at first to determine how well it’s tolerated by your skin.

“If skin doesn’t become irritated or red with benzoyl peroxide, after a few weeks, you can use it daily,” Qazi notes.

Retinol and vitamin A clear clogged pores and may boost effectiveness of antibiotics when used together. Differin, or adapalene, is a common retinoid for treating cystic acne, but can cause irritation, especially when you first start using it.

You might also benefit from using a salicylic facial cleanser, which can help prevent oily skin and reduce breakouts. “It’s great for clogged pores, removing dead skin cells and eliminating white and black heads, but it’s not strong enough to treat cystic acne on its own,” Qazi says.

Lastly, consider a serum that contains both retinol and hyaluronic acid to hydrate skin and boast youthfulness. “Retinol and hyaluronic acid work by getting underneath the skin to stimulate collagen and elastin production and reduce scarring,” Qazi says.

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