Cystic Acne: Causes, Symptoms, Treatment and Prevention

This skin condition mainly affects the face, but it also often affects the upper part of the trunk and the upper part of the arms.

Cystic acne is one of the most difficult types of acne to treat.

During adolescence, it is not unusual to have a pimple or two. But if there are large, red and painfully deep pimples on the skin, it could mean that something called cystic acne has developed.

These outbreaks can be treated. Cystic acne can persist for years.

It can affect large areas of your skin and leave permanent scars. A dermatologist can help you with a treatment plan.

How is cystic acne produced?

A pimple forms when a pore in the skin is covered, usually, with dead skin cells. Sometimes bacteria get trapped inside the pore, causing the area to swell and turn red.

Cystic acne occurs when this infection enters the skin, creating a tender red bump that is filled with pus. It can hurt or itch. The infection can spread, causing more acne outbreaks.


Who is more prone and in what places of the body?

You are more likely to develop cystic acne in your teens or at the age of 20. But it can happen to someone as young as 8 years old or as old as 50.

Your face, chest, back, arms, shoulders, may be affected. Severe cystic acne is more common in men than in women. Women often have cysts in the lower half of the face.

Symptoms of cystic acne

Acne produces family symptoms for all of us. Cystic acne is even more visible because it is the most severe form and produces cysts and nodules along with inflammatory papules and pustules.

Acne can also cause visible scars.

All forms of acne can affect self-esteem and mood, but the risk of psychological distress is greater for cystic acne, since it generally has a greater impact on the appearance of the face and disproportionately affects young adults They can be more socially sensitive.

Most people with acne do not usually experience physical symptoms, but the appearance of the skin can cause emotional distress. However, in cystic acne, the anguish may be greater and the cysts may be painful.

The importance of the treatment is underlined by the long-term risk of scarring cystic acne. This can cause long-term and permanent damage in the form of:

Small, deep pits, known as “ice scars.”
Larger wells
Shallow depressions in the skin.
Red scars, raised.



The pores of the skin have sebaceous glands that secrete a fatty substance known as sebum.

Normal secretions of sebum help protect the hair follicles and skin, but the overproduction of sebum and the overgrowth of skin cells can cause the pores to become clogged.

This can create the perfect conditions for the overgrowth of P. acnes.

Cysts are the most inflamed and broken type of acne.

The most important factor that causes acne is the hormonal changes in adolescence.

During puberty, levels of circulating androgenic hormones increase dramatically, which causes an increase in sebum production; The skin cells also start to grow faster.

Acne is not limited to teenagers, however, other factors are involved, including:

Hormonal changes related to the menstrual cycle, pregnancy, birth control, the use of hormone therapy and stress.
Fatty cosmetics, cleansers, lotions and clothes.
High levels of humidity and sweating.
Genetics, since some people are naturally more susceptible.
Some medications and chemicals, for example, corticosteroids, lithium, phenytoin and isoniazid, which can worsen or cause acne-like rashes.

There are numerous myths about the causes of acne, which blame factors that have been ruled out by scientific research.

Acne, including cystic acne, is not caused by:

Chocolate, nuts or fatty foods.
Most other dietary options.
Bad hygiene or inadequate face washing.
Masturbation or sex.


Treatment of cystic acne

The treatment of severe cystic acne requires the help of a medical specialist and some measures of personal care.

Pharmacological treatment can be effective in preventing cysts and scars.

Mild or moderate acne can be controlled with the help of a doctor.

However, severe acne characterized by nodules and cysts may require a specialist’s referral, as it may leave scars or show signs of scarring.

This is partly because the main drugs used to treat cystic acne are tightly controlled.

Benzoyl peroxide

Benzoyl peroxide is a treatment available for people with acne of any severity. It is also a treatment option for people with severe acne who are waiting for specialized treatment.

Benzoyl peroxide is available directly from over-the-counter pharmacies in several formulations that can be applied to the skin.

It has been a mainstay in the treatment of acne for more than 50 years, and acts by killing bacteria, particularly Propionibacterium acnes (P. acnes).

Some treatments with benzoyl peroxide are also available to buy online.

It also breaks comedones. These include white dots and black dots.

The water and alcohol based formulations of benzoyl peroxide are available, and the most appropriate form depends on the type of skin.

Alcohol-based preparations have a drying effect, which makes them more suitable for people with oily skin.

Benzoyl peroxide products, which include liquids and cleaning sticks, lotions, creams and gels, are used once or twice a day. The most common side effect is skin irritation. Allergies do not occur commonly.


Pharmacological treatment with isotretinoin

Isotretinoin is a prescription drug for the treatment of cystic acne, which is sold under various brand names in the United States, such as Absorica, Amnesteem, Claravis, Myorisan and Sotret.

Isotretinoin is a very effective treatment, but it has significant side effects and is dangerous for the fetus.

It is usually taken in a dose of 1 milligram (mg) per kilogram of body weight once a day for 16 to 20 weeks.

For cases of moderate acne, isotretinoin is not recommended until standard treatment with oral antibiotics has been tried and found to be ineffective.

However, isotretinoin is recommended as a first-line treatment for severe acne.

Potential adverse effects associated with the use of isotretinoin include:

Ocular and genital dryness.
Cracked lips
Joint pains
Hepatic injury.
High levels of lipids.

Isotretinoin is a teratogenic drug. This means that taking it during pregnancy in any dose, even for a short time, can cause congenital deformities.

Isotretinoin can also lead to pregnancy loss or premature birth and can cause the death of the newborn.

Therefore, women who can become pregnant should use two contraceptive methods for 1 month before, during and at least one month after treatment with isotretinoin.

It is also necessary to perform pregnancy tests before starting to take isotretinoin and then every month until 1 month after stopping the medication.

The conditions for prescribing the medication include the production of two negative pregnancy tests.


Steroid injections

Injecting a corticosteroid drug called triamcinolone directly into a cyst can help reduce inflammation and prevent scarring. This treatment is done by a dermatologist.

There may be localized effects of short duration after injection.

Dermatologists may also offer the incision and drainage of certain large cysts, but it is strongly recommended that people do not try this on their own as they will likely worsen the skin problem and could cause serious scars and deeper infections.
Birth control pills

The long-term treatment of acne in women may involve the contraceptive pill, which suppresses the production of sebum.

When appropriate, an oral medication containing estrogen and progesterone for 6 months or more may be used.

A medication called spironolactone may also be prescribed along with the pill. This is a synthetic steroid that inhibits androgens.
Home remedies

Practical steps to avoid getting worse acne are useful for anyone with acne, including people with cystic acne:

Do not wash too often: twice a day is enough, use a mild soap or cleanser and warm water.
Do not rub hard when washing: avoid abrasive soaps, cleaning granules, astringents or exfoliating agents.
 Leave the pimples in peace: it is likely that the act of picking and squeezing will make acne worse.
Avoid the use of heavy makeup: when applying makeup, choose formulations based on water, not comedogenic, avoid fat formulations and be sure to remove makeup before bedtime.



If you have milder acne or if you want to reduce the risk of acne on clear skin, the following steps can help:

Clean the skin gently in the morning, before going to sleep and after intense exercise.
Try to avoid touching the skin whenever possible.
Shave carefully and soften your beard with soapy water before grooming. Be sure to find the most comfortable shaving method for you and only when necessary.
Avoid excessive exposure to the sun, as it can affect the health and appearance of the skin.
Wash your hair with shampoo regularly. People with oily hair may want to do it daily.

There are other factors that cause and increase acne, such as genetics, but these tips can help prevent normal acne from becoming cystic.