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Cystic Acne: Complete Guide (Updated 2024)

  • Post category:Skincare

There’s acne, and then there’s cystic acne. Anyone who has suffered the latter will know there is a massive difference when it comes to these two conditions, and getting familiar with the differences is imperative to moving in the direction of treatment and healing. Here’s everything you need to know…

In this article we discuss the following:

What is Cystic Acne?

The cystic acne definition is given by the Cleveland Clinic as “a type of inflammatory acne that causes painful, pus-filled pimples to form deep under the skin”. This is the worst form of acne that one can experience, and it occurs the deepest under the skin of any acne within the human experience. 

It typically involves cystic acne face, however it is not unheard of for cystic acne to spread to other areas, including the back, neck, shoulders and chest. Dr. Shauna of NWPH gave us her definition of this invasive condition: “Cystic acne is the most severe kind of acne. It occurs when cysts grow deep beneath your skin. This can be caused by a buildup of germs, oil, and dry skin cells in your pores.”

a young woman

She went on to explain that although anybody can get acne, cystic acne is more common among persons with oily skin. “It is also more frequent in adolescent girls, women, and

elderly individuals who have hormonal abnormalities.”, says Shauna. 

What Causes Cystic Acne?

Cystic acne will sneak up on even the least suspecting of individuals. It occurs when a variety of bacteria, dead skin cells and oils (derived from excess sebum) become trapped beneath the surface of the skin, and slowly form an infection. As the infection grows, it becomes more deeply embedded, with no way to escape the surface, so swollen bumps occur that can be as small as a regular pimple, to as large as a coin. 

There are a number of reasons why cystic acne can occur so badly in some individuals, and mildly in others. Dr. Lisa M. Diaz attributes this variation to the following factors: bacteria, diet, hormones and genetics. According to her, gaining a better understanding of what could be causing your flare up will help you and your dermatologist devise a plan of action against the condition. 

Mild Cystic Acne

Most people with cystic acne will fall in the mild to moderate range of this condition. If you only experience cystic acne during ovulation, or hormonal cystic acne, then it’s likely your skin is quick to bounce back on the days where your body is more in balance. 

Mild cystic acne on chin and around the mouth area is common. It’s important to consider that even though one’s cystic acne may be considered “mild”, the condition itself is automatically always more severe, painful, and invasive than any other form of acne, so it is never a good idea to let someone know that “at least yours is quite mild”. 

Visually mild cases of cystic acne can be just as painful as cases where the skin is totally ruptured. In fact, sometimes visually mild cases are actually more painful than visually severe ones, because the cysts have had no release and are packed tighter under the skin. 

Severe Cystic Acne

Experiencing cystic acne on cheeks, cystic acne on chest or even cystic acne on back is a sure sign that your case is moving into more severe territory. This is more likely to occur in adult cystic acne, as teenage bodies are able to pass cysts a lot easier than adults. 

Erin Cooper, a certified wellness coach, tells us her journey with adult cystic acne. “I had really bad cystic acne for over one year. It’s very painful, and you can’t even pop the pimples, because they are like large nodules, deep under your skin. When they finally reach the surface, if you pop them it hurts, and they bleed. After you pop them, it leaves a scar, especially if you are of African descent, like me.”

While there is little scientific evidence to support the notion that a cystic acne diet could be responsible for levels of severity, it’s never a bad idea to watch what you eat when your skin is experiencing high levels of stress!

What does Cystic Acne Look Like?

Whether you’re encountering sudden cystic acne, or your condition develops over time, you can rest assured that the nodules are likely to look a lot like boils or pus-filled bumps. It’s actually quite important to learn how to tell the difference between cystic acne and regular acne, because they require vastly different types of treatment and care. 

Hard cystic acne is an easy way to classify one from the other. Despite being filled with pus and fluid, cysts hold a hard shell and can feel quite solid under the skin if they have yet to break the surface. As we mentioned, cystic acne could be pea-sized, or grow bigger than a dime coin. 

One of the easiest ways to determine cystic acne from regular would be how sensitive they are to the touch. While regular acne can be irritating and mildly painful, cystic acne is incredibly sore; sometimes an accidental touch or bump can give you that knees-cave-in feeling. 

No matter how your cystic acne may look, you should never let anyone make you feel bad about your condition. Supportive friends and family are imperative for your self-esteem during this time. Media associate, Shakeel Malik, knows this first hand. 

“Cystic acne can make you feel pretty… SPECIAL. When I was dealing with it, I had a lot of people tell me that my skin was glowing or that I was “glowing from the inside out.” That made

me feel special! It helped my self-esteem a little bit,” says Shakeel. “If you have a friend or family member that is constantly making negative comments about your skin then you might want to reconsider those relationships.”

Cystic Acne Diagram

Understanding cystic acne is a lot easier when you can see a visual representation of it. Even cystic acne pictures don’t do much justice identifying the condition itself, as from an external perspective, cystic acne can look like other less severe forms of acne. It’s what is going on beneath the skin that matters, and how you’ll be able to finally determine do I have cystic acne or not?

The following is a helpful diagram in which different types of acne are juxtaposed next to one another for the purpose of knowing the difference:

cystic acne diagram

The upper row shows what the acne may look like from the outside layer of skin, while the lower layer shows what is going on beneath the dermis and epidermis layers. As you can see, blackheads and whiteheads are relatively harmless, with most of their impact occurring on the outside of the skin. 

Moving into pimples, one can see that even though there is more inflammation and pus build up, the pimple itself is still not trapped from escaping out of the skin should it need to. 

Then, we observe the dreaded cyst. As you can see, the space beneath the skin is totally drowning in pus and fluid, so much so that breaking through the surface seems almost impossible. The inflammation is also incredibly severe. From the outside, cystic acne can look like overly inflamed whiteheads, only if you are able to push the pus out, you are likely to just create further infection and bacterial spread. 

Cystic Acne Symptoms

Anyone who has suffered from a bad case of acne will tell you that one of the most frustrating parts about it is that no one can tell how much pain and discomfort you’re in at all times. Other than the actual nodules, cystic acne doesn’t come with any physical symptoms that are observable by others. It’s not like suffering from the flu and having a cough to show for it. 

Sometimes cystic acne itchy spells can occur, leaving your skin raw, sensitive and desperate for a scratch. Unfortunately, scratching cystic acne is one of the worst things you can do, as hands and fingers are the number one carrier of everyday bacteria. You’ll make everything worse, just to relieve an itch. 

Swollen cystic acne is not uncommon, as inflammation levels vary from person to person. For some, the swelling occurs so deep into the layers of the skin that it is almost not visible from the outside. For others, it is the external layer that absorbs the swelling, so this would be a physical symptom to look out for. 

Other than this, one can sometimes expect cystic acne scars. This is less of a symptom and more of a side effect, especially when action has not been taken to try to heal the skin. Finally, there are some individuals who experience symptoms of mild to moderate headaches/migraines. This is largely dependent on the location of the cysts, and how painful they are. Cysts that occur around the forehead and temple region can trigger headache-like symptoms fairly easily. 

Cystic Acne vs Acne

Let’s take a dive into the differences between cystic versus regular acne, once and for all. As we saw in the aforementioned diagram, regular acne can occur in the form of pimples (also known as pustules), whiteheads, blackheads, and papules (small red or pink bumps). 

Cystic acne is in a league of its own, taking swelling, inflammation, congestion, pain and spreading to a whole new level compared to the others. Understanding the difference is often easier when someone offers up their personal experience of the condition. 

Cue Samantha Goldberg, a TV personality specializing in lifestyle, beauty, and fashion. “My family (all of the women on my mom’s side) dealt with cystic acne as young women, and I too suffered from this condition. I remember my aunt would get them on her forehead. They were huge, and a doctor had to eventually lancet and then drain them. That was the only cure at the time. Sadly, she has scarring from years of having this issue. The good news is that as she became older the problems were not as bad and went for longer time periods having no issues at all.”

Samantha points at something important: cystic acne truly can happen to anyone, and it very likely has quite a bit to do with genetics. Given her family history, and the fact that all women from her mother’s side suffered the same fate, it confirms what Dr. Lisa M. Diaz concluded in her trigger research. 

“When cystic acne is bad, it can be very bad. Not only painful and unattractive to look at, but psychologically damaging to those who suffer from this daily. They become shy with showing their face without makeup, they feel the north star on their nose will be the focus of millions and sadly don’t have a very good self image at all depending on the severity,” adds Samantha. 

a woman undergoing facial massage

Cystic Acne Treatment

While we’d love to give you the secret of how to get rid of cystic acne overnight, sadly this is still very much a developing science and an overnight cure is not yet a reality. That said, we can advise on how to get rid of cystic acne in general, and where to turn to when seeking help for cystic acne. 

As we delve into the different ways to treat this condition, we’ll explore some on the more holistic/natural side, and some more aligned with Western Medicine. We encourage all readers to take what resonates for them, and leave the rest. Herbal acne treatments aren’t for everyone, just as laser acne treatments, or medicinal acne treatments could send some people running in the opposite direction. 

More than this, always do your own research before opting to treat cystic acne with something you merely read about online. Dive deep, ask professionals and feel into all risks involved before going head first into a treatment that perhaps wasn’t the best option for your specific skin type. 

How to Treat Cystic Acne

Earlier we mentioned that we spoke with Erin Cooper, a certified wellness coach. Adding to her sharing of her acne journey, she told us the two main treatments that eventually lead to her healing: birth control and the correction of her leaky gut syndrome. 

“It took about 6 months for the acne to really show signs of improvement after being on the pill. I also learned that if you suffer from leaky gut syndrome, your body will not absorb whatever nutrients or medications you may be taking in. Fix your leaky gut if possible, as there are studies that show that certain acne can be linked to this condition,” said Erin. 

“There are also some great natural ways to heal the skin and calm the inflammation, as well.”, adds Roberta Perry from Scrubz Body. According to Roberta, when you calm and soothe the area around the cyst, bringing inflammation down, the entire papule comes to a head faster and the area starts to heal sooner. She invested in an all-natural anti-inflammatory cream, and worked on the acne from the outside in. While she acknowledges that healing did not take place overnight, she did, however, start to see improvement as early as two days in. 

In our opinion, herbal and anti-inflammatory balms make for great cystic acne treatment over the counter!

Antibiotics for Cystic Acne

While there is no distinct cystic acne cure, western medicine has proven to be instrumental in easing some of the more severe cases for which plants and herbs seem to have no match. Sometimes cystic acne pain gets too much for one person to manage, and seeking professional help from a health care provider becomes absolutely necessary. 

Dr. Shauna gave us some information on what to do in these instances: “If your cystic acne covers a wide region of your skin, oral antibiotics may be used to treat it. These operate by reducing bacteria and inflammation, which may be contributing to the production of cystic acne. Antibiotics, on the other hand, do not treat excess oil or dead skin cells.”

This last point is important, as it highlights that while antibiotics may help some cases of cystic acne, they may do nothing for those that are occurring due to a surplus of oil or dead skin. The problem with this is the harm that antibiotics tend to do to the human gut microbiome, completely depleting the colonies and leaving your digestive system totally out of whack. An imbalance in one’s gut bacteria can in turn lead to a worsening of acne — so we need to be very careful and sure before we turn to antibiotics as a possible treatment for this condition. 

Cystic Acne Laser Treatment

For those who dabbled in a little too much cystic acne popping, new laser treatments have entered the market offering a rapid healing solution, especially for scarred skin. This is technically a form of cystic acne removal, if you want to phrase it that way. 

The process is called PDT, or photopneumatic therapy. It involves sending a pulsating light ray down into the skin, while combined with a gentle vacuum system that works to extract all excess oil and dead skin cells from the clogged pores. This opens up the skin, creating room to breathe and space for healing to occur. 

cystic acne scar on face

In cases where the cystic acne is more mild, this kind of treatment can lead to permanent results. More severe cases can benefit from repeat treatments, which eventually train the skin into feeling more free of oils and dead cells, making way for healthier cells to filter through.

Cystic Acne Scar Treatment

Unfortunately, cystic acne is the one type of acne where scarring is relatively guaranteed. Dr. Shauna elaborates on this in stating that “Cystic acne is most prone to scar out of all forms of acne. By letting all cysts alone, you can lessen the danger of scarring. This implies that cysts

cannot be picked or popped. Picking at this sort of acne can spread infections as well.”

The hardest thing to do when suffering from cystic acne is not to pick, pop or scratch. The condition is so invasive and full of uncomfortable sensations, that it is almost unfathomable that one should refrain from seeking any physical relief through these methods. But cystic acne scarring can be for life, especially if scars are left without treatment for a period of 10 years or more. Thereafter, it is very difficult to get rid of any type of scarring, as the tissue has basically solidified. 

According to Dr Hassan Soueid from Longevita, scars can still develop depending on the person’s skin type, even if they have left their cysts alone or allowed them to heal over time. “Platelet-rich plasma (PRP) can help with acne scarring. The healing properties of the PRP can help rejuvenate the skin by stimulating the production of collagen, improving the appearance of scars,” says Dr Hassan. 

She adds that during the procedure, the dermatologist or doctor will most likely use a professional-grade derma-roller to create small punctures in the affected area. “Following this, the PRP will be applied to the skin. The microneedling helps the PRP penetrate deeper into the skin, which can further improve the results of the PRP. However, one PRP session is not enough to disappear the cystic acne scars.”

For cystic acne, regular sessions are required and encouraged. Exactly how many sessions are needed for a complete healing can be only determined after face-to-face consultation.

Mask for Cystic Acne

If lasering, medicating or draining cystic acne doesn’t sound like the path for you, there is one last treatment method we’d like to look at before we move on. You’ll find people around the world recommending the use of beauty masks for cystic acne, owing to the fact that they can do a fantastic job at sterilizing the skin, reducing inflammation and pulling out toxins. 

If you experience cystic acne on forehead, for example, you’ll know the feeling of relief that comes from lathering a physical product onto the affected skin. This goes for the rest of the body, and when a mask is made with quality ingredients that don’t aggravate the acne further, there is a lot of benefit to be found. 

The product we would most highly recommend is any type of face mask made with bentonite clay. This is an ancient healing formula that has been used across different civilizations for thousands of years, and is also known as ‘healing clay’, ‘Indian healing clay’ or ‘Aztec healing clay’. 

Bentonite clay is highly absorbent in powder form, and once mixed with a little water, rose water, or apple cider vinegar, it becomes a thick, powerful substance that can help remove excess sebum and oils from the surface of the skin. The clay also has a natural calming effect on inflammation. 

Best Spot Treatment for Cystic Acne

What is a spot treatment? When we use this term, we refer to any kind of treatment that targets the problem at the source. Antibiotics, for example, are not examples of spot treatments as they seek to work inside of the body, while the source of the problem remains on the outside skin. Topical creams that are applied directly onto the cystic acne are a form of spot treatment. 

So what then is the best spot treatment for cystic acne in particular? Due to the very unpredictable and varied nature of these pimples, it’s difficult to define a single treatment as the best for all sufferers. 

That said, we have been increasingly impressed by one product across the board: 

Differin Adapalene Gel 0.1% Prescription Strength Retinoid Acne Treatment

Differin Adapalene Gel 0.1% Prescription Strength Retinoid Acne Treatment

As far as spot treating cystic acne goes, we would encourage all those suffering take a closer look at this award winning product by Differin. Any dermatologist you speak to about your condition is likely going to recommend incorporating some sort of retinoid (vitamin A) into your skincare routine. 

This soothing gel is rich in retinoid, and a pea sized amount can do wonders for badly inflamed, pus-filled skin. Dr. Samer Jaber, the founder of Washington Square Dermatology, is known for having stated that “Differin should be the first OTC product someone with cystic acne should use.”

Please note that retinoids make your skin highly sensitive to the sun, and one should never leave the house without an SPF when using this product. Alternatively, use at night only, and wash it off before leaving the house the next morning. 

Home Remedies for Cystic Acne

Taking things to the far end of the natural spectrum, we’d like to now take a look at a number of helpful home remedies that could help if you are suffering from active cystic acne. 

Homemade Masks

Acne or none, we’re always going to advocate for homemade masks made with ingredients that you can find in any pantry. For cystic acne, the most soothing mask we’ve come across would be a simple mixture of turmeric in water. 

Mix a generous amount of turmeric with enough water to form it into a paste. Apply the paste directly across the affected skin, and allow it to settle and dry. Since turmeric is such a potent anti-inflammatory and antiseptic, there is only benefit to be found in using it directly on active cysts. 

We recommend doing this mask twice a day if possible. No need to leave it on for too long, just let the paste dry into a crust and then wash it off gently with warm water. 

Ice Your Face

Before you skim over this suggestion, consider it for a minute if you are someone who has highly inflamed, swollen cystic acne. Icing the cysts is an age old technique that works to naturally bring down inflammation, itching and even pain levels. 

It’s not going to heal your cystic acne, but it is going to bring some much needed relief on those days where you really “just can’t anymore”. Anyone who has lived with this condition for years at a time, knows that sometimes even just an hour of symptom relief is worth an entire ritual, be it ice or something of the like!

Diet and Probiotics

Blaming cystic acne on diet and diet alone would be somewhat ignorant, considering there really isn’t any research to support such a conclusion. That said, there is an undeniable connection between the gut and the skin, so keeping your gut in a healthy, balanced state can only work for you, and not against you. 

Some studies are seeking to prove that cystic acne is aggravated by dairy, so cutting that out of your daily consumption could be a good idea. The best way to tell if dairy is a trigger for your skin, is to go 3 weeks without consuming it at all, observe the state of your acne throughout, and then reintroduce it to your diet after 3 weeks and observe what happens then. 

A daily probiotic should be taken by anyone who is suffering from active acne. 

How to Prevent Prevent Cystic Acne

While we wish the answer to this particular question were so simple, it pains us to share that the truth of the matter is that cystic acne is very hard to prevent entirely. Again, we refer back to Dr. Diaz when she listed the possible causes of cystic acne in humans: bacteria, diet, hormones, and genetics.

Unfortunately, only half of these causes are within the control of the individual, and even then, bacteria is only to a certain degree. Hormones and genetics are largely out of our hands and left up to nature, so saying you’d like to control them in order to prevent cystic acne from ever occurring is somewhat like saying you’d like to learn to control the weather. 

That said, while one may not be able to guarantee never experiencing this kind of outbreak, there are many steps one can take to reduce the risk quite significantly, and create an environment that is simply less likely to indulge a visitation from cystic acne. They are:

  • Become a hygiene freak: Cleanse your face twice daily, use high quality products, never go to sleep with your makeup on, and regularly wash anything that touches your face (pillow case, towels, makeup brushes). 
  • Exfoliate often: Some forms of cystic acne are caused by a buildup of dead skin cells becoming trapped inside of pores. Exfoliating the face can reduce these levels and make for a less than suitable ecosystem for acne to thrive in. 
  • Avoid touching your face: If you are prone to regular acne, or inflammation in general, then make a conscious effort not to touch your face unnecessarily as you move through life. All it takes is the right kind of foreign bacteria to be transported onto already compromised skin, and suddenly you’re moving into cystic territory that could have easily been avoided. On this note, wash and sanitize your hands regularly!

Did You Enjoy This Article?

If you enjoyed this article, you might also like our other articles discussing acne such as: Acne Patch for Pimples, Best Face Wash for Acne, and Fungal Acne (Malassezia Folliculitis).

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