Article Summary

Cystic acne is the most extreme form of acne. It results in cysts that are large, red, painful, and filled with pus. Due to its ability to leave scars and lead to infections, cystic acne is typically treated by a doctor. When treated appropriately, most individuals can successfully control cystic acne, preventing the potential long-lasting effects on the skin. Understanding what leads to cystic acne, along with proper treatment options, provides the foundation for better overall skin health. 

What is Cystic Acne?

Cystic acne is a type of inflammatory acne caused by a blockage of a skin pore with excessive oil, dead skin cells and bacteria. As these materials build up inside the pore, the body's immune system becomes triggered into action, creating a swollen and inflamed reaction deep in the skin layers. Once formed, the resulting cyst is usually red, very painful and full of pus. Unlike smaller forms of acne, cystic acne grows much deeper into the skin and, therefore, is much more difficult to treat. Additionally, if left untreated, cystic acne can result in permanent scarring. For this reason alone, a medical professional should be consulted for treatment instead of treating yourself.

Types of Cystic Acne

Sometimes cystic acne is categorised together with nodular acne, since both types of acne can create deep and painful lesions in the skin, and both types of acne are capable of leaving scars behind. However, there is one major distinction between the two: the liquid content in each lesion. Fluid-filled and soft in texture, acne cysts are composed primarily of pus. On the other hand, hard and solid acne nodules are devoid of fluid. While some individuals may experience both at the same time, referred to as nodulocystic acne, either type of breakout must be addressed by a healthcare provider and should never be manually popped or squeezed, as doing so will greatly increase the likelihood of developing further scarring and/or infection. 

Common Cystic Acne Symptoms

The characteristics of cystic acne distinguish it from less severe forms of acne, such as whiteheads and blackheads. Typical signs include: 

  • Large red bumps under the skin 

  • Painful or tender when touched 

  • Cysts ranging in size from that of a small pea to a large coin 

  • White or yellow heads full of pus 

  • Crusting on the surrounding skin 

  • Redness  across a broad area of skin 

While cystic acne can appear anywhere on the body where there are many oil-producing glands, it most frequently occurs on the face. It can also occur on the back, chest, neck, shoulders, upper arms, and butt. These areas can be covered with multiple cysts and can also negatively affect an individual's self-esteem and or emotional state (i.e., feelings of anxiety). 

Cystic Acne Causes

There are several reasons why an individual may develop cystic acne. Most commonly, cystic acne develops as a result of excess oil being produced in the skin and subsequently becoming trapped in a pore. Dead skin cells then accumulate in the pore along with bacteria. The bacteria then multiply, causing inflammation and forming pus in the pore. There are four main elements contributing to the development of cystic acne: 

  • Excessive production of sebum clogs pores and provides an ideal environment for bacterial growth. 

  • Bacterial infection causes inflammation and leads to pus formation. 

  • Hormonal changes (menstrual cycles, pregnancy and menopause) lead to increased production of oil. 

  • Stress or hormonal fluctuations cause breakouts. 

Risk Factors for Cystic Acne

Several different populations are at higher risk of developing cystic acne. Adolescents are the largest population impacted by cystic acne, largely as a result of the dramatic hormonal changes occurring during puberty. Family histories also play a role in whether someone will develop cystic acne, as it is passed down genetically. Women experiencing hormone-related cystic acne often find that their breakouts tend to coincide with specific times. Those who have high-stress lifestyles, consume high-sugar, simple carbohydrate, dairy-rich diets, and work in greasy environments all have a greater chance of experiencing breakouts. 

How is Cystic Acne Diagnosed?

A dermatologist diagnoses cystic acne using a visual examination of the patient's skin. Laboratory testing is not necessary for diagnosing cystic acne. After examining the size and location of the patient's cysts and determining the best treatment option based on the severity of their case, the dermatologist can begin treatment. Self-diagnosis is not suggested, as cystic acne can easily be misdiagnosed as another skin issue, and improper treatment can exacerbate scarring.

Cystic Acne Treatment Options

Because cystic acne is considered severe, it requires professional treatment. Treatment for cystic acne can last at least 3-6 months before noticeable improvements can be seen. In addition, many patients use a combination of treatment methods. Topical treatments prescribed by a dermatologist include: 

  • Antibiotics applied topically to combat bacteria/reduce inflammation 

  • Azelaic and salicylic acids to help remove dead skin cells/target bacteria 

  • Benzoyl peroxide to decrease bacteria found on skin 

  • Retinoids to promote healthy skin cell regeneration 

How to Prevent Cystic Acne

It is difficult to completely avoid developing cystic acne; however, there are things you can do to minimise your chances of having breakouts as well as limit their severity: 

  • Wash your face with a gentle foaming cleanser and lukewarm water twice a day and after exercising. 

  • Use an oil-free moisturiser if needed 

  • Only wear non-comedogenic water-based makeup products on your skin 

  • Remove all makeup before bedtime 

  • Avoid touching your face 

  • Regularly wash your hair  

  • Limit consumption of high glycaemic index foods 

  • Manage your stress through regular exercise/relaxation techniques. 

When Should You See a Dermatologist for Cystic Acne?

 If you have developed painful cysts that grow deep into your skin, if you have been experiencing breakouts that could potentially scar, or if your breakouts have begun to affect your self-esteem, visit your dermatologist immediately. Delaying seeking professional help will put you at an even greater risk of permanently scarring your skin. In addition, visit your dermatologist when you exhibit signs of infection surrounding your cyst. 

Conclusion

Cystic acne is more than just a series of occasional blemishes on your skin. It creates large, painful cysts that are susceptible to scarring and infection if not properly treated. By obtaining proper medical attention quickly, you are able to greatly improve your outcome. Using a combination of topical treatments, oral medications and good hygiene practices, most individuals are able to alleviate their discomfort and protect their skin from irreversible damage. If you believe that your cystic acne has negatively impacted your appearance and self-confidence, contact your dermatologist.