Cystic acne is the most advanced stage of acne and sometimes, holistic factors will help you understand your causes and symptoms.
In this article, we’re going to discuss what cystic acne is, what it looks like, what causes it and how it can be managed.
Cystic acne can be upsetting, irritating and uncomfortable. But there are steps you can take to help keep it under control, by understanding what's causing it and using the right skincare.
What is Cystic Acne?
Acne is a result of a blockage within the sebaceous glands of the skin. Hormones and other factors such as genetics and stress cause excessive skin oil (sebum) production.
This excess sebum blocks the follicles which can then form blackheads and whiteheads. Bacteria called propionibacteria that are usually harmless and live naturally on the skin then start accumulating due to excessive sebum levels, leading to inflammation.
Inflammation is a process that attracts immune cells to the skin. The immune cells kill the bacteria but die in the process. This mix of dead bacteria and immune cells then forms pus that fills the hair follicles leading to cystic acne.
If the lining of the hair follicle is breached, the pus leaks into the underlying tissues, forming angry yellowheads surrounded by inflamed, red skin.
What Does Cystic Acne Look Like?
Cystic acne has a distinctive look. If the whiteheads and blackheads caused by blocked pores become inflamed and filled with bacteria, they form pustules - spots where pus starts accumulating along the shaft of the hair.
The next stage of cystic acne is the formation of acne cysts where the pus accumulates in significant quantities near the hair shaft, creating a pus-filled sack. These can then rupture and the acne cyst then empties into the underlying tissue. It then becomes a papule and bigger acne cysts develop nodules.
The lower layers of the skin become damaged, leading to uneven, pitted and rough skin with deep depressions and pimples in different stages. The healing of cystic acne leads to the formation of scars. Scars can be different in appearance ranging from ice-pick scars (that are deep and narrow) to boxcar scars (larger with sharp edges) and rolling scars (with shallow edges).
What Causes Cystic Acne?
Cystic acne is the most severe stage of acne. It develops in areas of skin that have a high density of sebaceous glands, including on the face. There are no cysts and nodules without whiteheads and blackheads as cystic acne will always start off as smaller, less noticeable spots.
Therefore the cause of cystic acne is varied and can include:
- Genetic causes that determines the formation or whiteheads and blackheads
- Hormonal surges at different stages of life such as puberty or pregnancy
- Lifestyle factors such as high levels of stress, physical inactivity, a junk food diet or a diet high in acid forming foods such as meat and dairy products
- A skincare regime that doesn’t support the needs of the skin
Can a Poor Diet Cause Cystic Acne?
Our diet can be a trigger for acne formation, including cystic acne. Modern Western-style diets rich in simple sugars such as glucose and fructose, fats and salt increase sebum production, the first step on the pathway of acne.
Eating animal protein, for example in the form of meat and dairy products is also a significant factor in experiencing acne prone skin. High meat consumption, especially beef that contains hormones similar to human hormones, exacerbates acne. Dairy can have the same effect.
Despite gluten and egg white albumin being proteins, no scientific data confirm the link between their consumption and cystic acne formation.
Probiotics (good bacteria similar to Lactobacillus found in yoghurts), on the other hand, had shown in clinical trials to reduce acne.
Can Allergies Cause Cystic Acne?
Allergies are usually caused by an overproduction of a specific type of antibody called IgE. Skin inflammation in cystic acne is linked with the production of white blood cells by the immune system. So allergies and inflammation leading to cystic acne are different.
Skin rashes associated with an allergy are quite different from the whiteheads and blackheads that are the basis of cystic acne. An allergic rash appears quickly after contact with an allergen, while acne pimples build up slowly.
The Cochrane review that analyses clinical studies have reported that eliminating products that cause allergy relieves acne in persons that suffer from allergy and acne at the same time. However, they don't recommend removing food such as eggs ( but always to be consumed in small quantities) if there is no proven allergy because vitamins and micronutrient deficiency as the result of this will do more harm than good.
Can Alcohol Cause Cystic Acne?
Many skin conditions look similar to acne. One of them is redness of the skin caused by rosacea which can be exacerbated by drinking alcohol. Cystic acne formation is a long term process that isn’t made worse by occasional alcohol consumption. However, it’s important to moderate your alcohol intake if you have acne as it can negatively influence the extent and severity of your acne.
Can Antibiotics Cause Cystic Acne?
Antibiotic sensitivity is caused by an antibiotic allergy. Allergies, irrespective of their trigger, cannot cause cystic acne. In fact, topical remedies containing antibiotics and oral antibiotics are often prescribed for cystic acne.
Can Anxiety Cause Cystic Acne?
Anxiety and other mental health issues are often associated with an increased level of the stress hormone, cortisol. Cortisol causes general inflammation. Because cystic acne is the result of local inflammation, increased levels of cortisol can make the condition worse.
Can a Lack of Sleep Cause Cystic Acne?
A chronic lack of sleep is one of the most substantial factors in causing stress. Stress, in turn, makes skin hormone-dependent conditions, including acne, worse.
To avoid acne becoming worse, it is vital to have at least 7 - 8 hours of uninterrupted sleep per day.
Can Stress Cause Cystic Acne?
Stress can be acute or chronic. An episode of severe stress but short term or acute, for example, where you were almost run over by a car but managed to escape does not have long-lasting effects.
Chronic stress is when you feel under pressure for a long time, for example, during preparation for exams. Unlike acute stress, when you have a temporary spike of cortisol, chronic stress leads to a high level of cortisol for a long time.
Cortisol is one of the hormones that leads to acne or worsens the degree of acne. So mild and moderate acne can become cystic acne as a result of stress.
Can Makeup Cause Cystic Acne?
Acne is caused in part by the accumulation of dead skin cells and excessive oil production by the skin. Anything that irritates skin will cause acne to become worse. Oil-based cosmetics, especially liquid or creamy foundations, add to the level of oil on the skin, leading to a worsening of acne prone skin.
Cosmetics applied generously and not removed for a long time blocks skin glands and causes irritation. An improper skin care routine can also irritate the skin, and this can also make acne worse.
Can Mould Cause Cystic Acne?
Mould is a type of fungi that can colonise our homes by growing on walls in damp places. Another type of mould grows on out of date products such as bread.
Moulds produce spores - microscopic particles that fungi use to spread and grow - that in high quantities can cause allergy and breathing difficulties.
They can be toxic for the skin as the mould spores are released into the air, they trigger allergies and compromise the immune system, potentially causing a multitude of skin problems, including acne.
What Causes Hormonal Cystic Acne?
Hormonal cystic acne is caused by surges in hormones at different stages of life. The hormones that cause cystic acne can be divided into two groups - sex hormones and stress hormones.
Acne is associated with transitional life stages such as puberty or pregnancy. Surges in female (oestrogens) and male (androgens) hormones create a sex hormone imbalance that the skin reacts to.
Persistent or chronic stress is associated with the primary stress hormone, cortisol. High cortisol levels lead to general inflammation. Skin inflammation causes the formation of cystic acne.
Where Does Cystic Acne Usually Form?
Cystic acne is most commonly found in areas of skin where whiteheads and blackheads have previously formed or where the highest concentration of sebum producing cells are.
This means that acne cysts are most common on the face around the chin, jawline and hairline and the upper half of the back and the chest.
Cystic Acne on the Face
Cystic acne on the face often causes much stress and upset as it’s so visible. For this reason, most people with cystic acne on the face look for treatments.
Oral acne treatments target the acne breakouts all over the body, including the face. The most common oral acne treatments are antibiotics and vitamins, as well as hormonal therapy for women.
Topical applications for acne include creams, lotions and other preparations that are applied directly onto the sites of cystic acne outbreaks. They include skin clearing agents such as benzoyl peroxide, retinoids, and antibiotics.
Cystic Acne on the Chin
Acne outbreaks often concentrate on the chin because it contains a large number of sebaceous glands and hair follicles.
The chin and other acne-prone areas such as the nose and hairline need an extra thorough skincare routine involving cleansing, exfoliating and moisturising.
Cystic Acne on the Jawline
The jawline is a common area for cystic acne formation. Firstly, it has a large number of sebaceous glands and hair follicles. Additionally, it’s often the location of skin irritation by the chinstraps of helmets and face coverings.
Cystic Acne on the Neck
The neck is one of the places where cystic acne can also be found. The cause of neck acne is the same as for cystic acne elsewhere on the face. It's the result of blockages in the sebaceous glands followed by a buildup of skin bacteria and inflammation.
Cystic neck acne can usually be treated in the same ways as other acne treatment including retinoids, vitamins, antibiotics and hormonal therapy.
Cystic Acne on the Nose
The nose is one of the places with the highest concentration of highly active sebaceous glands that get blocked easily and form blackheads.
If left untreated, blackheads can progress to cystic acne. In addition to the usual treatments for cystic acne, there are specific treatments for the nose that safely unblock the pores such as pore strips and face masks.
Cystic Acne on the Back
The back can also be affected by cystic acne. Cystic acne on the back can be tricky to treat with topical medications due to the high surface area, difficulty reaching it and because it’s often covered with clothing. Therefore oral medications are often used, including vitamins, retinoids and antibiotics. Hormonal contraceptives may be prescribed for women as they are shown to normalise hormone levels that cause cystic acne on the back.
Cystic Acne Complications
Due to the severity of cystic acne, it can often lead to scarring of the skin, which can sometimes be permanent. It can also lead to the development of hidradenitis suppurativa, a rare skin condition that causes abscesses under the skin.
Having cystic acne can also lead to mental health problems such as depression and anxiety due to its severity and potential for scarring.
Cystic acne can also be a sign that something else is going on, health-wise, such as polycystic ovary syndrome, or PCOS. If you're concerned, speak to your GP for a diagnosis.
How to Get Rid of Cystic Acne
It's certainly possible to reduce the extent and severity of cystic acne and to minimise cystic acne scars. But it’s important to understand that cystic acne treatment isn’t a miracle cure that clears acne overnight and with minimum effort.
Because cystic acne is a severe and chronic condition, it requires a systematic and long-term approach. The best way of clearing cystic acne starts with lifestyle changes and the correct skincare routine.
How to Cure Cystic Acne Naturally
Cystic acne is the result of hormonal surges followed by skin pore blockage and inflammation. For a natural way to cure cystic acne, you need to start with lifestyle changes. Everything that reduces stress will be beneficial to the skin balance and will help to clear acne.
Food should be alkaline and low in simple sugars - glucose, fructose, and saccharose. Your diet should include lots of green vegetables and starchy, fibre filled potatoes and be very low in highly processed, high fat and/or fried food. Cow’s milk and dairy should be eliminated. Read more about what foods can form acne here
Over the Counter Cystic Acne Treatments
There are several classes of cystic acne treatments available over the counter. They can be oral in the form of pills and topical in the form of creams and include:
Group 1 that promotes skin cell metabolism:
- Vitamins A (retinol), E, B9 (biotin)
- Retinoids - vitamin A-like compounds
- Zinc and selenium
Group 2 that kill bacteria:
- Benzoyl peroxide
- Azelaic acid
- Salicylic acid
- Ozonated olive oil by Sönd
Because these compounds are not antibiotics, they don't cause the development of resistant bacteria.
Usually, different classes of anti-acne compounds are combined to increase their efficiency.
Using Antibiotics to Treat Cystic Acne
Bacteria that live on skin play an important role in cystic acne development. When they colonise blocked hair follicles and start to grow, they cause inflammation. That's why antibiotics are routinely prescribed to treat cystic acne.
Antibiotics can be taken either orally or applied to the sites of cystic acne. Oral antibiotics are more effective than topical antibiotics because they act on all acne sites at the same time, preventing the development of the local antibiotic resistance.
Commonly used antibiotics include tetracycline derivatives doxycycline and minocycline. Other antibiotics include clindamycin, erythromycin, metronidazole and sulfacetamide.
Different antibiotics should not be taken together at the same time to avoid interference and side effects. It’s also vital to complete the course and not exceed the recommended dose and course duration to prevent antibiotic resistance development.
Does Epiduo Work on Cystic Acne?
Epiduo® Forte Gel is a topical medication. It contains adapalene and benzoyl peroxide, that is, a retinoid and an antibacterial agent.
Both adapalene and benzoyl peroxide are shown to be effective against mild and moderate acne. Combining them in one preparation enhances their effect. However, other topical generic preparations can be as efficient.
Benzoyl Peroxide Spot Treatment for Cystic Acne
Benzoyl peroxide has been used as an acne treatment for several decades and shown its efficacy in clinical trials. It kills bacteria that cause lesion formation and therefore, reduces the number and severity of cystic acne lesions.
Benzoyl peroxide is typically applied to the affected areas in gel, cream, or liquid form. The concentration of benzoyl peroxide varies from 2.5% up to 10%, but there is no reliable evidence that higher levels are more efficient, so it's better to start from the lowest concentration.
However, the best spot cream for you may be different to someone else. A combination of benzoyl peroxide with other anti-acne compounds is more efficient than benzoyl peroxide alone. Two common combinations are benzoyl peroxide/antibiotic clindamycin and adapalene/benzoyl peroxide (for example, in Epiduo® Forte Gel).
Common side effects of topical medications that contain benzoyl peroxide include peeling, itching, and dryness of the skin in the affected area. Higher concentrations cause side effects more aggressively.
Can a Facial Help with Cystic Acne?
Cystic acne arises because of the blocked pores so unblocking them is crucial and efficient in reducing the extent of acne.
Professional facials designed to unblock pores are efficient and beneficial for cystic acne clearance. However, facials are a temporary relief, and it’s important to have a proper diet and skin care regime to extend its benefits.
Cystic Acne Light Treatment
There is some evidence that treatment with red light (MAL‐PDT) or blue light (ALA‐PDT) can reduce the severity of mild and moderate acne. However, data supporting light therapy on its own isn’t very strong.
Isolaz Treatment for Cystic Acne
Isolaz is a treatment that combines the removal of blocked pores content with laser treatment. Low negative pressure sucks out the blockage vacuum cleaner style. Broadband pulsed light is applied at the same time. Clinical trials evidence supports the claims that in many cases the severity of the cystic acne lesions decreases after the treatment in most cases.
Does Apple Cider Vinegar Help with Cystic Acne?
Apple cider vinegar is a folk remedy for cystic acne. Organic acids such as glycolic, lactic, maleic acid are used in chemical skin peels targeted to reduce the extent of acne and scarring. Apple cider vinegar contains the same and similar organic acids.
However, there is an enormous difference between a controlled chemical peel performed by professionals and an attempt to recreate similar conditions at home without any knowledge. The strength of the vinegar, its purity, and the length of treatment are individual. The vinegar may cause burns.
We do not recommend the use of apple cider vinegar directly onto the skin.
Does Coconut Oil Help Cystic Acne?
Lauric acid, palmitic acid and oleic acid contained in coconut oil have strong bactericidal activity against P. acnes, the bacteria associated with cystic acne. However, the data that shows this activity were obtained in laboratory conditions and with pure forms of the acids.
Coconut oil is a mixture of similar acids with the other compounds found in coconut oil. This means that application of coconut oil will clog the skin pores and far from helping cystic acne will make it worse.
Does Honey Help Cystic Acne?
Honey is widely used in folk remedies because of its antibacterial properties. Unfortunately, clinical trials have shown that honey preparations have no effect on the size or number of cystic acne lesions. However, another honey bee-derived product, venom, is effective against cystic acne. Ask your pharmacist about the availability of products containing bee venom.
Is Tea Tree Oil Good for Cystic Acne?
Tea tree oil is one of the most popular active ingredients in the treatment of mild to moderate acne. There are numerous cosmetic products available that contain various concentrations of tea tree oil.
Multiple clinical trials have shown the efficacy of this ingredient against acne. However, it is too mild to control cystic acne on its own; you will probably require other treatments.
Does Witch Hazel Help Cystic Acne?
Cystic acne is the inflammatory stage of acne development. Witch hazel contains a combination of natural anti-inflammatory compounds that are efficient in reducing acne lesions. Therefore witch hazel containing moisturizers are good to use during cystic acne.
Another popular botanic compound with similar anti-inflammatory compounds is aloe vera and you can add benefit from also using Sönd ozonated olive oil.
Popping Cystic Acne - is it a Good Idea?
Cystic acne is an inflammatory skin condition that involves not only sebaceous glands and hair follicles, but underlying deep tissues within the skin.
It’s therefore not a good idea to damage the inflamed glands by popping or squeezing them. You will damage the skin even further risking pushing bacteria into the deep layers of skin where they can spread to other parts of the skin.
Also, popping cystic acne can make the infection worse by transferring the bacteria from your hands into the wound.
Using mechanical implements such as needles to pop cystic acne nodules is also a bad idea even if you sterilise them. It's hard to regulate the pressure and depth of the needle insertion. You may not only spread the infection but seriously damage nerves and blood vessels inside the skin.
How to Reduce the Redness of Cystic Acne
Redness during cystic acne is a sign of skin irritation. What you can do about it depends on the cause.
Some topical medications used for cystic acne may cause redness. If you discover that this is the case you need to reduce the concentration of the active compound, apply it less frequently or replace it with something else.
However, in many cases, redness can be made worse by not having a kind, nourishing skincare regime. It’s essential to develop a proper skin care regime and maintain it. Cleansing and moisturising is especially important.
Cystic Acne Treatment at Home
Cystic acne can be a damaging skin condition that requires professional attention. Before treating face acne at home, you need to consult your home doctor and a certified dermatologist.
Once they’ve provided their professional opinion you can support the healing process by addressing the lifestyle factors that might be contributing to your cystic acne.
Can Cystic Acne Be Prevented?
Cystic acne develops gradually over time in those with regular acne. Genetics plays a vital role in cystic acne development. Most people don't get cystic acne, but for those who do, it's essential to lessen the extent of previous stages of acne formation.
Mild acne needs to be managed and alleviated so it doesn't progress to cystic acne. It’s important not to pick at cystic acne to avoid long-term scarring.
Tips to Help Prevent Cystic Acne From Developing
Cystic acne causes severe acne spots and breakouts and can be very upsetting. Although you may not be able to prevent it entirely if cystic acne runs in your family or you already have moderate acne, you can help to prevent cystic acne from taking over your skin.
Here’s how to prevent cystic acne:
- Use a gentle cream cleanser twice a day
- Only use non-comedogenic oil-free skincare products and makeup
- Try to avoid touching your face throughout the day to avoid transferring dirt, bacteria and oil
- Where possible, avoid wearing face coverings (or tight fitting clothing if you have cystic acne on your body)
- Eat a healthy, mostly alkaline diet and stay well hydrated
- Take steps to reduce stress and get plenty of quality sleep
Ask your doctor if any medications you may be taking could be contributing to your acne
The Best Treatment for Cystic Acne Scars
Cystic acne leaves three types of scars - ice-pick, boxcar, and rolling. Most of them will disappear or become less prominent with time. However, if they persist, you may consider removing them.
All types of cystic acne scar removal are based on removing the top layer of the skin that is affected by scarring to reveal the smoother skin underneath.
The main types of cystic acne scars removal are:
- Laser abrasion - the top skin layer is burned away by lasers
- Dermabrasion - the top layer of skin is removed mechanically, by a rapidly rotating wheel to promote skin regeneration
- Chemical peel - the top layer of skin is removed by a combination of strong organic acids
Whatever method of acne scars you choose, it should be carried out by certified professionals.
Managing Cystic Acne
We completely understand that cystic acne is upsetting and often traumatic. The Sönd skincare range of alkalising skincare products has been developed with skin just like yours in mind.
Try it today and see how we can transform your skin and the way you feel about your skin.
This article is not meant to treat or diagnose. Please visit your doctor for advice about any health concerns you may have.