cystic acne

More About Acne

What is Cystic Acne?

Cystic acne is the most advanced stage of acne. 

Acne is a result of sebaceous glands blockage. Hormones cause excessive skin oil (sebum) production. The sebum blocks the follicles forming blackheads and whiteheads. Bacteria called propionibacteria that are usually harmless start accumulating using excessive oil. This causes inflammation. 

Inflammation is a process that attracts immune cells to the black and white cells, which kill bacteria but die in the process. The mix of dead bacteria and immune cells is pus that fills hair follicle during cystic acne. If the lining of hair follicle breached, the pus leaks into the underlying tissues.

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What Does Cystic Acne Look Like?

Cystic acne has a distinctive look. The next stage of whiteheads and blackheads progression are pustules where pus starts accumulating along the shaft of the hair. 

The third stage of cystic acne formation are cysts where the pus accumulates in significant quantities near the hair shaft creating a pus-filled sack. After rupture and emptying of a cyst into underlying tissue, it becomes papule, bigger cysts develop nodules. 

Because of undersurface skin damage. The skin during acne looks like the surface of the Moon: uneven, pitted, rough, with shallow and deep depressions and pimples in different stages. 

Healing of cystic acne leads to scars formation. Scars can be - ice-pick (deep and narrow), boxcar (bigger, sharp edges) and rolling (shallow edges).

What Causes Cystic Acne?

Cystic acne is the most severe stage of acne. It develops in places that have a high density of sebaceous glands, including the face. There is no cysts and nodules without whiteheads and blackheads. So we can say that the cause of cystic acne is:

  • the genetics that determines pimples formation,

  • hormonal surges at different stages of life such as puberty or pregnancy,

  • the lifestyle - much stress, physical inactivity, junk food diet,

  • improper skin care regime

There are also data that excess of vitamin B3 (nicotinic acid) and B12 (folate) causes acne to become worse. Vitamin B9 (biotin) found in bananas helps to strengthen hair and nails and fight acne.

can diet cause cystic acne?

Diet is a significant trigger of acne formation, including cystic acne. Modern Western-style diet rich in simple sugars such as glucose and fructose, fats and salt induces sebum production, the first step on the pathway of acne. 

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 yogurts), on the other hand, had shown in clinical trials to reduce acne.

can allergies cause cystic acne? 

Allergies have a different cause and mechanism than acne. Allergies are mediated by overproduction of a specific type of antibodies, IgE while skin inflammation in cystic acne mediated mostly via white blood cells attraction. 

Skin rash associated with an allergy is quite different from the whiteheads and blackheads that are the basis of cystic acne. The allergic rash appears quickly after contact with an allergen, while the 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 to remove food such as eggs if there is no proven allergy because vitamins and microelement 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 skin rosacea caused by alcohol. Cystic acne formation is a long term process that cannot be altered by occasional alcohol consumption. However, it is 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. The allergies irrespective of their trigger cannot cause cystic acne. In fact, topical remedies containing antibiotics and oral antibiotics are often prescribed for cystic acne. See also ‘Can Allergies Cause Cystic Acne?’ for more details.

can anxiety cause cystic acne?

Anxiety and other mental health issues 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 level of it in the organism can make the condition worse.

can lack of sleep cause cystic acne?

Chronic lack of sleep is one of the most substantial factors that cause 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, 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 fell under pressure for a long time, for example, during preparation and 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 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 add to skin oil and promotes acne. 

Cosmetics applied generously and not removed for a long time blocks skin glands and causes irritation. Improper skin care routine also irritates the skin, and this can also make acne worse. 

Can mould cause cystic acne?

Mould is a generic name of various lower fungi that colonise human homes growing on walls in damp places. Another type of mould grows on out of date products such as bread. 

Mould produces spores - microscopic particles that fungi use to propagate - that in high quantities can cause allergy and breathing difficulties. 

Mould can be toxic for the skin. As the mould spores are released into the air, they trigger allergies and compromise the immune system, trailing a multitude of skin problems including acne. 

what hormones cause cystic acne?

In a sense, all acne, including 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 associated with transitional life stages such as puberty or pregnancy. Surges in female (estrogens) 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 is cystic acne usually found?

Cystic acne found in the places of the most density of previous acne stages, blackheads and whiteheads. In turn, they are formed in the locations of the densest concentration of glands that secrete sebum - on the face and upper half of the back and on the chest. On face cystic acne concentrates on chin, hairline, and jawline.


The face is the most inconvenient place for cystic acne formation at it usually causes social embarrassment and anxiety. Treatment for cystic acne on the face can be divided into general and topical. 

General treatment targets the source of acne all around the body. The face will be one of the places where the acne will be relieved or eradicated. Most common general treatments are antibiotics and vitamins, as well as hormonal therapy for women. 

Topical applications are included in 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. It is important to avoid an overdose due to a combination of the same general and topical treatment for cystic acne.


Acne outbreaks often concentrate on the chin because it contains a large number of sebaceous glands associated with hair follicles. 

Chin and other acne-prone areas such as the nose and hairline need an extra thorough skin care routine - cleansing, exfoliating, moisturising. It is also essential to use the non-irritating methods of hair removal.


A jawline is often a place of cystic acne formation. Firstly, it has a large number of sebaceous glands and hairs. Additionally, it often the location of skin irritation by chinstraps of bicycle and other types of helmets and head hovers. See Face for treatment options.


The neck is one of the places where cystic acne can localise to. The cause of neck acne is the same as for cystic acne appearance in the other body locations. It’s the result of sebaceous glands blockage, colonisation by skin bacteria and following inflammation. 

Cystic neck acne usually targeted in the course of comprehensive acne treatment such as retinoids, vitamins, antibiotics, and hormones prescriptions.


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. 

Additionally to the usual treatments for cystic acne that lessen the extent of cystic acne, there are specific treatments for the nose that safely unblock the pores such as pore strips and face masks.


The back can be affected by acne during moderate to severe acne when cystic acne appears. 

Because of the high surface area of the back and the fact that it is mostly covered by clothing which would remove topical treatments, back cystic acne is treated via the general route. That means pills with a combination of vitamins including retinoids or antibiotics. Hormonal contraceptives may be prescribed for women as they are shown to normalise hormone levels that cause acne formation and severity.

how to treat and get rid of cystic acne

Is it possible to clear cystic acne? It’s certainly possible to reduce its extent and get rid of its remnants, the pitted scars. What is essential to understand about the cystic acne treatment is that there is no 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 ends with correct skin care routine.

how to cure cystic acne naturally

Cystic acne is the result of hormonal surges followed by skin pores blockage and resulting 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 low in simple sugars - glucose, fructose, and saccharose. It should not contain a lot of highly processed, high fat and/or fried food. Milk and dairy are also often detrimental for the skin condition. 

Fish specifically oily fish, vegetables excluding starch-rich potato are good for the skin as they contain fibre important for the digestive system. They also contain vitamins that are shown to be necessary for cystic acne clearance. 

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

  • Dapsone

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.

Medications for cystic acne

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 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, sulfacetamide. 

Different antibiotics should not be taken together at the same time to avoid interference and side effects. It is 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, e.g., 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.

topical treatments for cystic acne

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. 

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 application places. Higher concentration causes side effects more frequently.

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 is important to have a proper diet and skin care regime to extend its benefits.

alternative treatments for cystic acne

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, the data supporting the light therapy on its own are not 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.

which ingredients help with cystic acne?

does apple cider vinegar help with  cystic acne?

Apple cider vinegar is a folk remedy for cystic ane. 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. Do not try to use it on your 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. However, the data that show 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 the 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 size or number of lesions during cystic acne. 

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.

caring for cystic acne

can you pop cystic acne?

Cystic acne is a skin inflammation that involves not only sebaceous glands and hair but underlying deep tissues. It is a terrible idea to damage the inflamed glands by popping or squeezing them. You will damage the skin even further risking to get bacteria into the deep layers of skin where they can spread to other parts of the skin. Also, you can make the infection worse by transferring the bacteria from your hands into the wound. 

Using mechanical implements such as needles to pop the cystic nodules is also a bad idea even if you can 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 redness of cystic acne

Redness during cystic acne is a sign of skin irritation. What you do about it depends on the cause. Some topical medications used for cystic acne alleviation 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 by something else. 

However, in many cases, redness is worse because you don’t have a correct skin care regime. It is essential to develop a proper skin care regime and maintain it. Moisturising is especially important.

how to treat cystic acne at home

Cystic acne is a serious condition that requires professional attention. Before treating it at home, you need to consult your home doctor and a certified cosmetologist. 

Once they have provided their professional opinion you can support the healing process by addressing the lifestyle factors that might be contributing to the cystic acne.

can cystic acne be prevented?

Cystic acne develops gradually from regular acne. Genetics plays a vital role in cystic acne development. Most people don’t get cystic acne, 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 is important not to pick at cystic acne because long term scarring is mostly induced by picking the pimples.

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 has scars. The resurfacing new skin that is regenerated is then smoother. 

The main types of cystic acne scars removal are

  • Laser abrasion - the top skin layer is burned by laser,

  • Dermabrasion - the top layer removed mechanically, by a rapidly rotating wheel,

  • Chemical peel - skin removed by a combination of strong organic acids. 

There are also less drastic techniques: 

  • Using a roller device covered with needles that punctures the skin and promotes skin regeneration. Because it’s milder than abrasion, you may need to do it several times.  

  • Filling the uneven skin with collagen or fat. As the fillers get absorbed, you will need to top it up. 

Whatever method of acne scars you choose, it should be done by certified professionals.


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