Cystic Acne – Causes, Symptoms & Treatment

January 15, 2026 4:26 am

Cystic acne is one of the most severe forms of acne and can be physically painful as well as emotionally draining. Unlike common pimples that appear on the surface of the skin, cystic acne forms deep underneath and often lasts much longer. Many people struggle with it for years and feel frustrated when typical acne treatments do not work.

This guide explains cystic acne in detail, including what it is, why it develops, how it looks, treatment options, daily care tips, and ways to reduce scarring. It also answers common questions people search for when trying to manage cystic acne and improve their skin health.

 

What is cystic acne

Cystic acne is a severe type of inflammatory acne that develops deep within the skin. It appears as large, swollen, and painful lumps known as cysts or nodules. These lesions are filled with fluid or pus and are surrounded by inflammation.

Unlike whiteheads or blackheads, cystic acne does not come to a visible head. Because it forms deep under the skin, it heals slowly and often leaves scars or dark marks if not treated properly.

 

How cystic acne is different from regular acne

Acne exists in different forms, and cystic acne is the most severe.

Mild acne includes blackheads and whiteheads that affect the surface of the skin. Moderate acne involves red pimples and pustules that may contain pus but are still closer to the surface.

Cystic acne forms much deeper. The inflammation spreads into surrounding tissue, which causes pain, swelling, and long healing times. This depth is also why cystic acne has a higher risk of permanent scarring compared to other types of acne.

 

Common areas affected by cystic acne

Cystic acne usually appears in areas where oil glands are more active. These areas include:

• Face, especially the jawline, chin, and cheeks
• Neck
• Chest
• Shoulders
• Upper back

Jawline and chin acne are especially common in adults and are often linked to hormonal changes.

 

What causes cystic acne

Cystic acne does not have a single cause. It usually develops due to a combination of internal and external factors.

Excess oil production

The skin produces oil called sebum to stay moisturized. When the body produces too much oil, pores can become clogged. This trapped oil creates an environment where bacteria can grow and cause inflammation.

Clogged pores and dead skin cells

Dead skin cells are normally shed from the surface of the skin. When they do not shed properly, they mix with oil and block hair follicles. In cystic acne, this blockage happens deep inside the skin, leading to severe inflammation.

Bacteria growth

A bacteria known as Cutibacterium acnes lives naturally on the skin. When it becomes trapped in clogged pores, it multiplies and triggers the immune system. This response causes swelling, redness, and the formation of cysts.

Hormonal changes

Hormones play a major role in cystic acne. Androgens increase oil production, which raises the risk of clogged pores. Hormonal changes are common during:

• Puberty
• Menstrual cycles
• Pregnancy
• Polycystic ovary syndrome
• Menopause

This is why cystic acne often appears along the jawline or worsens at certain times of the month.

Genetics

Family history can increase the risk of cystic acne. If close relatives had severe acne, it is more likely that you may develop it as well.

Stress

Stress increases cortisol levels in the body. High cortisol can increase oil production and inflammation, making cystic acne worse.

 

Signs and symptoms of cystic acne

Cystic acne has clear signs that set it apart from other skin conditions.

Common symptoms include:

• Large, firm lumps under the skin
• Red or skin colored swelling
• Pain or tenderness, even without touching
• Lesions that last for weeks or months
• Multiple cysts appearing at the same time

Cystic acne is often painful and may feel warm or tight.

 

Emotional impact of cystic acne

Cystic acne can affect mental and emotional well being. Many people experience frustration, embarrassment, or low confidence, especially when acne is visible on the face.

Emotional effects may include:

• Low self esteem
• Anxiety in social situations
• Avoiding photos or public events
• Feelings of sadness or hopelessness

These feelings are common and valid. Treating cystic acne early can help reduce both physical and emotional effects.

 

Can cystic acne cause scarring

Yes, cystic acne has a high risk of scarring. Because cysts damage deeper layers of skin, healing often leaves changes in texture or color.

Common acne scars include:

• Ice pick scars, which are deep and narrow
• Boxcar scars, which are wide and shallow
• Rolling scars, which create uneven skin texture
• Dark spots that remain after acne heals

Picking or squeezing cysts greatly increases the risk of permanent scarring and should be avoided.

 

How cystic acne is diagnosed

Cystic acne is usually diagnosed through a visual skin examination. In most cases, no special tests are needed.

If acne is severe, persistent, or linked to other symptoms such as irregular periods or excess hair growth, a healthcare provider may check for hormonal imbalance.

 

Treatment options for cystic acne

Cystic acne usually requires medical treatment. Over the counter products alone are rarely effective.

Prescription topical treatments

Topical treatments may include:

• Retinoids that prevent clogged pores
• Antibiotics that reduce bacteria and inflammation
• Combination products that target multiple causes

These treatments are often used alongside oral medications.

Oral antibiotics

Oral antibiotics help reduce inflammation and bacterial growth. They are usually prescribed for short periods to avoid resistance.

Hormonal treatments

Hormonal treatments may help individuals whose acne is linked to hormone changes. These treatments reduce oil production and improve breakouts over time.

Isotretinoin

Isotretinoin is one of the most effective treatments for severe cystic acne. It works by reducing oil production, preventing clogged pores, and decreasing inflammation. It requires close medical monitoring.

Cortisone injections

For large and painful cysts, a healthcare provider may inject medication directly into the lesion. This can reduce swelling and pain quickly.

 

Daily skincare for cystic acne

Daily skincare plays an important role in managing cystic acne.

Cleansing

Use a gentle cleanser twice a day. Harsh soaps or scrubs can irritate the skin and make inflammation worse.

Moisturizing

Moisturizing is important even for acne prone skin. Choose a non comedogenic moisturizer that does not clog pores.

Sun protection

Sunscreen helps prevent dark marks and scarring. Use a lightweight sunscreen suitable for acne prone skin.

Avoid picking

Picking or squeezing cysts increases inflammation and scarring. It also slows healing.

 

Home care tips

While medical treatment is often necessary, certain habits can support skin health.

• Wash pillowcases and towels regularly
• Avoid touching your face frequently
• Remove makeup before bed
• Use oil free and non comedogenic products

Consistency matters more than using many products.

 

Diet and cystic acne

Diet does not cause cystic acne, but it may affect some people.

Some individuals notice improvement when limiting:

• Sugary foods
• Highly processed foods
• Certain dairy products

Eating a balanced diet with fruits, vegetables, whole grains, and lean protein supports overall health.

 

Stress management

Stress does not directly cause cystic acne, but it can worsen flare ups.

Helpful stress management techniques include:

• Regular exercise
• Deep breathing or meditation
• Adequate sleep
• Taking breaks from daily stress

Reducing stress can help improve skin over time.

 

How long does cystic acne take to heal

Cystic acne takes longer to heal than mild acne. Individual cysts may last weeks or months.

Most treatments require several weeks before improvement is noticeable. Some treatments may cause temporary flare ups before results appear. Patience and consistency are important.

 

When to see a dermatologist

You should seek professional help if:

• Acne is painful or worsening
• Over the counter products are not effective
• Scarring is developing
• Acne affects emotional well being

Early treatment can prevent long term skin damage.

 

Long term outlook

With proper treatment and care, many people achieve significant improvement or long term control of cystic acne. Finding the right treatment plan may take time, but effective options are available.

 

Common myths about cystic acne

Poor hygiene causes cystic acne

Cystic acne is not caused by dirty skin. Over washing can make it worse.

Popping cysts helps them heal

Popping cysts increases inflammation and scarring.

Only teenagers get cystic acne

Cystic acne affects both teenagers and adults.

 

Living with cystic acne

Living with cystic acne can be challenging, but it is manageable. Building a routine, following treatment plans, and seeking support can make a significant difference.

Remember that cystic acne does not define your worth or appearance.

 

Frequently Asked Questions

1. Can cystic acne go away on its own

Cystic acne may improve over time for some people, but it rarely goes away completely without treatment. Because it forms deep under the skin, medical treatment is often needed to prevent scarring and long term skin damage.

2. Is cystic acne always painful

Most cystic acne lesions are painful or tender because of deep inflammation. However, the level of pain can vary from person to person and from one breakout to another.

3. Why does cystic acne keep coming back in the same spot

Cystic acne often returns to the same areas due to ongoing inflammation, oil gland activity, or hormonal influence in that region. Deep damage to the pore can make repeat breakouts more likely.

4. Can stress alone cause cystic acne

Stress does not directly cause cystic acne, but it can worsen existing acne by increasing oil production and inflammation, leading to more frequent or severe breakouts.

5. Is cystic acne contagious

No, cystic acne is not contagious. It cannot be spread through touch, sharing towels, or close contact with others.

6. Does popping a cystic pimple help it heal faster

No, popping or squeezing cystic acne usually makes it worse. It increases inflammation, delays healing, and greatly raises the risk of permanent scarring.

7. Can adults develop cystic acne even if they never had acne before

Yes, adult onset cystic acne is common, especially in women. Hormonal changes, stress, and genetics can trigger cystic acne later in life.

8. How long does it take for cystic acne treatment to work

Most treatments take several weeks to show improvement. In some cases, it may take a few months before significant changes are seen. Consistency with treatment is essential.

9. Can cystic acne scars be treated

Yes, acne scars can be treated with professional procedures such as chemical peels, laser therapy, microneedling, or fillers. A dermatologist can recommend the best option based on scar type.

10. Should I see a dermatologist for cystic acne

Yes, cystic acne should be evaluated by a dermatologist. Early professional treatment reduces the risk of scarring and helps control breakouts more effectively.

 

Conclusion

Cystic acne is more than a surface level skin problem. It is a deep inflammatory condition that often requires patience, proper treatment, and consistent care. While it can be painful and emotionally challenging, effective treatment options are available, and improvement is possible for most people.

Understanding what triggers cystic acne, recognizing early symptoms, and avoiding harmful habits like picking or over treating the skin can make a meaningful difference. Seeking professional help early, following a simple skincare routine, and making supportive lifestyle choices can protect both your skin and your confidence over time.

With the right approach and ongoing care, cystic acne can be managed successfully, and healthy, clearer skin is an achievable goal.