What does cystic acne mean?

What does cystic acne look and feel like?

An acne cyst can look like a red lump under the skin and feel tender or painful. Some are about the size of a pea; others reach the size of a dime. A cyst can develop a whitish yellow head, release pus or become crusty. The face is a common location, but cysts also develop on the back, chest, shoulders, neck, upper arms and buttocks.1

An acne cyst contains pus. An acne nodule is also deep and painful, but contains no pus and feels harder. Both can occur alongside blackheads, whiteheads and smaller pimples. A surface pimple with pus is called a pustule; pus alone does not make a pimple cystic. The depth of the inflammation matters.2

Why does cystic acne happen?

Acne starts when oil and dead skin cells block a pore. Bacteria normally present on the skin can become trapped and multiply, triggering inflammation, meaning swelling. When that inflammation extends deep into the skin, a nodule or cyst develops.2

Hormonal changes can make skin oilier, including changes during puberty, menstrual periods and pregnancy. Acne also tends to run in families. Certain medicines, oily cosmetic or hair products, heavy sweating and humidity can contribute. Adults can develop acne too; deep breakouts are not limited to teenagers.3

What should you do next?

1. 1Arrange a skin examination with a dermatologist. Deep nodules and cysts need medical treatment, and starting sooner reduces permanent scarring.
2. 2Leave the bumps alone while waiting. Squeezing, scratching or picking can cause infection, slow healing and leave scars.
3. 3Wash gently with a mild cleanser in the morning, before bed and after sweating. Use lukewarm water and your fingers rather than a washcloth or sponge.
4. 4Remove makeup before sleeping and use an oil free moisturizer if your skin feels dry.

A mild cleanser is enough for washing, without turning the sink into a product demonstration.3

Choose water based cosmetics or noncomedogenic creams, which are made to avoid clogging pores, rather than letting a promise of 'perfect skin' do the shopping.3

How is cystic acne treated?

Treatment often combines oral antibiotics with prescription creams or gels. Other options include hormonal treatment and isotretinoin, an oral medicine related to vitamin A. A dermatologist can inject an especially painful cyst to reduce pain and help it clear faster. Treatment choice depends on your age, acne type and severity.125

Topical retinoids, medicines related to vitamin A that help prevent blocked pores, are used across the affected area rather than only on individual spots. Follow the directions for the prescribed medicine instead of treating every acne product as interchangeable.35

Isotretinoin requires close medical monitoring and regular blood tests. It must not be taken during pregnancy because it causes severe birth defects.3

How long does it take, and what can remain?

Clearing acne cysts can take three months or longer. Acne treatment in general can take six to eight weeks to show a response, so early improvement and complete clearing are different milestones.13

A permanent acne scar can be indented or raised. A completely flat pink, red, purple, brown or black mark left after a breakout is different: these colour changes eventually fade, although some last a year or longer. You cannot predict with certainty who will develop scars.2

Contact your clinician if acne is worsening, scars are developing or you notice signs of infection. Emotional distress also deserves attention. Severe acne can have a substantial psychological impact, and effective treatments are available.136