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If you break out in large, pus-filled pimples, you may have cystic acne, the most severe type of acne.

Cystic acne is different from whiteheads and blackheads; therefore, it does not respond to the same treatments.

There’s no cure for cystic acne, but there are effective treatments. Here’s what you need to know.

What Is Cystic Acne?

Cystic acne is more than just a stray pimple here and there. Cystic acne refers to painful, inflammatory cysts that extend deep into the skin from the surface. They are usually red, filled with fluid called pus, and larger than other pimples.

People with acne cysts may also have acne nodules. A nodule is similar to a cyst but remains under the skin. A nodule doesn’t contain fluid — it is a buildup of oil, dead skin cells, and bacteria, making it harder and more solid.

Cystic acne often appears as large, red, and painful bumps on the skin. These bumps are typically filled with pus and can be tender to the touch. Unlike other forms of acne, cystic acne is deeply embedded in the skin, which makes it more painful and prone to scarring.

Cystic acne can occur on various body parts, including the face, chest, back, upper arms, and shoulders, and range in size from small (like a pea) to large (like a dime). They often resemble boils on the skin and are red and swollen.

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What Causes Cystic Acne?

When oil and dead skin block skin pores, pimples form. When bacteria also enter the pores, it can cause inflammation or swelling in the middle layer of the skin, which can then become cystic acne.

Risk factors for acne flareups include:

• A family history of acne — If your mother or father had acne, you will likely also.
• Changes in hormone levels — Anytime there’s a hormonal change in the body (like puberty or your period), you’re more likely to break out. Hormones cause oil-producing glands in the skin to make more oil, which can clog skin pores.
• Hair and skin care products — Using products not made for acne-prone skin can increase your chances of breakouts.
• Stress — There’s a relationship between stress and breakouts. Our bodies produce more hormones called androgens in response to stress. In turn, the hormones stimulate the oil glands to ramp up production, leading to breakouts.

Why am I getting cystic acne all of a sudden?

Cystic acne can suddenly develop due to various factors, including hormonal changes, genetics, stress, medications, and others. Even if you have never experienced it, these factors can lead to the sudden onset of cystic acne.

Where does cystic acne appear?

Cystic acne can cover your cheeks and forehead. You can also get cystic acne on the chin, jawline, and neck. Some people get cystic acne on their chest, back, and buttocks.

Side effects of cystic acne

Cystic acne is more than just a nuisance. It can cause other physical and emotional problems, such as:

• Acne scars — Cystic acne goes deep into the skin, damaging the skin and underlying tissue. This can lead to scarring when the cyst heals.
• Depression — Teens with severe acne have a higher risk of developing depression. That’s one reason it’s important to get treatment for cystic acne right away.
• Low self-esteem — Feeling self-conscious about your appearance with acne can affect your social life and confidence.

Cystic Acne Treatment

You may wonder how to get rid of cystic acne or shrink a cystic pimple. Over-the-counter treatments that may work for other kinds of acne have little effect on hormonal cystic acne. To treat cystic acne effectively, you need to see a dermatologist.

Treating cystic acne can help clear your skin, prevent new scars, and boost your self-esteem.

Your doctor may prescribe:

• An oral antibiotic — This is usually the first treatment your dermatologist will suggest. An antibiotic can reduce the redness and swelling of cysts and fight the bacteria causing them.
• Birth control pills — If you have a female reproductive system, your doctor may suggest birth control pills as part of your treatment. The pills balance your hormones. That helps clear acne by slowing down overactive oil glands in the skin.
• Isotretinoin — This strong medicine requires your doctor to monitor you closely. Side effects include dry mouth and eyes, light sensitivity, and congenital disabilities should you become pregnant. Most people who take isotretinoin see permanent clearing after several months of the drug.
• Topical medicine — With the antibiotic, your doctor may also prescribe medicine you put directly on your skin to reduce bacteria and clogged pores.

Once you start treatment, be patient. It may take up to three months to see improvement in your skin.

Do pimple patches work on cystic acne?

Pimple patches, made of hydrocolloids, can help surface-level acne heal. They absorb fluid and prevent picking. This won’t help with cystic acne deep under the skin, though. They may reduce redness but can’t reach deep enough to affect cysts or relieve pain.

Traditional treatments include topical retinoids, oral antibiotics, isotretinoin, steroid injections, and hormonal medicines. These treatments tackle the causes, reduce inflammation, and prevent new cysts.

Can You Remove an Acne Cyst?

You should never pick at or squeeze your pimples, especially cysts and nodules. You’ll risk making the pimples worse and also increase your chance of scarring.

Your dermatologist can help remove a large cyst.

Here’s how:

• Injecting it with a corticosteroid — Can quickly reduce the size and pain of the cyst.
• Incision and drainage — Your doctor can drain a large, painful cyst that doesn’t clear with medicines.

To help prevent breakouts, use a mild cleanser, oil-free moisturizer, and water-based makeup. Ask your dermatologist about acne-friendly skin care products.

Editor's Note: This article was originally published on April 11, 2023, and was last reviewed on December 11, 2024.