What Is Cystic Acne?

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Cystic acne (sometimes called nodulocystic acne) is the most severe form of acne vulgaris. It causes deep, inflamed breakouts to develop on your face and/or other areas of the body, and it can leave scars. The blemishes themselves can become large, measuring up to several centimeters across.

Dermatologist examining patient
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Inflamed vs. Cystic Acne

Although many people use the term "cystic" to describe any type of severely inflamed acne, only those who develop acne cysts truly have cystic acne.

Acne cysts are the most serious kind of acne blemish. They feel like soft, fluid-filled lumps under the skin' surface. Acne cysts are painful.

People with nodulocystic acne develop acne nodules as well as acne cysts. Acne nodules are hard, painful lumps under the skin's surface. Much larger than acne papules, nodules form deep within the skin and take a long time to heal.

Some skincare experts believe acne cysts are not really cysts at all, but rather severely inflamed nodular breakouts. For those who have nodules, but do not have cystic lesions, the term nodular acne is more accurate.

No matter what label you use, home treatments are unlikely to help—you need a dermatologist to treat acne of this severity. Talk to your primary care provider to get a referral to someone who can help.

Scarring

Nodulocystic breakouts damage and destroy healthy skin tissue. Because of this, the likelihood of developing scars is extremely high.

Picking at the skin and trying to pop cysts or nodules should be avoided at all costs. Doing so can greatly damage the skin, lead to scarring, and worsen acne. Aggressively treating this form of acne can help limit the severity of scarring.

It's also common for those with severe acne to have feelings of embarrassment, shame, and anger regarding their skin. Some people may avoid mirrors or shy away from social situations.

Acne can hurt self-esteem and may lead to depression. If you feel acne is greatly affecting the quality of your life, please talk to your doctor. Luckily, with treatment, most people find their self-confidence improves.

Causes

Cystic acne is caused by the same factors as other forms of acne, which are:

  • Overactive oil glands
  • Excess dead skin cells within the hair follicle (pore), and
  • A large number of acne-causing bacteria, Propionibacteria acnes

Inflamed acne blemishes develop when the follicle wall ruptures, leaking infected material into the dermis. If this break occurs near the skin's surface, the blemish is usually minor and heals quickly.

Deeper breaks in the follicle wall cause more serious lesions. Nodules develop when the contaminated material infects adjoining follicles.

Like nodules, cysts begin as a deep break in the pore wall. A membrane then forms around the infection within the dermis. Some people are more prone to developing these types of serious breakouts than others.

Cystic acne is not caused by drinking soda, eating sweets, or a lack of cleansing. Rest assured that you did nothing to cause your skin problems.

Genetics of Acne

Acne seems to run in families. If your parents had cystic acne, you are more likely to experience severe acne yourself.

Treatment

A doctor must treat cystic and nodulocystic acne. Powerful systemic medications are usually required.

Acne of this severity can be hard to control. Don't be discouraged if the first treatment attempt fails. It may take several tries to find the treatment or combination of treatments that work for you.

Some common treatments for nodulocystic acne include:

A Word From Verywell

Severe acne like cystic acne is painful and can make you self-conscious. While you can't help that you got it, you don't have to just live with it. A dermatologist can work with you on how to treat your skin condition and clear it up with the least possible amount of scarring, which can make you feel more confident about your appearance.

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  1. American Academy of Dermatology Association. What can clear severe acne?

  2. National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases. Living with acne. Updated September 2016.

  3. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-73.e33. doi:10.1016/j.jaad.2015.12.037