What Is Cystic Acne?

Cystic acne (sometimes called nodulocystic acne) is the most severe form of acne vulgaris. It causes deep, inflamed breakouts 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.

This article discusses the causes of cystic acne and the scars it can leave. It also covers who is at risk for cystic acne along with what can be done to treat it.

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's 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. Aggressively treating this form of acne can help minimize scarring.

Avoid picking at or trying to pop acne cysts or nodules. Doing so can greatly damage the skin, lead to scarring, and even worsen your acne.

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 healthcare provider. Getting treatment for your acne can help improve your self-confidence,

Causes

Acne—including cystic acne—has three basic causes, which include:

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

Inflamed acne blemishes develop when the follicle wall ruptures, leaking infected material into the dermis (skin). 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. Some people are more prone to developing these types of serious breakouts than others.

Nodules develop when the infected material leaks into nearby follicles. Cysts form when a membrane forms around the infection in the skin.

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.

Treatment

Cystic and nodulocystic acne should be treated by a dermatologist. Powerful systemic medications are usually required. Systemic medications circulate through the whole body, rather than targeting just one part.

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:

• Oral antibiotics
• Accutane (isotretinoin)
• Oral contraceptives (for women)
• Surgical excision and drainage, in which a healthcare provider makes a small incision in the skin and extracts the infected material
• Intralesional corticosteroid injections

Summary

Cystic acne is a severe form of acne that causes painful, fluid-filled bumps under the skin's surface and sometimes scars. Nothing you do (or don't do) causes cystic acne, though it does seem to run in families. Treatment varies depending on how severe the acne is, and ranges from oral antibiotics to surgical drainage for blemishes that are especially painful and stubborn.

A Word From Verywell

Severe acne like cystic acne is painful and can make you self-conscious. While you can't help your breakouts, you don't have to just live with them. 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.