Understanding and Treating Cystic Acne


Cystic acne requires surgery or prescription medication, the most common one being Accutane.

Cystic acne is one the most severe and difficult forms of acne to treat. Causing masses of infection to accumulate underneath the skin, cystic acne cannot be treated simply by opening up pores in the skin—because the pores no longer exist. No over the counter products, natural treatments, or home remedies can cure this severe, painful problem. With the right combination of strong medication and simple skin care, however, cystic acne can be reversed and skin damage repaired.


  • An acne cyst is basically a pimple you couldn’t ever pop.
  • Cysts are covered with healthy skin.
  • Anyone can get cystic acne, but certain groups are more susceptible.
  • Treating cystic acne requires surgery or oral medication. You should never try to treat cystic acne on your own.

What Is Cystic Acne?

Cystic acne is basically a pimple you cannot possibly pop. The bacterium that causes acne, Propionibacterium acnes, grows faster when it is not exposed to the air. A skin pore gets clogged with the skin oil sebum that hardens over a colony of this acne bacteria. The bacteria themselves produce peroxides that help break down the sebum they consume as food. These peroxides are irritating, but they are not the main source of the problem in cystic acne.

The major damage of cystic acne is done by the immune system itself. The body sends white blood cells that release inflammatory chemicals known as interleukin-8, interleukin-12, and tumor necrosis factor. The bacteria send out chemicals that make the skin unusually sensitive to these chemicals, and the walls of the pore dissolve. Since acne bacteria don’t need air, and grow faster when they are not exposed to air, they invade surrounding tissues around the pores. They send out more chemicals to make more skin cells sensitive to inflammation, and the immune system sends out even more inflammatory agents.

As long as the pore is open to the surface, the infection can be treated with topical antibiotics and benzoyl peroxide. In babies who have rapidly growing skin and in certain people whose skin grows faster in response to inflammation (more about those groups in a moment), however, new skin encases the infection. This forms a cyst that can persist for months or years, causing itching, irritation, and embarrassment.

Who Gets Cystic Acne?

Anyone can get cystic acne, but the condition is most common in:

  • Babies of all races who have compromised immune systems,
  • Teenage and adult Hispanic men and women,
  • Teenage and young adult African-American men and women, and
  • Women of all races who have a condition called polycystic ovarian syndrome, of PCOS.

Babies can be born with blackheads. These blemishes are distressing to the new parents, but they usually go away in a few weeks. When the baby has been exposed to some chemical that alters the immune system, however, the blackhead can trap bacteria inside the skin and cause a cyst to form.

Hispanic teens and adults of both sexes are much more likely to get cystic acne than people of northern European descent. Actually, one does not have to have a Hispanic surname or Hispanic ancestors to have an elevated risk of acne. Dermatologists term the type of skin that gets “Hispanic” acne Fitzpatrick Skin Types IV and V.  This is skin that is beige to dark brown that takes a tan but very seldom burns.

By “African” skin, dermatologists really mean Fitzpatrick Skin Type VI. This is black skin that never burns. Most people who have black skin only get cystic acne on the face. When cystic acne occurs elsewhere on the body, it is a telltale sign of another condition that is most common among people of African heritage, sarcoidosis. Blacks and Whites get acne about the same rate, although Blacks typically develop acne in response to changes in sex hormones, while Whites typically develop acne in response to stress hormones.

White people can get cystic acne, too. Unlike people of African heritage, people of European heritage usually develop cystic acne on the back and chest, not on the face. In Whites, cystic acne on the face is a sign of immune deficiency disease.

Women of all races can develop persistent acne with polycystic ovarian syndrome, or PCOS. In PCOS, acne is due to overproduction of testosterone by the ovaries, but it is not exclusively due to the overproduction of testosterone by the ovaries. Growth hormone also affects the condition of the skin. Ironically, the women who are working hardest to control their PCOS by natural means are the women who are most likely to develop cystic acne. This is due to the fact that fasting diets are used to bring down blood sugar levels to bring down testosterone levels, and growth hormone levels increase during fasting.

What Can Be Done About Cystic Acne?

Nothing you put on your skin heals cystic acne. Microdermabrasion won’t work, because the skin over the cysts is still healthy. Laser therapies won’t work because they don’t penetrate deep enough. Natural therapies just don’t work, either. This form of acne has to be treated from the inside out with heavy duty acne medication, or treated with surgery. Most people prefer medication to lancing or surgery.

The drug most commonly prescribed for cystic acne is isotretinoin, also known as Accutane. This drug is taken by mouth, not spread over the skin. It gradually shrinks the tissues encasing the cyst, and it stimulates the growth of the skin over the cyst so it eventually opens to the surface without lancing. But that’s when your daily acne skin care routine has to begin in earnest.

Stimulating the growth of the skin opens cysts, but it also closes pores. If you do not follow an effective daily skin care routine, preferably with the help of a treatment kit such as Exposed Skin Care so you take care of every aspect of mild to moderate acne care, your underlying condition can cause your skin to form new cysts about as fast as the old cysts heal. It is essential to do the same cleansing, moisturizing, and exfoliating routine anyone does for non-cystic acne, probably for the rest of your life. But if you keep up your skin care, cysts will be gone for good. Then you can turn your attention to acne scar removal.

Never try to treat cystic acne on your own.

There are conditions that look like cystic acne that are not really cystic acne, especially acne keloidalis nuchae, which occurs most frequently in Black and Hispanic teenaged males. Never take someone else’s acne treatment. Work with your dermatologist to find your own acne solutions to get the best results.

{ 13 comments... read them below or add one }

    Accutane is a dangerous drug. There was a class-action lawsuit recently against it as it can cause life long damage to the digestive system.

    My son has severe, cystic acne. Want can he do to stop it? Please help!

    My son’s acne has escalated and he has had a couple of cystic acne blemishes. His dermatologist just prescribed him Doryx (doxycycline). I’m reading about the side effects right now. You might check it out.

    Ahhhhh, no! Doryx is awful! It is awful in the sense that when you stop taking it, the cysts come back even worse. I had to learn that the hard way. I researched the drug and read a lot about it and the vast majority of people who took it ended up with cysts worse than before, but I didn’t care at the time. I just wanted the nasty cysts gone so I went ahead with the treatment. Mine is back after a little over a year after I stopped taking it. I really regret taking Doryx. Back to being a hermit, I guess.

    ice the cysts then use grapeseed oil on them overnight (i used Hobe Labs brand) but other brands will work too i think……..avoid sugar, caffeine, wheat and soy……Queen Helene Mint Julep mask is very good too………people say drinking Lugol’s iodine will make acne worse but it actually improves for me !

    I have heard Queen Helene Mint Julep Mask works well, also, but I have not tried it yet. But I think I’ll try it soon because I was prescribed “Doryx” and it DID work for the most part, but about a year after finishing the treatment (NOW), it is rearing it’s ugly ‘head’ again, worse than before, in my opinion. You are correct about icing, though. it really does help.

    Vicks Vaporub is a miracle for cystic acne.It helped my daughter.

    I am a male in my early 30s and have had cystic acne on my back and chest since I was about 14 years old. I am of Australian Greek background. I have taken Accutane. The drug helped only slightly. But more than helping the acne, it actually changed the pigmentation in my skin from tanned southern european to whiter northern european looking skin. I much preferred the skin I was born with! Anyway, that was 15 years ago. Since then, I have found that a number of major lifestyle changes have really helped, to the point where I can go whole weeks without any acne and clear lovely tanned skin. They are as follows:
    -Avoid alcohol, caffeine and chocolate;
    -Regular exercise (sweating…a lot, by running 8km for an hour every couple of days or swimming in salt water. AVOID chlorine where possible!…I have actually become quite a good surfer as a result!);
    -Eat low GI and low sugar food and drink and minimise saturated fatty foods;
    -Eat lots of green and yellow vegetables (good for the skin);
    -Drink 7-8 glasses of water a day!

    My daughter is half greek and at 14 her acne became horrible. Aside from everything you listed, have you found anything else that has helped. Shes been on doxy and now is on cefadroxil. The derm is talking about accutane and maybe a birth control. She is gluten free, minimal dairy because her twin is dairy free so I keep very little around and cook with no dairy products. I feel terrible for herj. She showers twice a day and uses epiduo at night, but sometimes it’s too harsh for her skin. any advice?

    Have been using Citrus Clear for just over a week. I have hormonal cystic acne and I think there is a limit to what any topical treatment can do. That said, Citrus Clear’s Control Wash seems to stop my spots getting worse and it’s very gentle on the skin, unlike some prescribed treatments. I’m pleased with the results and will keep using this, as it is the only thing I have found that does treat my spots but doesn’t make my skin dry and itchy. I would recommend this to anyone with problem acne, and over any topical treatment a doctor would prescribe.

    Accutane will ruin your life way more than acne will. DO NOT put that drug into your body. I am dealing with the consequences for the rest of my life.

    I took Acutane for five months . I had severe cystic acne with fluid pockets.
    After trying many options. I decided to take this drug after six years of weeping cysts. At the time I took this drug, it was experimental., 1995. It cost 1800 a month. I was carefully monitored. Blood screens and clear instructions twice a month. Acutane changed my skin permanently! I am now 40 years old. And I am blessed to say I have been acne free all my adult life.
    My thoughts: maybe the generic form of this drug is not the same as the name brand. I am blessed that this drug is out there. Dee

    It looks like abscess .. The picture looks so similar to my condition.. Help me.. :/

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