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What You Can Do About Cystic Acne

Cystic acne is the kind of acne that forms large bumpy knots that lodge deep in the skin. In cystic acne, an inflamed pore becomes completely covered by tough pink skin so that it cannot drain, but instead grows larger and larger until it is eventually opened by lancing, surgery, or medical treatment of the skin.

Cystic Acne
Cystic acne most commonly affects those with darker skin tones.


  • Cystic acne encapsulates infection inside the skin.
  • Cystic acne is most common in young adults, aged 20 to 22, who did not have serious acne as teenagers.
  • Cystic acne is most common on brown skin.
  • Cystic acne is a really bad form of acne vulgaris, also known as common acne. Acne keloidalis nuchae involves cysts that form over ingrown hairs, usually on the scalp and neck, and acne conglobata is characterized by pimples that seem to burrow together. Cystic acne does not involve either phenomenon.
  • It’s better to prevent cystic acne than to treat it.
  • Prevent cystic acne with regular use of exfoliating cleansers that contain polyethylene beads or salicylic acid.
  • You can try to treat cystic acne with tretinoin topical on your own, but you will probably get better and faster results from medical treatment.

How Cystic Acne Develops

Why do some people get pimples while others get cysts? The answer seems to be that people who have the healthiest growing skin are actually more likely to get cysts instead of pimples.

Many teens have skin that grows so dynamically that pores never get clogged. The skin stays flexible and soft so that dead skin cells don’t accumulate at the top of pores trapping sebum and bacteria beneath them—until they reach the age of 20 or 22.

In early adulthood, skin growth begins to slow down. The skin does not naturally keep pores open, so tiny flakes of dry dead skin can begin to accumulate in pores. This creates a pool of sebum and acne bacteria underneath a cap of matted dead skin, too small to see with the naked eye.

At this point in life, the skin is isn’t growing fast enough to keep a pore open, but it is growing fast enough to close over the pore. The pore becomes a cyst. The immune system detects the bacteria in the cyst and releases substances known as defensins to initiate a series of events that would destroy them with inflammation. The bacteria, however, release chemotactins that redirect inflammation away from them to the encapsulated skin tissue surrounding them.

The mass of inflamed tissue around the bacteria in effect protects them from competition from the other microorganisms they would normally encounter on the skin. Cysts grow larger and larger as the immune system releases more and more inflammatory chemicals, always fighting the bacteria but never removing them from the skin.

Who Is Most Likely to Get Cystic Acne?

People who have brown skin are more likely to get cystic acne than people who have white, black, or Asian skin. They may have hormone imbalances or they may undergo stress, but hormonal fluctuation and stress have less to do with cystic acne than with milder cases of common acne.

Also, cystic acne usually does not involve follicles that support the growth of visible hairs. There is a condition more common in men (primarily) and women (occasionally) who have black skin known as acne keloidalis nuchae, in which tough pink skin grows over an ingrown hair.

Cystic acne is a different problem with different treatment. It’s a condition that is most likely to strike people who have brown skin when their facial features stop growing and their skin stops growing as fast. It is primarily a problem on facial skin, but it can also form on the back, shoulders, and chest in people who do vigorous physical labor or sweaty exercise.

Preventing Cystic Acne

Cystic acne is not caused by oily skin. It is caused by drying of the skin inside pores. People who are very careful to use soap and showers to remove excess oil from the skin can get cystic acne because they cleanse their faces and bathe their bodies too frequently with drying soaps and cleansers.

Cystic acne used to be a terrible problem when families made their own soap from wood ashes and lard. Anything abrasive or caustic in a soap can dry the skin so that it clogs pores leaving them vulnerable to infection and formation of cysts. And unless you have visible dirt or grease on your skin, you should not rub it with a wash cloth, and then only gently.

The kinds of cleansers that work best on brown skin prone to cystic acne are those that contain a combination of cleanser and salicylic acid or polyethylene beads that lift and separate dead skin from the lining of pores before they are clogged. Some easy-to-find products that work include:

  • Olay Definity Pore Redefining Scrub, US $10.49 for 5 fluid ounces/150 ml. This product contains tiny polyethylene beads that bounce around in the bubbles made by the foam. They are sharp enough to cut through the “glue” that sticks dead skin into pores but not sharp enough to injure healthy skin. The product also lists salicylic acid on the label, but it is not strong enough or at the right pH to remove dead skin cells, even if you were to leave the scrub on your face for several hours—which you won’t, because in just a few seconds after application you will rinse the entire product down the drain.
  • Paula’s Choice 1% Beta-Hydroxy Acid Lotion for All Skin Types and Paula’s Choice 2% Beta-Hydroxy Acid Lotion for All Skin Types, both of which retail for US $18.95 for 4 fluid ounces/120 ml, are both great skin scrubs that contain salicylic acid in the right amount and at the right pH to keep dead skin from accumulating in pores. Use the 1% lotion if you have sensitive skin or if you have never tried the product before, and graduate to the 2% lotion if you don’t have any negative reactions to the 1% product. This product also stimulates the growth of new skin so that your pores are more likely to stay open even on the days you don’t use the product. Especially recommended for areas of skin that are exposed to the sun.
  • Exposed Skin Care’s Clearing Tonic, which retails for US $19.95 for 4 fluid ounces/120 ml, is probably the best option for oily skin. It contains both alpha- and beta-hydroxy acids, including salicylic acid, plus green tea extract for reducing sebum production. None of the other scrubs on the market has more anti-acne activity for cyst-prone skin.

These products, however, only help prevent cystic acne. They don’t do anything to treat existing cysts.

What Can You Do About Existing Cystic Acne?

Until recently, there was not a lot you could do on your own to treat cystic acne. It has recently become possible to buy topical tretinoin (Retin-A) creams and gels over the counter. These products stimulate the growth of the skin so that the skin opens up over a cyst and lets it drain, without lancing or surgery. It’s important to use them exactly as directed, and you also need to wear sunscreen of at least SPF-15 when you go outside, to keep brown spots from forming where the pimples heal.

You’ll probably get better results, however, from medical treatments. Cystic acne is one of the kinds of acne that responds better to systemic, pill-form antibiotics, and you may also be asked to use a stronger, prescription strength form of Retin-A such as Renova. Whatever you do however, don’t lance acne cysts. You will only force infection farther and wider underneath your skin.

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