Helping People Achieve Clear Skin Since 2007

Helping People Achieve Clear Skin Since 2007

Meet the team >
  • 10

Understanding and Treating Cystic Acne

By Megan Griffith

Reviewed for medical accuracy by Dr. Jaggi Rao,
MD, FRCPC Double board-certified dermatologist

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.

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


  • 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 air1. 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 brown2 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 common among people of African heritage3, 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 skin4. 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 acne5 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 teenage males. Never take someone else’s acne treatment. Work with your dermatologist to find your own acne solutions to get the best results.


  1. Achermann Y., Goldstein E.J., Coenye T., Shirtliff M.E. Propionibacterium acnes: from commensal to opportunistic biofilm-associated implant pathogen. Clinical Microbiology Reviews. 2014;27(3):419-440.
  2. Davis E.C., Callender V.D. A review of acne in ethnic skin: Pathogenesis, clinical manifestations, and management strategies. Journal of Clinical and Aesthetic Dermatology. 2010;3(4):24-38.
  3. Rybicki B.A., Major M., Popovich J., Maliarik M.J., Iannuzzi M.C. Racial differences in sarcoidosis incidence: a 5-year study in a health maintenance organization. American Journal of Epidemiology. 1997;145(3):234-241.
  4. Lange M., Thulesen J., Feldt-Rasmussen U., Skakkebaek N.E., Vahl N., Jørgensen J.O., Christiansen J.S., Poulsen S.S., Sneppen S.B., Juul A. Skin morphological changes in growth hormone deficiency and acromegaly. European Journal of Endocrinology. 2001;145(2):147-153.
  5. Rumsfield J.A., West D.P., Tse C.S., Eaton M.L., Robinson L.A. Isotretinoin in severe, recalcitrant cystic acne: A review. Drug Intelligence and Clinical Pharmacy. 1983;17(5):329-333.
  • 10
Comments 23
Comments (23)
Add Comment
trisha parish Reply

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.

November 12, 2014 at 5:46 pm Reply
Deb Olson Reply

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

February 9, 2015 at 8:30 pm Reply
Cat Reply

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.

February 17, 2015 at 3:51 am Reply
Erin Reply

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.

November 23, 2015 at 5:58 am Reply
fm Reply

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 !

September 8, 2015 at 1:59 pm Reply
Erin Reply

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.

November 23, 2015 at 5:44 am Reply
L.P Reply

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

September 15, 2016 at 8:23 pm Reply
Veronica Reply

My husband had it starting in his teens, it was worse than many Google Images I've seen. He stopped dairy, milk cheese etc and it went away within a couple weeks it was dramatically better. I would recommend starting with a simple change such as cutting out gluten and dairy and see what happens... Imagine how much money you could save with these simple changes. Wish you the best

July 29, 2017 at 8:34 am Reply
George Reply

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!

March 9, 2015 at 1:22 am Reply
Linda Reply

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?

March 28, 2016 at 8:13 pm Reply
Patty Weal Reply

linda, is your daughter still suffering from cystic acne? My cousin suffered horribly and tried everything including accutane. I may have a suggestion, it has completely cleared her skin for almost a year now. and she doesn't not even need makeup anymore. feel free to email me and I can even put you in contact with her.

June 7, 2017 at 1:39 am Reply
C R Reply

What is it? What's your suggestion?

September 8, 2017 at 11:10 am Reply
Laura Reply

Hi saw your note about cystic acne. I have it real bad can you give any advice ? I’m 54 and was put on Doxy and suffer with rosesa also. Thanks Laura

January 11, 2018 at 2:53 am Reply
dottie798 Reply

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.

March 6, 2016 at 1:58 am Reply

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.

April 13, 2016 at 9:31 pm Reply
Dee Reply

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

May 4, 2016 at 5:12 pm Reply
Prasad Reply

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

June 6, 2016 at 2:47 pm Reply
Zetta Evans Reply

I'm just a normal 30 year old female with cystic acne. Painful, annoying, ugly looking... not awful, but enough to bother me and leave patches of trouble skin on my face. I've been washing my face at night and applying dermalmd acne serum over the troubled areas and my morning the swelling is significantly reduced!! I sometimes also apply in the morning. I have bought other acne topical treatments that have not helped anything like this has helped! Totally worth what I paid for it.

July 9, 2017 at 4:55 am Reply
Lisa Reply

I'm a 27 year old femal and have been suffering from cystic acne on my chin for the last 15 years. I have tried everything internally and topical but nothing seems to work. The oral medications all destroyed my stomach and I'm sure it can't be good to be on an antibiotic for months at a time. So far the only thing I've found that works 75% of the time is putting a hydrocolloid bandaid on cysts that I pop. The bandage sucks everything right up and it's gone the next morning. But that's not a way to live so I really am considering acutane.

September 11, 2017 at 3:08 am Reply
SixtyYearOldFart Reply

Trust me. I suffered scaring acne until I was about 30 years old. I had luck with antibiotics, but started to develope back acne which my dermatologist said typically doesn’t respond to antibiotics. She recommended accutane saying all along that she likes to tackle acne aggressively. Accutane changed everything for me. It was 5 months of very dry skin. Painfully dry, but after the course of treatment, my skin was no longer sopping wet with grease. I would blot my face and ten minutes later I’d be greasy. Accutane changed all of that. My skin looks great. I only wished I’d have used antibiotics or accutane in high school. Accutane hadn’t be invented yet, but tetracycline was being used. My skin was left scared from to years of battling acne. I work on a collage campus and see young kids with bad acne and the beginning of scarring and wish someone would steer them to a dermatologists office

October 22, 2017 at 6:28 am Reply

I'm 62, female and have had oily skin like yours as well. I have acne since I was 12 or 13. It's oily again 3 minutes after washing it. I have scars and pumps under the skin that never fester. They sometime get bigger at which point I use a tool to push some of the puss out so they will shrink a little. I have had the same bumps for many years, they never go away. When I do have a big red bump come up , it takes for ever to heal and it always leaves a scar and I never mess with those kind of pumps (I don't mash them). My skin is so oily , that if I'm where I can't wash it , after 9 hours the oil gets in my eyes and my vision is blurred. I had a doctor prescribe Accutane once, but when I read the side effects, I was afraid to take it.

January 20, 2018 at 11:33 pm Reply
Elizabeth Reply

My daughter has Cystic acne and due to extreme side effects, she can't take prescribed medications. Dermalmd acne serum is excellent, natural and amazing. It works! My daughter finally has found a spot treatment that really works for her cystic acne.

September 28, 2018 at 6:58 pm Reply
Amaka Reply

Dermalmd acne serum is amazing! I get bad cystic acne and this product heals it pretty much overnight(usually by day 2 the acne is gone). It’s better than any product I have ever used, and I have tried everything!

October 27, 2018 at 1:07 pm Reply

Our Mission

To be your most trusted ally in your pursuit of clear, healthy skin.

Do NOT follow this link or you will be banned from the site!