Cystic Acne: What It Is, What Causes It, and How It Is Treated

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026

Quick Answer: What Is Cystic Acne?

Cystic acne is the most severe type of inflammatory acne, causing painful, pus-filled pimples deep under the skin when oil and dead skin cells clog pores and trap bacteria. It is more likely to scar than other pimples and is best treated by a dermatologist with prescription topical creams and oral antibiotics. Clearing cysts typically takes three months or more.

What the research says

• Spironolactone helped women with acne in placebo-controlled trials. A meta-analysis of 5 randomized placebo-controlled trials (563 patients) found that the odds of objective acne improvement were about six times higher with oral spironolactone (odds ratio 6.59), without a significant increase in menstrual irregularities or breast enlargement; spironolactone is still used off-label for acne ( (Ghanem et al., Journal of Cosmetic Dermatology, 2025) [2].

• Spironolactone is an option when long-term antibiotics are not ideal. A separate meta-analysis of randomized trials in adult women with moderate to severe acne reported a pooled odds ratio of 2.51 for treatment success compared with placebo or doxycycline, and highlighted spironolactone as an alternative to long-term antibiotic therapy ( (Kow et al., Australasian Journal of Dermatology, 2025) [3].

What Is Cystic Acne?

Cystic acne is a type of inflammatory acne that causes painful, pus-filled pimples to form deep under the skin. Acne starts when oil and dead skin cells clog skin pores. In cystic acne, bacteria also gets into the pores, causing swelling or inflammation.

Cystic acne is the most severe type of acne. Its cysts are often painful and more likely to cause scarring. People with cystic acne develop these pus-filled acne cysts (pimples) deep under the skin, and the cysts can be large.

Because of the scarring and infection risk, a dermatologist should treat cystic acne. This specialist approach helps reduce both risks compared with self-treating.

Cystic acne: what it is, how it forms, and why a dermatologist should treat it.

How is cystic acne different from nodular acne?

Cystic acne is often compared with nodular acne because the two conditions are very similar. Both cause deep, painful bumps under the skin, and both can scar. The key difference comes down to what is inside the bump.

Feature	Cystic Acne	Nodular Acne
Fill material	Filled with pus (a fluid)	Solid and hard; no fluid
Depth	Deep under the skin	Deep under the skin
Pain	Often painful	Often painful
Scarring risk	High	High

The name 'cystic' refers to the pus-filled nature of the bumps, while nodules are firmer because they do not contain fluid.

What Causes Cystic Acne?

Pores in the skin can clog with excess oil and dead skin cells, causing pimples. Bacteria can enter the skin pores and get trapped along with the oil and skin cells. The skin reaction causes swelling deep in the skin's middle layer, the dermis. This infected, red, swollen lump is an acne cyst.

Specific cystic acne causes and risk factors include:

• Age: teenagers are more prone to cystic acne.

• Family history of cystic acne.

• Hormone changes during the teenage years and sometimes during menopause, as well as stress.

Cystic acne causes are not limited to poor hygiene. The condition is largely driven by how your skin, hormones, and genetics interact.

Cause Category	What It Means
Pore clogging	Excess oil and dead skin cells block pores, creating the starting point for acne
Bacterial trapping	Bacteria enters pores and gets trapped with oil and skin cells
Deep inflammation	The skin reaction causes swelling deep in the dermis, forming the cyst
Age	Teenagers are more prone to cystic acne
Family history	Having relatives with cystic acne raises risk
Hormones and stress	Hormone changes during adolescence and menopause, plus stress, can trigger outbreaks

What Does Cystic Acne Look Like?

Acne cysts resemble boils, a type of skin infection. Recognizing the appearance helps you know when regular acne has become something a dermatologist should manage.

An acne cyst may be:

• A red lump under the skin

• Painful or tender to touch

• Small as a pea or big as a dime

• Oozing pus from a whitish-yellow head

• Crusty

A cystic acne breakout may cover a large area of skin. Cystic acne tends to appear on the face, which has a lot of oil glands, but acne cysts can also form on other body areas.

How cystic acne looks and where it commonly appears.

Body Area	Notes
Face	Most common site; the face has a lot of oil glands
Back	Frequent breakout location
Chest	Common oil-gland-rich area
Neck	Visible and treatment-sensitive area
Shoulders	Often involved in large-area breakouts
Upper arms	Less obvious but possible site
Buttocks	Can develop acne cysts

How Is Cystic Acne Diagnosed?

A dermatologist, a doctor who specializes in skin conditions, can examine your skin and make a cystic acne diagnosis. Diagnosis is primarily visual, based on the appearance, depth, and behavior of the bumps.

Seeking a professional diagnosis matters because cystic acne is more likely than other zits to scar or develop infections, and because treating it correctly requires prescription-level care.

How Is Cystic Acne Treated?

Acne cysts can be difficult to treat. Because they can scar, you should seek help from a dermatologist instead of trying over-the-counter acne products. A dermatologist can teach you how to treat cystic acne.

It can take three months or more to clear up acne cysts. Treatment often involves taking oral antibiotics and applying prescription-strength topical gels or creams to the skin.

Treatment	How It Works
Antibiotic creams, gels, solutions, and lotions	Kill bacteria and decrease inflammation
Azelaic acid or salicylic acid	Kill bacteria and get rid of excess dead skin cells
Benzoyl peroxide	Reduces the number of bacteria on the skin
Retinoids (adapalene, tretinoin, tazarotene)	Vitamin A derivatives that help slough dead skin cells
Corticosteroid injections	Quickly shrink large, painful acne cysts
Incision and draining	Opens up an acne cyst and drains the pus
Birth control pill or spironolactone	Used by women to lower hormone levels that cause cystic acne
Isotretinoin	An oral retinoid for the most stubborn cases

The cystic acne treatment toolkit: topicals, oral medications, and in-office procedures.

What Should You Never Do With a Cystic Acne Cyst?

Opening up acne cysts, by popping or picking them, increases the risk of scarring and bacterial skin infections like cellulitis. It is tempting to want to touch or pick at painful, swollen acne cysts, but resisting that urge is one of the most important parts of managing the condition.

After an acne cyst clears, some people develop pigment changes (light or dark spots) at the site. These spots may be pink, purple, red, black, or brown. They eventually fade away, but it may take more than a year.

What Is the Outlook?

Most people with cystic acne can prevent severe breakouts or quickly treat acne cysts to prevent scarring. Often, but not always, cystic acne clears up or diminishes with age, as hormones settle down.

Severe or untreated cystic acne can affect how you feel about your appearance, making you anxious or depressed. If cystic acne bothers you, talk with your healthcare provider about getting help with fostering a positive self-image.

Scenario	Outlook
Treated early by a dermatologist	Best chance of preventing scarring and clearing breakouts
Consistent treatment for 3+ months	Acne cysts typically improve or clear
Untreated or self-picked cysts	Higher risk of scarring, cellulitis, and longer-lasting pigment spots
Natural course	Often diminishes with age as hormones settle, but not always

How Can You Lower Your Risk of Acne?

You can lower your risk of acne, including cystic acne, with gentle face washing, oil-free and noncomedogenic products, and not picking at pimples.

• Use a mild foaming facial cleanser, lukewarm water, and your fingers (not a washcloth or sponge) to wash your face after you wake up, before going to bed, and after exercising or sweating.

• Apply oil-free moisturizer if you feel dry.

• Use noncomedogenic (water-based) makeup and facial products.

• Don't sleep in makeup.

• Keep your hands away from your face during the day.

• Don't pick at or pop pimples or scabs.

• Wash your hair regularly and keep hair (which can be oily) away from your face.

• Be aware that occasionally oily environments, such as working at a fast food restaurant, can contribute to acne flares.

• Note that diets high in simple sugars and dairy (a high glycemic index diet) may contribute to flares as well.

When Should You See a Healthcare Provider?

Call your healthcare provider about cystic acne if you have swollen, red, painful pimples, acne or scarring that makes you self-conscious, or signs of a skin infection.

• Swollen, red, painful pimples

• Acne or scarring that makes you feel self-conscious

• Signs of a skin infection

Conclusion

Cystic acne is the most severe form of acne, forming painful, pus-filled cysts deep in the dermis when oil, dead skin cells, and bacteria combine inside pores. It is most common in teenagers, can run in families, and is influenced by hormone changes and stress. Unlike regular breakouts, cystic acne carries a real risk of scarring and infection, and it rarely responds to over-the-counter products.

The good news is that treatment works. A dermatologist can combine prescription topicals, oral antibiotics, hormone therapy, corticosteroid injections, or isotretinoin to clear acne cysts over three months or more, and the condition often diminishes with age. If you have deep, painful, recurring pimples, schedule a dermatology appointment: early professional care is the single most effective way to prevent permanent scars.

Related reading: Acne: complete guide to symptoms, causes, diagnosis, and treatment, cyst: what it is, types, symptoms, causes, and treatment, cellulitis: symptoms, causes, diagnosis, and treatment.

Frequently Asked Questions

What is cystic acne and how is it different from regular pimples?

Cystic acne is a type of inflammatory acne that causes painful, pus-filled pimples to form deep under the skin. It is the most severe type of acne. Unlike regular surface pimples, cystic acne involves bacteria trapped deep in the dermis, causing larger, more painful bumps that are much more likely to scar.

What causes cystic acne?

Cystic acne forms when oil and dead skin cells clog skin pores, then bacteria enters and gets trapped along with the oil and skin cells. The resulting skin reaction causes swelling deep in the skin's middle layer. Key risk factors include being a teenager, having a family history of cystic acne, and hormone changes during adolescence or menopause, plus stress.

What does a cystic acne cyst look like?

An acne cyst appears as a red lump under the skin that is painful or tender to the touch. It can be as small as a pea or as large as a dime, may ooze pus from a whitish-yellow head, and can become crusty. Cysts resemble boils, which are a type of skin infection.

Is cystic acne the same as nodular acne?

Cystic acne and nodular acne are very similar but not identical. Both cause deep, painful bumps under the skin and both can scar. The difference is that acne cysts are filled with pus (a fluid), while acne nodules are more solid and harder because they do not contain fluid.

Where does cystic acne most commonly appear?

Cystic acne tends to appear on the face, which has a lot of oil glands, but acne cysts can also form on the back, buttocks, chest, neck, shoulders, and upper arms. A cystic acne breakout may cover a large area of skin.

Why shouldn't you pop or pick at cystic acne?

Opening up acne cysts by popping or picking them increases the risk of scarring and bacterial skin infections like cellulitis. Cystic acne is more likely than other zits to scar or develop infections, which is why professional treatment is recommended instead of self-extraction.

How is cystic acne treated?

A dermatologist treats cystic acne with prescription medications rather than over-the-counter products. Common treatments include antibiotic creams or lotions, azelaic or salicylic acid, benzoyl peroxide, retinoids, corticosteroid injections to shrink large cysts, incision and draining, birth control pills or spironolactone for women, and isotretinoin (an oral retinoid).

How long does it take to clear up cystic acne?

It can take three months or more to clear up acne cysts. Treatment often involves taking oral antibiotics and applying prescription-strength topical gels or creams to the skin consistently over that period.

Does cystic acne go away with age?

Often, but not always. Cystic acne frequently clears up or diminishes with age as hormones settle down. Most people with cystic acne can prevent severe breakouts or quickly treat acne cysts to prevent scarring.

Can cystic acne cause scarring and pigment changes?

Yes. Cystic acne is the type of acne most likely to cause scarring, especially when cysts are picked or popped. Some people also develop pigment changes (light or dark spots that may be pink, purple, red, black, or brown) after an acne cyst clears. These spots eventually fade but may take more than a year.

How can I lower my risk of getting cystic acne?

Wash your face with a mild foaming cleanser, lukewarm water, and your fingers (not a washcloth or sponge) morning, night, and after sweating. Use oil-free moisturizer and noncomedogenic (water-based) makeup, don't sleep in makeup, keep your hands off your face, don't pick pimples, wash your hair regularly, and be aware that oily work environments and high-sugar or high-dairy diets may contribute to flares.

References

1. Cleveland Clinic. Cystic Acne. Cleveland Clinic. Medically reviewed; last reviewed August 25, 2021. https://my.clevelandclinic.org/health/diseases/21737-cystic-acne

2. Ghanem L, Kirmani N, De León Fernández N, et al. Efficacy and safety of oral spironolactone for women with acne vulgaris: a systematic review and meta-analysis of randomized placebo-controlled trials with trial sequential analysis. Journal of Cosmetic Dermatology. 2025;24(8):e70411. PMID 40823723. https://doi.org/10.1111/jocd.70411

3. Kow CS, Ramachandram DS, Hasan SS, Thiruchelvam K. Spironolactone for the treatment of moderate to severe acne in adult women: a systematic review and meta-analysis of randomised controlled trials. Australasian Journal of Dermatology. 2025;66(3):165-168. PMID 39912292. https://doi.org/10.1111/ajd.14428

Medical disclaimer

This article is for general educational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the guidance of your healthcare professional with any questions about your or your child's health. In a medical emergency, call 911 or your local emergency number.