What is cystic acne
Cystic acne is what happens when hair follicles clogged with sebum and bacteria burst inside the dermis, inflaming the skin around them. The lumps hold pus but have no sac of their own, so DermNet calls them pseudocysts.
How do yours feel under a fingertip?
Pimple, nodule or cyst?
Acne spots differ mostly by depth. Step through the slide, then answer three quick questions about one spot that bothers you.
Oil and shed skin cells block a hair follicle.
What cystic acne is
Cystic acne is acne at its deepest. It means a blocked hair follicle has split open well below the surface, leaving a sore lump packed with pus. The cause of cystic acne is a chain of events inside one follicle: oil (sebum) and shed skin cells clog it, skin bacteria multiply in the clog, and the follicle wall gives way, emptying its contents into the tissue around it, as the NIAMS acne overview explains.
Other names for it are severe nodular acne, used by the NIAMS, and nodulocystic acne, used by MedlinePlus.
Why the word pseudocyst
A true cyst, an epidermoid cyst for example, is a pouch with its own lining. It often shows a small opening at its center, holds a cheesy paste, and a surgeon cuts it out when it has to go. Acne lumps have no such lining. DermNet's guide to cysts and pseudocysts names lumps without a capsule pseudocysts and notes that they commonly arise in acne.
Key Features
Cystic acne lumps share four features.
- Deep Lumps
- They lie deep in the skin, well under an everyday pimple (NIAMS, AAD).
- Fluid-Filled
- They hold pus. A nodule is similar in size but solid all the way through (NIAMS).
- Tender and Painful
- Lumps this deep are usually sore, unlike blackheads and whiteheads (AAD, NIAMS).
- High Risk of Scarring
- When inflammation destroys collagen in the dermis, a sunken scar forms. When healing skin makes too much collagen, a raised scar forms, which is seen more often in darker skin tones (DermNet, AAD). Cysts and nodules are the likeliest to scar (AAD).
If several of these fit, a photo grades how severe it is.
Common Locations
Cystic acne shows up where oil glands are busy. The AAD and DermNet both point to the face, neck and upper body:
- the face, especially along the jawline
- the neck
- the chest
- the back, and at times the buttocks
Small spots gathered on the chin and around the mouth usually have other causes; see acne on chin for what drives them.
Causes and Triggers
Clogged Follicles
Oil and shed skin cells clump inside the pore and seal it, so the oil is trapped below the surface (NIAMS).
Bacterial Infection
The AAD is clear that acne isn't an infection. Germs that are always on your skin multiply inside the clog, and the body's reaction to them brings the swelling, redness and pain (NIAMS).
Hormones and Genetics
Puberty brings a rise in hormones called androgens, which enlarge the oil glands (AAD). Your chance goes up if a parent or other close blood relative had deep, painful pimples (AAD). DermNet names anabolic steroids and whey protein powders among the risk factors. For women, periods and pregnancy can shift how oily the skin is (MedlinePlus).
Who gets it
Cystic acne mostly starts in the teen years or early adult life, and DermNet reports it most often in males. A family history of severe acne raises the odds (AAD). A rare and more severe form, acne conglobata, groups many lumps and blackheads together and often lasts into a person's 30s or 40s (DermNet).
Teens with a few red pimples rather than deep lumps can usually start at home; best acne treatment for teens covers those first steps.
Cystic acne vs regular acne
| Trait | Regular pimple | Cystic acne |
|---|---|---|
| Depth | At or near the surface | Deep in the skin |
| Feel | Small bump | Large, painful lump |
| How long | Under 2 weeks | Can last for months |
| Scar risk | Low | High |
| What treats it | Store products with benzoyl peroxide or salicylic acid | A dermatologist |
Based on NIAMS, DermNet and the AAD.
Treatment
Shop-bought products can't clear severe acne, and leaving it alone may mean years of breakouts (AAD). A dermatologist picks from tablets, creams and gels, a corticosteroid shot for a single large, sore lump and, for severe acne, isotretinoin (AAD). Don't try to drain a lump yourself; doing it at home carries a high chance of infection (AAD).
Knowing what the lump is comes first; the order of steps that follows is set out in how to treat cystic acne.
Is it harmful? When to see a dermatologist
Cystic acne mostly harms through scarring and through its weight on your mood. Many studies tie acne to low self-esteem, depression and anxiety (AAD, NHS). Any deep, sore lump is worth a dermatologist visit, because early treatment means fewer lasting scars (AAD).
The NHS lists a few more signs that mean you should book a visit soon:
- skin around a spot turns hot, swollen and red, which can mean infection
- home treatment has not helped
- your acne is wearing down your mental health
Quick questions
Can cystic acne come to a head?
It sits so deep that squeezing only drives what's inside further down, making scars and infection more likely. If one needs draining, a dermatologist can do it safely.
Is cystic acne harmful?
Its main harms are scars and the strain on your mood. Feeling low about your skin is a good enough reason on its own to ask for help.
What are the differences between cystic acne and regular acne?
Depth, size, pain and time. Regular pimples sit near the surface and often clear within two weeks. Cystic lumps sit deep, hurt, can last for months and scar more often.
How do I know if my acne is cystic?
Look for lumps you feel under the skin rather than on top of it, that hurt, and that stay for weeks. A dermatologist can tell you for sure at a visit.
Can cystic acne be cured naturally?
No home cure has been proven. Shop products don't clear severe acne, and leaving it can mean years of breakouts, so a dermatologist is the quicker path.
Sources
- NIAMS (NIH): Acne
- DermNet: Cutaneous cysts and pseudocysts; Epidermoid cyst; Acne scarring; Nodulocystic acne; Acne vulgaris
- MedlinePlus: Acne
- AAD: Severe acne; Types of acne breakouts; Popping pimples; Antibiotics for acne; Acne causes; Acne scar symptoms
- NHS: Acne
Last reviewed . This page is general information, not a diagnosis. See a dermatologist if a lump is deep, painful or leaving scars.