Cystic Acne Treatment: How to Treat Deep, Painful Breakouts

Cystic acne is the most severe form of acne—deep, inflamed, painful nodules that form beneath the skin's surface. Unlike regular pimples, cystic acne rarely responds to over-the-counter treatments and carries a high risk of permanent scarring. Here's what actually works.

What Is Cystic Acne?

Cystic acne occurs when infection and inflammation reach deep into the skin, forming pus-filled cysts or hard nodules. These lesions are 5mm or larger, extremely painful, and can last weeks or months.

Cystic vs Regular Acne

Depth: Cystic acne sits deep in the dermis; regular acne is near the surface
Pain: Cystic lesions are painful to touch; regular pimples are mildly uncomfortable
Duration: Cysts last weeks to months; regular pimples resolve in days
Scarring: Very high risk of permanent scarring; regular acne rarely scars
Treatment: Almost always requires prescription medication; OTC rarely helps

What Causes Cystic Acne?

1. Hormonal Imbalances

Androgens stimulate oil glands to overproduce sebum. Hormonal surges during puberty, menstrual cycles, PCOS, and stress are the most common triggers for cystic breakouts.

2. Genetics

If your parents had severe acne, you're significantly more likely to develop cystic acne. Genetics influence pore size, oil production, inflammatory response, and how your immune system reacts to bacteria.

3. Bacterial Infection

C. acnes bacteria trapped in clogged pores multiply rapidly, triggering an aggressive immune response. The body walls off the infection with a cyst membrane, creating the characteristic painful lump.

4. Inflammatory Response

Some people's immune systems overreact to acne bacteria, producing intense inflammation that damages surrounding tissue and leads to deep cystic lesions.

Emergency Spot Treatment

When a painful cyst appears, here's what to do (and not do) immediately:

Do This

Ice it: Apply ice wrapped in cloth for 5-10 minutes to reduce swelling and pain
Hydrocolloid patch: Absorbs pus and protects from touching/picking
Benzoyl peroxide 5%: Apply directly on the cyst to kill bacteria
Cortisone shot: Ask your dermatologist—can flatten a cyst in 24-48 hours

Never Do This

Don't squeeze or pop: Pushes infection deeper, spreads bacteria, guarantees scarring
Don't use toothpaste: Irritates and damages the skin barrier
Don't use harsh scrubs: Friction makes cystic inflammation worse
Don't ignore it: Early treatment prevents scarring

Prescription Treatments (Most Effective)

Isotretinoin (Accutane)

How it works: Shrinks sebaceous glands by up to 90%, reduces oil production, kills bacteria, and decreases inflammation. The only treatment that addresses all four causes of acne simultaneously.

Effectiveness: 85% of patients achieve long-term remission after one course (4-6 months).

Side effects: Dry skin/lips, joint pain, elevated cholesterol, mood changes. Requires monthly blood work and strict pregnancy prevention.

Best for: Severe cystic acne that hasn't responded to other treatments, or acne causing significant scarring.

Spironolactone (Anti-Androgen)

How it works: Blocks androgen receptors, reducing oil production at the hormonal level.

Dosage: 50-200mg daily. Results in 3-6 months.

Best for: Hormonal cystic acne in women, especially along the jawline and chin.

Oral Antibiotics

Options: Doxycycline (50-200mg) or minocycline (50-100mg) daily.

How they work: Reduce bacteria and inflammation. Usually combined with topical retinoids.

Limitation: Not for long-term use (3-6 months max) due to antibiotic resistance risk.

Cortisone Injections

How they work: Corticosteroid injected directly into the cyst. Reduces inflammation and flattens the lesion within 24-48 hours.

Best for: Individual, painful cysts that need rapid relief. $50-$200 per injection.

Preventing Scarring from Cystic Acne

Start Treatment Early

Every day of untreated inflammation increases scarring risk. Don't wait months hoping it resolves on its own.

Absolutely No Picking

Cystic acne scars are almost always worse when lesions are manipulated. The infection is too deep to extract safely at home.

Use Gentle Skincare

Avoid harsh scrubs, alcohol-based toners, and over-cleansing. A gentle cleanser, moisturizer, and SPF is all you need alongside prescription treatment.

Wear SPF 30+ Daily

Post-inflammatory marks from cystic acne darken significantly with sun exposure. Sunscreen prevents permanent staining.

When to See a Dermatologist

See a dermatologist immediately if you experience any of these:

Deep, painful nodules or cysts that last more than 2 weeks
Acne that's leaving scars or dark marks
OTC treatments haven't helped after 8-12 weeks
Acne is affecting your confidence or mental health
You have signs of hormonal imbalance (irregular periods, excess hair growth)

Don't wait. Cystic acne rarely resolves on its own and early treatment prevents permanent scarring.

Key Takeaways

✓ Cystic acne is the most severe form—deep, painful, high scarring risk
✓ OTC treatments rarely work; prescription medication is almost always needed
✓ Isotretinoin is the most effective treatment with 85% long-term remission
✓ Spironolactone is highly effective for hormonal cystic acne in women
✓ Never pick or squeeze cysts—it guarantees worse scarring
✓ Ice and hydrocolloid patches provide emergency relief
✓ See a dermatologist early—every day of inflammation increases scarring

Track Your Cystic Acne Treatment with Pimpl

Cystic acne treatment takes months to show full results. Pimpl helps you stay on track by logging medications, documenting progress, and identifying patterns in your breakouts.

✓ Log medications and dosage changes over time
✓ Track cyst locations, pain levels, and duration
✓ Document healing progress with photo comparisons
✓ Identify hormonal patterns and trigger factors