This updated guide explains causes of cystic acne and practical, evidence-based steps for treatment and prevention. Start with gentle cleansing and non-comedogenic products. Use topical retinoids and benzoyl peroxide consistently. For moderate to severe cases, dermatologists may recommend short-course antibiotics, hormonal treatments (combined oral contraceptives or spironolactone), or isotretinoin under specialist supervision. Procedural options include intralesional steroid injections and in-office treatments. Lifestyle changes and dietary adjustments may help some people. Seek dermatology care for painful or scarring cysts.
Understand cystic acne
Cystic acne is a deep, inflamed form of acne that often forms painful nodules or cysts under the skin. It results from a mix of factors: excess oil, blocked follicles, inflammation, and skin bacteria (Cutibacterium acnes). Hormonal changes and genetics make some people more prone to cystic lesions.
Start with gentle daily care
Use a gentle, non-comedogenic cleanser twice daily. Avoid scrubbing, abrasive soaps, or alcohol-heavy toners that strip and irritate the skin. Moisturize with a non-comedogenic lotion after cleansing to support the skin barrier.
Never pick, squeeze, or lance cysts at home. Doing so raises the risk of infection and permanent scarring.
First-line topical and medical options
Topical retinoids (adapalene, tretinoin) and benzoyl peroxide remain foundational treatments. They normalize cell turnover, reduce comedones, and reduce bacteria when used consistently.
For moderate to severe cystic acne, dermatologists commonly prescribe oral therapies: short courses of antibiotics (to limit resistance) combined with topical agents, hormonal treatments for people who menstruate (combined oral contraceptives or spironolactone), and for severe, scarring, or treatment-resistant cases, oral isotretinoin. Isotretinoin requires specialist supervision and pregnancy-prevention measures because of significant side effects.
Procedural treatments for individual lesions
Dermatologists can inject an intralesional corticosteroid into a large cyst to reduce size and pain quickly. In-office drainage or excision is sometimes performed, but these procedures should be done only by professionals to minimize scarring.
Other in-clinic options - chemical peels, light/laser therapies, and microneedling - may help selected patients but vary in effectiveness and should be considered alongside medical treatments.
Lifestyle and supportive measures
Manage stress, get regular sleep, and maintain exercise - these help overall skin health. Replace heavy cosmetics with non-comedogenic or oil-free products and remove makeup before bed.
Dietary changes can help some people. Evidence supports reducing high-glycemic-load foods; links between dairy and acne are modest and vary. Track your diet and symptoms to see if changes affect your skin.
When to see a dermatologist
See a dermatologist for painful, recurrent, or scarring cysts, or if over-the-counter measures don't help after several weeks. Early, specialist treatment reduces the risk of permanent scarring and can offer faster relief.
Be patient and consistent
Treatments take time - often several weeks to months. Follow your treatment plan, communicate side effects with your clinician, and avoid stopping medication abruptly without medical advice.