Cystic Acne: Symptoms, Causes & Treatment

zoe miller medical editor

Medically reviewed by

Dr Zoe Miller

Last reviewed: 12 Mar 2025

Cystic acne is a severe form of acne that causes painful pus-filled lumps under the skin. It’s caused by a build-up of dead skin cells, oils, and bacteria in hair follicles.

Anyone can develop cystic acne, but it’s more common in people with oily skin. It’s recommended to speak to a doctor if you have it, as it can be managed much better with a comprehensive treatment plan.

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What is cystic acne?

Cystic acne is a severe type of acne. It is an inflammatory type of acne that develops when cysts form under the skin.

Anyone can get cystic acne, but it is more common in people with oily skin. Often, it improves with age, but the painful cysts can take a long time to go away on their own, and you may benefit from medication to treat them.

Cystic acne can look like boils, but some of the common signs include:

  • cysts and spots that range in size from small pimples to a medium-sized bean
  • painful pus-filled pimples
  • painful abscesses that form deep under the skin
  • painful or tender to touch
  • spots that ooze pus from pressure from white or yellow heads
  • some cysts and spots can become crusty and eventually scar
Cystic acne on white skin

Where can you get cystic acne?

Cystic acne spots or pimples are most noticeable on the face, but they can also occur on the:

  • neck
  • chest
  • shoulders
  • arms
  • back
  • bum
  • behind the ears

Who can get cystic acne?

Anyone can get cystic acne, but it’s most common in teenagers and young adults, especially if they have oily skin, and anyone experiencing hormonal imbalances, including women and older adults.

What causes cystic acne?

Acne is caused by hair follicles becoming blocked by sebum (oil) and dead skin cells, leading to outbreaks of spots, pimples, or papules.

It isn’t clear why some people are more likely to get acne than others, but people who do get it may make too much sebum. The skin naturally produces sebum to stop the skin drying out, but people who develop acne may produce too much, resulting in acne symptoms.

Common causes of cystic acne include:

Hormonal changes

Changes in hormone levels, particularly during puberty, but also menopause, pregnancy, and fluctuating levels during the menstrual cycle can cause acne to develop.

Smoking

Clinical research shows that people who smoke are at a higher risk of developing acne compared to non-smokers.

Some medications

Several medications can cause acne flare-ups, sometimes called drug-induced acne, such as:

  • lithium
  • corticosteroids
  • phenobarbital
  • barbiturates
  • androgenic steroids

Family history

Acne can run in families, so if your parents had acne, you’re more likely to develop it. Research has shown that if one of your parents had adult acne, you are at a greater risk of getting it compared to someone whose parents didn’t have adult acne.

How to treat cystic acne

Cystic acne is hard to treat because of the severe symptoms. So, in most cases, over-the-counter medications are not effective. Instead, there are prescription treatments available to help manage cystic acne symptoms.

At Superdrug Online Doctor we have a wide range of acne treatments available. We also offer a photo diagnosis service where our doctors will review photos of the affected area and provide a diagnosis within 24 hours, so you can get the correct treatment.

Medical acne treatments

Medical cystic acne treatments include:

  • topical creams, lotions, and gels
  • oral antibiotics
  • combined contraceptive pills
  • injectable steroids

Acne treatment can take up to 3 months to work.

Prescription topical treatments

Retinoids

Retinoids are a type of acne treatment that are only available with a prescription from a doctor. They are produced from vitamin A, also known as retinol, and work by promoting the growth of new skin cells and breaking down dead skin cells and other debris which may clog pores and cause acne symptoms.

Retinoids are an effective treatment for acne and work best alongside benzoyl peroxide. One study has shown that a combined treatment of retinoid and benzoyl peroxide reduced inflammatory lesions by 68% in 12 weeks.

Retinoids are usually available as creams, foams, and gels and are applied directly to the affected area. However, they may not be suitable for everyone. Some of the potential side effects of retinoids may include:

  • itching
  • burning
  • stinging
  • sensitive skin or redness, dryness, and/or irritation
  • eye irritation
  • increased sensitivity to UV light
  • changes to skin pigmentation

Retinoids are not suitable for use during pregnancy and breastfeeding.

At Superdrug Online Doctor, we offer the following retinoid treatments:

  • Differin Cream – contains the active ingredient, adapalene
  • Treclin gel – a combination of an antibiotic (clindamycin) and a retinoid (tretinoin)
  • Epiduo gel and Epiduo Forte gel – contains a combination of adapalene and benzoyl peroxide

Benzoyl peroxide

Benzoyl peroxide is an effective treatment for cystic acne. It works as an antiseptic agent to lower bacteria numbers on the skin’s surface to reduce the severity by killing the bacteria. Benzoyl peroxide 5% gel sold under the brand name Acnecide is available from most UK pharmacies and online without a prescription.

Some of the common side effects are:

  • peeling or red skin
  • dry skin
  • stinging or burning sensation

However, benzoyl peroxide can be combined with other medications and is available with a prescription, such as:

  • clindamycin 1% + benzoyl peroxide 5% Gel
  • doxycycline 100mg + Epiduo gel 0.1%

It can take 4 weeks for benzoyl peroxide to start working and up to 4 months to have a full effect.

Clindamycin

Clindamycin is a topical prescription-only antibiotic that is used to treat acne. It works by killing or stopping the growth of bacteria on your skin. Research shows that twice-daily topical clindamycin used for 8 weeks resulted in an 88% reduction in the free fatty acids on the skin surface, improving acne symptoms.

Clindamycin can be applied on its own or in combination with benzoyl peroxide or a retinoid, also known as Treclin gel.

The most common clindamycin side effects include:

  • skin irritation
  • dry skin
  • hives
  • oily or crusty skin

Oral medication

As well as topical creams, gels, and lotions, there are several oral medications that may be useful for treating acne.

Antibiotics

Antibiotic tablets are usually prescribed in combination with a topical treatment for severe acne. Usually, the class of antibiotics that are prescribed for acne are tetracyclines. It can take up to 6 weeks for you to notice an improvement in your symptoms.

At Superdrug Online Doctor, we offer the following combination antibiotic treatments:

Oral antibiotics can cause side effects, including:

  • feeling sick (nausea)
  • stomach pain
  • diarrhoea
  • headaches
  • light sensitivity
  • allergic reactions

Rarely, you can have a serious allergic reaction from antibiotics. You must call 999 straight away if you have a severe reaction, which can include swelling, difficulty breathing, skin reactions, and fainting.

Birth control pills

The combined oral contraceptive pill may be prescribed to women with acne, especially if it’s hormonal or linked to your period.

Research shows that a levonorgestrel containing combined pills result in fewer total spots and inflammatory and non-inflammatory lesions than taking a placebo.

The combined pill works by reducing the level of male hormones (androgens) in the body which lowers the production of sebum, resulting in fewer outbreaks.

Although Superdrug Online Doctor can prescribe the combined oral contraceptive pill to prevent pregnancy, we cannot prescribe it solely for acne treatment.

Spironolactone

Spironolactone is a type of medication called a potassium-sparing diuretic which is used to treat many conditions, including high blood pressure and heart failure. However, it also lowers the amount of testosterone made by your body. For this reason, it is sometimes prescribed to women with acne.

Some of the common side effects of spironolactone include:

  • dizziness
  • feeling or being sick
  • muscle or leg cramps
  • tiredness
  • breast pain and enlargement

Only a specialist can prescribe spironolactone for acne as there’s a very common risk of high potassium levels while taking it. You’ll need to have regular blood tests to check your potassium levels, as well as avoid low-sodium salt or salt substitutes, as they also contain a lot of potassium.

Isotretinoin (Accutane)

Isotretinoin capsules are used to treat severe acne. Isotretinoin is considered the most effective acne treatment available and can prevent scarring. It is estimated that 80% of people who use isotretinoin for 5 to 8 months experience long-term improvements in their symptoms.

Isotretinoin can cause serious side effects and must be prescribed and supervised by a specialist doctor.

Some of the side effects include:

  • dry skin, eyes, nose, or lips
  • skin rashes
  • sore or dry mouth or throat
  • headaches
  • back pain
  • joint or muscle pain
  • vaginal dryness
  • erectile dysfunction
  • low sex drive

Isotretinoin can also cause birth defects if used when pregnant. A doctor will usually only prescribe it if you are using an effective form of contraception. If you’re not, you may be advised to start taking one before you can get a prescription.

Procedures

There are also procedures to help the appearance of acne available, like cortisone or steroid injections. Steroids are injected directly into the acne cyst to reduce inflammation and reduce the size of the lesion.

There are also non-medical treatments available for acne, such as:

  • chemical peels – a chemical solution is applied to the face to peel off old, dead skin cells, and for new skin cells to develop to replace it
  • laser therapy – lights and lasers can reduce inflammatory acne lesions by targeting some of the causes such as bacteria, sebum production, and clogged pores

Home remedies for treating cystic acne

Some of the things you can do at home to help treat cystic acne outbreaks include:

Following a good skincare routine

It is important to adopt good skincare practices to help manage cystic acne, such as:

  • use ‘non-comedogenic’ (non-pore-blocking) skincare products, including beauty products and cleansers
  • drink plenty of water throughout the day to keep your skin hydrated
  • always remove makeup before going to bed
  • wear sunscreen, minimum SPF30, to protect your face in the sunlight (many sunscreens are comedogenic, so find one that is face-friendly and non-comedogenic)
  • use natural anti-inflammatory ingredients like tea tree oil, green tea, and honey

Looking at how your diet may impact your skin

Diet can have a significant impact on your skin health because it can influence your hormone levels. For example, foods that increase your blood sugar levels can cause acne outbreaks. Although evidence in this area is still limited and the NHS doesn’t recommend cutting out particular food groups, you may consider avoiding:

  • white bread, pasta, and rice
  • sugary snacks (cakes, biscuits, pastries, and other sweets)
  • milk and dairy products

Although there is no specific diet for managing acne, eating foods that limit rapid blood sugar spikes may be beneficial, such as:

  • fruit – apples, cherries, grapefruit, strawberries, and green bananas
  • vegetables – carrots, artichokes, broccoli, spinach, and avocado
  • unsweetened milk
  • nuts
  • pulses
  • wholegrain bread, pasta, and rice

Lifestyle changes to prevent flare-ups

There are several lifestyle changes you can make to reduce your risk of cystic acne flare-ups, like:

✓ reducing stress through mindfulness, meditation, or yoga

✓ getting good, regular sleep

✓ avoiding common triggers like harsh skincare routines, picking spots, and not frequently changing pillowcases

✓ promoting hormonal balance through diet and exercise

✓ quitting smoking

In summary

Cystic acne is a severe type of acne, causing painful pus-filled cysts deep in the skin. Over-the-counter acne treatments are often ineffective for cystic acne and instead, you may need prescription medications such as antibiotics and retinoids to manage the symptoms. At Superdrug Online Doctor, we can provide several acne treatments to help manage painful and bothersome lesions.

Cystic acne FAQs

Can retinol cause cystic acne?

No, retinol does not usually cause cystic acne, but in some people it can cause outbreaks that look similar, also known as retinol purging.

Does cystic acne cause scarring?

Yes, cystic acne can cause scarring because it involves deep inflammation that can cause tissue damage. You can help to limit the risk of scarring by avoiding picking or squeezing the cysts that form.

Can toothpaste help get rid of cystic acne?

No, toothpaste is not a treatment for cystic acne. Toothpaste can clog pores and make acne worse.

Should I moisturise cystic acne?

Yes, it is a good idea to use moisturiser on cystic acne, but choose non-comedogenic (non-pore-blocking), oil-free, water-based moisturisers that are less likely to irritate your skin and clog your pores.

Can ibuprofen help with cystic acne?

Yes, ibuprofen is a non-steroidal anti-inflammatory medication so it can help reduce swelling and pain. However, you should speak to your doctor before taking ibuprofen for cystic acne.

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