Zits, pimples—call them what you will—are the bane of many teenagers and young adults. Some varieties are just unsightly and annoying, while others pose a more serious problem.

Cystic acne is a severe form of acne characterized by deep, inflamed cysts and nodules that form under the skin. Unlike typical pimples, these lesions are filled with pus and can be quite large, often feeling like hard, painful lumps. They commonly appear on the face, especially the cheeks, jawline, and chin. They can also occur on other areas of the body, such as the back, chest, and shoulders.

Cystic acne is marked by significant inflammation. The cysts are red, swollen, and tender to the touch. This inflammation is due to the immune system’s response to the infection and irritation within the clogged pores. The inflammation and pressure from the buildup of pus can cause considerable discomfort, even without touching the affected area.

Unlike milder forms of acne, which may heal relatively quickly, the lesions tend to persist for weeks or even months. Because of their depth and size, cystic acne lesions are more likely to cause scarring. This can be severe, resulting in deep, pitted scars or hyperpigmentation, which can be challenging to treat.

Causes of cystic acne

Hormonal fluctuations, such as those during puberty, menstrual cycles, pregnancy, or due to certain medical conditions, can trigger excess oil production and lead to cyst formation. Overactive sebaceous (oil) glands produce more sebum, which can mix with dead skin cells and clog hair follicles. The clogged pores create an ideal environment for the bacteria Cutibacterium acnes (formerly known as Propionibacterium acnes), which can proliferate, causing infection and inflammation that contribute to cyst formation.

A family history of severe acne can increase the likelihood of developing cystic acne. Genetics can influence its vemergence, including skin type, oil production, and immune response. Certain lifestyle factors, such as stress, a high-glycemic diet, and the use of certain skincare products or medications, can exacerbate cystic acne.

Treatment options

Prescription-strength topical treatments, such as retinoids (such as tretinoin), benzoyl peroxide, and antibiotics, can help reduce inflammation and prevent clogged pores.

For more severe cases, oral antibiotics (doxycycline and minocycline) may be prescribed to reduce bacterial infection and inflammation. Hormonal therapies, such as oral contraceptives or anti-androgen medications like spironolactone, can be effective for hormone-related cystic acne.

Isotretinoin (Accutane) is a powerful oral medication is often used for severe cystic acne resistant to other treatments. It reduces sebum production, shrinks oil glands, and has long-term effects on acne. Due to its potential side effects, it’s use must be closely monitored by a healthcare professional.

In some cases, a dermatologist may inject a corticosteroid directly into a cyst to reduce inflammation and pain, helping to shrink the lesion.

Maintaining a proper skincare routine, managing stress, and avoiding triggers such as certain foods or cosmetics, can help manage cystic acne.

The emotional challenge

Cystic acne strikes young people at an age where they are prone to be highly self-conscious and emotionally vulnerable. This is why acne can have a significant impact on mental health, causing a range of emotional and social challenges. Because acne is a psychosomatic disorder that affects both the body and the mind, it can lead to a variety of psychological distress, including depression (the feeling that life is bad right now), anxiety (the feeling that bad things are coming in the future), low self-esteem, social withdrawal, and even suicidal ideation. If you or your child are emotionally affected by any type of acne, you may want to consult a mental health professional. And the message of hope should be, “This too shall pass.”