5 minute read

Treating Cystic Acne: What To Do and What Not To Do

Written by
Reviewed by
Dr Ai Nhi Bui

Pimples are always annoying, but cystic acne is particularly bad. That’s because cystic acne is the most severe type of acne - it’s painful, difficult to get rid of and can cause acne scarring. Like all other spots, it starts with your pores getting clogged. What makes it exceptionally bad is when it becomes inflamed and infected. 

Because these cysts are rooted deep within your skin, oftentimes over-the-counter cleansers and treatments won’t cut it. The good news is that treating cystic acne is possible with prescription treatments. If you think you have cystic acne and want to find out how to manage and treat it, read on.

What is cystic acne?

Before we dive into the causes and treatments, let’s explain what cystic acne is. The words pimple and acne tend to cover a wide range of different types, but they range quite a bit in terms of severity. 

Blackheads and whiteheads are the most mild form of acne and are both noninflammatory. The next stage are papules (red and tender) and pustules (red, tender and pus-filled), both of which are inflammatory types of acne. Then you have nodules: large, hard lumps that develop deeper under the skin. 

Finally, the most serious type of acne is cystic acne. Cysts are inflamed, filled with pus and painful. They develop further below the surface of your skin than nodules when your pores are clogged by a combination of bacteria, oil and dead skin. They can look like boils on your skin and can show up on your face, neck, chest, back, arms and shoulders. 

What causes cystic acne?

Like all forms of acne, cysts are caused by your pores getting blocked. Excess sebum (the oily substance your body naturally produces to keep your hair and skin soft), dirt, bacteria and dead skin cells are common culprits. The key difference between cysts and other types of acne is that cysts develop much deeper underneath the skin than other types of zits. 

People with oily skin are more likely to have cystic acne. It’s also more common in teenagers going through puberty due to the hormonal changes in your body, but it’s possible to have cystic acne as an adult as well. 

Popping cystic acne

Because cysts are big and pus-filled, it can be extremely tempting to pop them. Whatever you do, do not pop your cystic acne! This will be painful, delay the healing process and likely cause scarring. 

While pustules, blackheads and whiteheads have a core of dead skin or pus that can be squeezed out, cysts don’t have this core because they’re deep under your skin. Popping cystic acne results in trauma and more inflammation, which leads to scarring and discolouration. In general, it’s not a great idea to pop any of your pimples but especially not cystic zits. 

Treating cystic acne

When it comes to acne treatments, there’s an endless supply of cleansers, moisturisers, masks and skincare products that claim to give you clear skin. A good skincare routine (including sunscreen!) is an important aspect of a cystic acne treatment plan. However, because these cysts are further beneath the surface of your skin than milder forms of pimples, cystic acne treatments are typically prescription medications.


Retinoids are some of the most effective ways to treat all forms of acne, from mild to severe. There are a few different kinds, including adapalene, tretinoin and isotretinoin. Adapalene and tretinoin are topical retinoids, while isotretinoin is a stronger cystic acne treatment that is taken orally.

Retinoids work by increasing the rate of skin cell turnover, giving your pores less time to become clogged with acne-causing debris. They are commonly associated with skin purging, the initial period of starting acne treatment when your skin gets worse before it gets better. For most patients, skin purging (also known as the tretinoin purge) is uncomfortable but after four to six weeks (one full skin cycle) you’ll see fresher, clearer skin. 

Because retinoids are extremely effective in fighting acne, they are one of the most popular cystic acne treatments.

Oral antibiotics

If your cystic acne is on a large area of your skin, your doctor or dermatologist may prescribe you oral antibiotics. One of the causes of cystic acne is bacteria getting stuck in your pores, leading to infection, inflammation and cysts. Oral antibiotics decrease the amount of bacteria present, thus working to reduce the amount of acne you have. 

In Australia, you may be prescribed doxycycline, minocycline or erythromycin to treat cystic acne. It’s common to be using both oral antibiotics and a topical retinoid at the same time. However, antibiotics should be used for the shortest amount of time possible in order to prevent bacterial resistance.

Oral contraceptives

While the birth control pill’s main use is for preventing pregnancy, it is also a great way to manage hormonal acne. Women who tend to develop acne cysts during hormone fluctuations due to their menstrual cycles might find that taking oral contraceptives helps manage their cystic acne breakouts. 

Cystic acne treatment online with Rosemary Health

If you’re breaking out with cysts, don’t panic. There are proven prescription medications that can help treat cystic acne. Rosemary Health connects you with licensed Australian doctors online who can help prescribe a personalised cystic acne treatment plan for you. Start your skin assessment today - no appointments or video calls needed. 


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