Treatment for Cystic Acne

Inflammatory acne manifests as pustules, papules, purple or red macules or nodules called cysts.  It grows as a cyst under the skin and it is considered a severe form of acne. The acne nodules begin to harden slowly into painful cysts. Cystic acne treatment cannot be done with home remedies. It requires the intervention of a doctor.

Causes of cystic acne

When acne scars do not get treated properly, they can develop pus-filled nodules that become deep acne cysts. One cause of acne cysts forming is not following a proper cleansing routine. This causes bacteria to continue growing in the pimples.  

Severe cystic acne is formed when the sebaceous glands produced uncontrollable amounts of sebum. The bacteria thrive and become more pervasive. Pimples get buried deep into the skin. The body tries to fight off the bacteria resulting in further damage to the skin. Lesions surface to the top of the skin, interconnect and start forming deep cysts. There is widespread scarring and pitting. 

Treatment for cystic acne

Topical medications : Topical creams and antibiotics are the first line of treatment for any type of acne. Benzoyl peroxide is normally prescribed to manage acne cysts. However, this is not enough and your dermatologist will prescribe stronger oral medications.

cystic acne treatments

Oral Antibiotics : These are also used by dermatologists as mainstays in cystic acne treatment. Some oral antibiotics that give relief for cystic acne are doxycycline, tetracycline, minocycline and erythromycin. These antibiotics cannot be taken for long periods. They must also be taken for the full duration prescribed. Otherwise, bacteria will become resistant to them and require a fresh course of a different antibiotic. 

Isotretinoin : This is the common medication prescribed for cystic acne treatment. It works on the sebaceous glands and shrinks it. This reduces the amount of sebum produced by these glands. Bacteria growth is also controlled. Isotretinoin is a vitamin A derivative (retinoid). It is usually taken for 15-20 weeks – once or twice a day. It must be taken along with food. Isotretinoin is very effective in preventing acne scars.   It also reduces shedding of skin, reduces stickiness of the skin and prevents extensive scarring.  If cystic acne recurs after one course, doctors could prescribe a second course. 

Isotretinoin is a drug that causes serious birth defects. Hence, women of childbearing age must be extremely careful. They will be advised to follow at least two effective birth control methods a month before and after and during treatment. Pregnant women cannot take isotretinoin. There are cases of people taking isotretinoin and becoming suicidal. However there is not connection between the two and suicidal tendencies is said to be more because cystic acne causes deep scars that can make a person feel depressed.

Isotretinoin can cause side effects like:

  • Dry eyes, nose, skin, lips or mouth
  • Nosebleeds
  • Muscle aches
  • Itching
  • Sensitivity to sun
  • Poor vision at night
  • Increased cholesterol and triglycerides
  • Liver problems

Please report any side effects you experience to your doctor. 

Isotretinoin was sold originally as Accutane. However, since 2009, this medication has been removed due to various complaints received from the public and financial losses of the company. Since then, there are other less expensive forms of isotretinoin available in the market such as Claravis, Amesteem and Sotret.

Steroid Injections : One painless cystic acne treatment that could be substitute for antibiotics is intra-lesional cortisone injection. Cortisone is a steroid and is very effective in reducing the swelling, pain and redness of acne cysts. This treatment is effective for cysts that are long lasting and have large lesions. Each cyst is targeted and a single dilute solution of cortisone is injected using an ultra thin small needle. Although the injection is slightly painful, you will see results in a few days. The cysts will soften and become flat in a week. If the lesions do not respond immediately, the treatment can be repeated. If there are only a few cysts, doctors may prefer to use this treatment over oral antibiotics.

With steroid injections, if too strong a dose of cortisone is used, the injected sites will become depressed scars. These scars can be permanent. 

Other treatments :Other cystic acne treatments are available. Their effectiveness cannot be guaranteed until the patient tries them for a period. Female patients could get help for cystic acne from oral contraceptives. Since hormonal fluctuations are one cause of acne, oral contraceptives work by suppressing oil glands that become overactive due to this imbalance. Oral contraceptives can be used for long periods but are not very effective for those above the age of 35, those who suffer from periodic migraines, women who smoke or have blood clotting problems. 

Treatment for Cystic Acne Scars

Cystic acne will usually leave behind scars that can be deep and pitted. Depending on the size, depth and intensity of the scars, there are many surgical procedures available that can treat them like punch excision, laser resurfacing, microdermabrasion, injectable fillers and dermabrasion.   Your dermatologist will advise you as to which type of treatment will suit your acne scars.


We have seen various cystic acne treatments. There can be side effects with some, and it is important that treatments be taken under medical supervision and all side effects reported immediately.

When you first develop pimples, it is important to treat them at once. Not following a proper cleansing routine can cause the bacteria to linger and develop into deep cysts. Once these cysts are formed, the patient requires strong medications that can give many side effects. Hence, make sure you take care of your skin everyday by washing with oil-free cleansers and mild soaps. Use only oil-free makeup and avoid products that can irritate the skin. Avoid sweat buildup by showering and washing especially after exercising and at night. 

Eating fresh fruits and vegetables is a way to maintain a healthy lifestyle and avoid severe forms of acne.