Subcutaneous cystic acne causes types and advanced treatment methods

Cystic acne under the skin is a deep and stubborn type of acne that develops beneath the surface of the skin, causing painful lumps that can sometimes lead to long-lasting scars. If you’re struggling with this condition, you may have already tried several treatments without success, leaving you searching for more effective solutions.In this Dalily Medical article, we’ll discuss the main causes of cystic acne under the skin, how it’s diagnosed, and the most effective treatments that can help you get rid of it for good. Whether you’re looking for medical or natural remedies, we’ve gathered everything you need to know to achieve healthy, clear, and acne-free skin.

What is Cystic Acne?

Cystic acne is one of the most severe and complex types of acne. It appears as large, red, swollen lumps that are often painful to the touch. Some of these lumps may contain pus, while others are firm and tight, making them difficult to treat. Due to the deep inflammation associated with this condition, it’s often resistant to simple home remedies.

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What Does Cystic Acne Look Like?

Cystic acne appears as large, red, painful bumps that differ from regular pimples, which usually have a visible head. These cysts are typically buried deep under the skin and can be felt more easily than seen. Unlike blackheads or whiteheads, cystic acne does not have an open pore or head, making it harder to treat. If left untreated, it can lead to permanent scarring.

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Does Cystic Acne Always Form Under the Skin?

Yes — being deep under the skin is one of the key characteristics of cystic acne. Unlike surface pimples that are easily visible, cystic acne lesions are often invisible but painful when touched. However, not every bump under the skin is cystic acne — diagnosis depends on several factors such as size, inflammation, and the presence of pus. Consulting a dermatologist is always the best approach for accurate diagnosis.

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How Does Cystic Acne Form?

Cystic acne develops when natural oils (sebum), dead skin cells, and bacteria accumulate inside clogged pores. This buildup leads to deep inflammation within the skin, causing swelling, pain, and the formation of large cystic lumps.

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Where Does Cystic Acne Commonly Appear?

Cystic acne tends to form in areas with a high concentration of sebaceous (oil) glands, including:

• Chin and jawline: Common in women and often linked to hormonal changes such as menstruation or PCOS.

• Cheeks: Can be triggered by frequent contact with phones or pillowcases.

• Back and shoulders: Common in people who sweat heavily or exercise frequently.

• Chest: Can result from excessive sweating or unsuitable skincare products.

• Scalp and hairline: Caused by clogged pores due to heavy hair products or sweating.

• Buttocks: May occur due to friction, tight clothing, or prolonged sitting.

• Lower abdomen or waist: Rare, but can develop due to excessive sweating or friction.

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Do Cystic Acne Scars Go Away?

Cystic acne scars can be stubborn, but they are not permanent. With proper treatment and skincare, their appearance can be significantly reduced. Treatments like chemical peels, microneedling, and laser therapy can improve skin texture and reduce scarring.

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How Long Does Cystic Acne Take to Heal?

Cystic pimples usually take two weeks to several weeks to subside, depending on severity and treatment response. Sometimes, they leave behind dark marks or scars. With effective treatment and medical supervision, healing can be faster and the risk of scarring minimized.

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Types of Cystic Acne on the Face

1. Deep Cystic Acne

• Description: Large, painful lumps that form deep under the skin and take a long time to heal.

• Features: Often filled with pus and remain beneath the surface for weeks.

2. Multiple Cystic Pimples

• Description: Clusters of cysts appearing together as a group.

• Features: Form lumps or swollen areas caused by recurring pore blockages.

3. Severe Inflammatory Cystic Acne

• Description: Marked by intense inflammation and redness; may result from bacterial infection.

• Features: Painful, swollen cysts often filled with pus.

4. Reactive Cystic Acne

• Description: Triggered by hormonal fluctuations, stress, or diet.

• Features: Appears sporadically and tends to form deep, isolated pimples.

5. Chronic Cystic Acne

• Description: Persistent acne that lasts for months and is difficult to treat.

• Features: Recurs regularly and may cause scarring or pigmentation if untreated.

6. Cystic Acne on Chin and Jawline

• Description: Primarily affects the chin and jaw, common during hormonal changes like menstruation or pregnancy.

• Features: Very painful and often leaves dark marks or scars.

7. Cystic Acne with Scarring

• Description: Severe cysts that cause deep, long-term scarring due to tissue damage.

• Features: Large cysts that leave permanent marks even after healing.

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What Causes Cystic Acne on the Face?

1. Excess Sebum Production

Overactive sebaceous glands produce excess oil, which clogs pores and fosters bacterial growth — a main trigger for cystic acne.

2. Bacteria (Propionibacterium acnes)

This bacteria thrives in clogged pores, causing inflammation and pus-filled cysts deep under the skin.

3. Hormonal Imbalances

Hormonal fluctuations — especially during puberty, menstruation, or PCOS — stimulate oil production, leading to cyst formation.

4. Genetics

If acne runs in your family, you may be genetically predisposed to overactive oil glands or inflammatory responses.

5. Inappropriate Skincare Products

Using oily or comedogenic products can block pores and worsen cystic acne, especially for oily skin types.

6. Stress

Stress increases cortisol levels, which can boost oil production and trigger flare-ups.

7. Hormonal Medications

Certain hormonal drugs, such as birth control pills or androgen-based medications, may increase oil secretion.

8. Friction or Pressure on the Skin

Constant pressure from helmets, glasses, or tight clothing can irritate pores, causing "acne mechanica."

9. Environmental Pollution

Exposure to dirt, sweat, and air pollutants clogs pores and aggravates acne.

10. Improper Skin Care

Over-exfoliating or using harsh chemicals can irritate the skin and worsen cystic acne.

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Stages of Cystic Acne Development

1. Pore Blockage:
   Oils, dead cells, and dirt block the pores. Skin may appear oily or shiny.

2. Formation of Blackheads or Whiteheads:
   If pores remain closed, oil builds up under the skin, forming cysts.

3. Inflammation and Redness:
   The immune response causes swelling, pain, and redness.

4. Cyst Formation:
   Deep, pus-filled cysts form beneath the skin.

5. Severe Infection:
   Without treatment, cysts may become abscesses with spreading infection.

6. Scarring:
   Improper treatment or squeezing cysts can cause permanent scars.

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Complications and Effects of Cystic Acne

• Deep Scars and Skin Damage: Inflammation destroys tissue, leading to visible scars.

• Severe Infections: Pus-filled cysts can spread bacteria to nearby areas.

• Wider Spread: Squeezing cysts can transfer bacteria to other parts of the skin.

• Psychological Impact: Painful cysts can cause embarrassment, low self-esteem, and social withdrawal.

• Subcutaneous Bumps: Painful lumps develop under the skin due to deep clogging.

• Oily Skin Appearance: Excess oil production gives the skin a greasy look and worsens breakouts.

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Medical Treatments for Cystic Acne

1. Topical Antibiotics

• Examples: Clindamycin, Erythromycin.

• How they work: Reduce bacteria and inflammation.

• Usage: Apply directly to affected areas once or twice daily.

2. Oral Antibiotics

• Examples: Doxycycline, Tetracycline.

• How they work: Treat bacterial infection and reduce deep inflammation.

• Usage: Taken as prescribed by a dermatologist.

3. Retinoids

• Examples: Tretinoin, Adapalene.

• How they work: Promote cell turnover and unclog pores.

• Usage: Apply once daily at night.

• Note: May cause initial dryness or irritation; use sunscreen during the day.

4. Benzoyl Peroxide

• How it works: Kills acne-causing bacteria and reduces oil.

• Usage: Apply once or twice daily to clean skin.

• Note: Moisturize after use to prevent dryness.

5. Hormonal Therapy

• Examples: Birth control pills, Spironolactone.

• How it works: Regulates hormones and reduces oil production, especially in hormonally triggered acne.

Corticosteroid Treatment

Common Drugs: Hydrocortisone.

How It Works: Corticosteroids help reduce severe inflammation and can be injected directly into cystic pimples to shrink them quickly.

How to Use: Corticosteroids can be applied topically or injected directly into large cystic lesions under medical supervision.

Notes: They should be used with caution, as prolonged use may cause skin thinning.

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Antifungal Treatment

How It Works: If cystic acne is caused by a rare fungal infection, doctors may prescribe antifungal creams or oral medications.

How to Use: Apply the cream to affected areas twice daily.

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Chemical Peel Treatment

How It Works: Chemical peels remove dead skin cells and unclog pores, which can help reduce cystic acne.

How to Use: This procedure is performed in dermatology clinics by professionals using peeling agents such as glycolic acid or salicylic acid.

Notes: Peels help reduce clogged pores and soothe inflammation.

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Biologic Drugs

How It Works: In severe or chronic cases of cystic acne, doctors may prescribe biologic drugs such as isotretinoin or immunosuppressive medications.

How to Use: These medications must be used under strict medical supervision and are typically prescribed when other treatments have failed.

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Surgical and Laser Treatments for Cystic Acne

Sometimes, cystic acne requires advanced procedures such as laser therapy or minor surgery—especially for severe cases that do not respond to medication. Here’s an overview of the available options:

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1. Laser Treatment for Cystic Acne

Laser therapy is an effective option when medications alone are insufficient. It works by reducing inflammation, unclogging pores, and stimulating skin regeneration.

Types of Lasers Used:

• Carbon Dioxide (CO₂) Laser
  How It Works: Removes superficial skin layers and gently exfoliates the skin, helping open clogged pores and reduce cyst swelling.
  Benefits: Minimizes pimple size and reduces the appearance of enlarged pores.

• Pulsed Dye Laser (PDL)
  How It Works: Primarily used to treat redness and swelling caused by cystic acne.
  Benefits: Reduces skin irritation and promotes faster healing.

• Fractional Laser
  How It Works: Creates tiny microchannels in the upper skin layer to stimulate cell renewal and improve blood circulation.
  Benefits: Promotes skin regeneration and reduces scars and fine lines.

Laser Treatment Procedure:

• Preparation: Clean the face thoroughly to remove oil and impurities.

• Procedure: The laser beam is directed at the affected area. Treatment sessions typically last 15–30 minutes, depending on the area size.

• Frequency: Usually, 2–3 sessions are needed for optimal results.

• Aftercare: Some redness or swelling may appear but usually subsides within a few days.

Advantages of Laser Therapy:

• Fast Results: Noticeable skin improvement in a short time.

• Scar Reduction: Helps minimize acne scars.

• Collagen Stimulation: Boosts collagen production for firmer, smoother skin.

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2. Surgical Treatment for Cystic Acne

For severe cases that don’t respond to medication or laser therapy, minor surgical procedures may be required to drain cysts or remove damaged tissue.

Types of Surgical Procedures:

• Abscess or Cyst Drainage
  How It Works: If the cyst has developed into a large pus-filled abscess, the doctor drains it using a sterile needle or performs a small incision.
  Procedure: Local anesthesia is applied, and a small incision is made to release accumulated fluid.

• Removal of Damaged Tissue (Surgical Excision):
  How It Works: In advanced cases, damaged skin layers are removed with precision surgical tools to eliminate infected tissue.

Surgical Treatment Procedure:

• Preparation: Local or general anesthesia may be used depending on the case.

• Procedure: A small incision is made, and cysts or abscesses are drained using sterile instruments.

• Duration: Typically takes around one hour, depending on the severity.

Advantages of Surgical Treatment:

• Effective for Severe Cases: Provides a reliable solution when other treatments fail.

• Removes Damaged Tissue: Helps eliminate cysts and infected areas completely.

Post-Surgery Notes:

• Swelling and Redness: Mild swelling or redness may occur but usually resolves with time.

• Scarring: Small scars may remain but fade gradually as the skin heals.

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Benefits of Laser and Surgical Treatments:

• Quick Effectiveness: Results appear faster than with topical or oral treatments.

• Improved Skin Appearance: Laser helps minimize scarring and enhances overall skin texture.

• Treatment for Advanced Cases: Offers a solution for severe cystic acne when conventional methods are ineffective.