Cystic Acne: Causes, Treatments, and What Actually Works

When you hear cystic acne, a severe form of acne characterized by large, painful, pus-filled lumps deep under the skin. Also known as nodulocystic acne, it doesn't respond to regular face washes or over-the-counter spot treatments. It’s not just about oil or dirt—it’s driven by hormones, inflammation, and bacteria working together under the skin. This isn’t teenage acne that fades with time. For many adults, especially women, cystic acne flares up with menstrual cycles, stress, or even diet changes. It leaves scars, lowers confidence, and often feels impossible to fix.

What makes cystic acne different is where it forms—deep in the hair follicles, where sebum, dead skin cells, and Propionibacterium acnes, a bacteria naturally found on skin that can trigger inflammation when overgrown. Also known as P. acnes, it thrives in clogged pores and turns minor breakouts into painful lumps. Topical creams rarely reach this deep. That’s why treatments like isotretinoin, a powerful oral medication that shrinks oil glands and reduces bacteria. Also known as Accutane, it’s often the only solution for severe, recurring cystic acne. Antibiotics like doxycycline or minocycline help control the bacterial side, but they’re not a long-term fix. Hormonal therapies, like birth control pills or spironolactone, work for many women by balancing androgen levels that fuel oil production.

You won’t find miracle cures here—no tea tree oil or lemon juice will erase deep cysts. But you will find real, science-backed approaches in the articles below. Some explain how antibiotics interact with other meds, others show how steroid use can worsen skin, and a few dig into how systemic inflammation affects skin health. These aren’t generic tips. They’re practical insights from people who’ve been through it, and doctors who’ve treated it. Whether you’re wondering why your acne won’t go away, or you’re scared of starting isotretinoin, the answers are here. No fluff. No hype. Just what works.