Cystic acne
Acne turns cystic when lumps fill with pus deep under the skin of the face, back, chest or shoulders and can last for months. Lumps found only where skin touches skin, like the armpits or groin, point to hidradenitis suppurativa.
Where do your deep lumps sit?
Last reviewed
Cystic acne or something else?
Three other deep lumps get mistaken for cystic acne. Two answers show which one yours looks like.
- Acne zones
- Skin folds
| Lump | Where | What it looks like | Who treats it |
|---|---|---|---|
| Cystic acne | Face, jaw, neck, chest, back, shoulders | Deep, painful lumps full of pus | A dermatologist |
| Hidradenitis suppurativa | Armpits, inner thighs, groin, buttocks, under the breasts | Lumps that return in the same spot and leak blood and pus; not contagious | A dermatologist |
| Boil | Face, neck, armpits, buttocks, thighs | One tender, swollen spot that fills with pus, usually from staph bacteria | A doctor or urgent care |
| Epidermoid cyst | Chest, shoulders, face | A firm, round lump with a tiny pore and cheesy contents; twice as common in men | A dermatologist, by minor surgery |
Hidradenitis suppurativa affects about 1 in 100 people (NHS). Warm compresses help a boil drain (MedlinePlus).
What cystic acne is
Cystic acne is the most severe form of acne, with deep, painful lumps full of pus. It means the trouble starts deep in the skin, not at the surface. The cause of cystic acne is a hair follicle plugged with oil and dead skin cells: skin bacteria grow in the plug, and when the follicle wall breaks down, the contents spill into the skin and inflame it (NIAMS).
Doctors also call it severe nodular acne or nodulocystic acne (NIAMS, MedlinePlus). Acne "cysts" have no capsule of their own, so dermatologists call them pseudocysts (DermNet).
Symptoms and Characteristics
- Appearance
- Nodules and cysts are larger lumps under the skin, and they may join together (NHS).
- Pain
- Deep breakouts tend to hurt (AAD, NHS).
- Common Locations
- Face, jawline, neck, chest, back, sometimes the buttocks (AAD), and shoulders (NIAMS). Lumps on the trunk tend to linger and scar differently; see cystic acne on the back and chest.
- Duration
- A regular spot clears in under two weeks; a deep lump can last months (DermNet), and scars often follow (AAD).
If those four sound familiar, a photo can rate how severe your breakouts are.
Causes and Triggers
Pore Blockage
Oil and dead skin cells clog a hair follicle, bacteria grow inside, and the wall gives way deep down (NIAMS).
Hormones
Androgens rise in puberty and enlarge oil glands (AAD); periods, pregnancy and the pill shift oil too (MedlinePlus). Acne with irregular periods or extra facial hair can point to PCOS, which the NHS now calls PMOS (AAD).
Genetics & Lifestyle
A close relative with deep, painful pimples raises your risk, and stress may worsen acne (AAD). Anabolic steroids and whey supplements are risk factors (DermNet). A sugar or dairy link is unproven; MedlinePlus calls it controversial.
Treatments
| Option | What it is | What it does for deep lumps | Who gives it |
|---|---|---|---|
| Prescription Topicals | A retinoid, benzoyl peroxide or azelaic acid | Keeps pores clear; alone, usually not enough for deep lumps (DermNet) | Ask your dermatologist |
| Oral Medications | An antibiotic with a medicine you apply; for women, the pill or spironolactone | Often the first plan (AAD); spironolactone is not prescribed for men | Ask your dermatologist |
| Isotretinoin | One course of pills, with a required monitoring program | About 85% see permanent clearing after one course (AAD); a 2024 US guideline strongly recommends it for severe or scarring acne | Ask your dermatologist |
| In-Office Procedures | A corticosteroid shot, or incision and drainage | The shot quickly shrinks one big, painful lump; drainage is for one medicine cannot clear (AAD) | A dermatologist |
| At-Home Care | Ice, and hands off | Ice eases pain; never drain a lump yourself, the infection risk is high (AAD) | You |
Store products cannot clear severe acne, and waiting it out can take years (AAD).
Going deeper on cystic acne
If you want to know what is going on under the skin, and why these lumps are not true cysts, start with what is cystic acne.
Lumps that swell along the jaw before each period follow a pattern of their own, explained under hormonal cystic acne.
Every prescription route, from tablets to injections, is weighed side by side under cystic acne treatment.
When to see a doctor
- Any deep, painful lump: the sooner a dermatologist treats it, the fewer scars (AAD).
- Hot, swollen, red skin around the spots, a sign of infection (NHS).
- A boil on your face, or a boil while you feel hot or shivery (NHS).
- Acne plus signs of PCOS (AAD).
- Acne that weighs on your mood (NHS).
Quick answers
What is cystic acne caused by?
A plugged hair follicle that bursts deep in the skin (NIAMS). Puberty hormones and a family history of deep pimples make it more likely (AAD).
What is mistaken for cystic acne?
Hidradenitis suppurativa (lumps in skin folds), a boil (one infected follicle) and an epidermoid cyst (a round lump with a tiny pore). The sorter above tells them apart.
Does cystic acne mean PCOS?
Not by itself. PCOS affects 7 to 10% of women of childbearing age, and 60 to 80% of them have high androgen levels (Endocrine Society). Other signs are irregular periods, extra facial hair, thinning scalp hair or darkening skin (AAD).
How to tell if a pimple is cystic acne?
It is a large, painful lump under the skin, not a small bump on top, and it lasts far longer than the two weeks of a regular spot (NHS, DermNet).
What draws out a cystic pimple?
Nothing safe at home: squeezing pushes it deeper. Ice eases pain; a dermatologist can inject or drain it (AAD).
Sources
- What can clear severe acne? American Academy of Dermatology (AAD).
- Types of acne; Pimple popping; What causes acne; Hormonal therapy; Stubborn acne; Diet and acne. AAD.
- Hidradenitis suppurativa: overview; signs and symptoms. AAD.
- Hidradenitis suppurativa; Boils; Acne. NHS.
- Boils; Acne. MedlinePlus, National Library of Medicine.
- Acne. NIAMS, National Institutes of Health.
- Epidermoid cyst; Cutaneous cysts and pseudocysts; Nodulocystic acne; Acne vulgaris. DermNet.
- Polycystic ovary syndrome. Endocrine Society.
- Guidelines of care for the management of acne vulgaris. JAAD, 2024. PMID 38300170.
General information, not a diagnosis. See a dermatologist for deep, painful lumps.