What to Do About Cystic Acne

Jeff Hautala
By Jeff Hautala, Co-Founder of Exposed Skincare

If you have cystic acne, you probably already know that it isn’t like other forms of acne. Cysts are large, raised bumps on the skin, and they’re often painful. Blackheads, whiteheads, even pimples just aren’t the same. But what exactly makes cysts different? To understand this, we need to take a look at how less severe acne forms, and what happens when cysts develop. This allows you to reverse-engineer a solution: once you understand the factors that contribute to cysts, you can find treatments that target those factors specifically, rather than using a generic acne treatment.

Cystic Acne
Understanding cystic acne is the first step toward getting rid of it for good.

How Acne Usually Forms

The same three factors are involved in all forms of acne, from blackheads to cysts: inflammation, bacteria, and oil production.

Acne starts with inflammation, which can be caused by any number of things, from stress to a minor bacterial infection, like strep throat. Inflammation causes the skin to swell slightly, constricting pores. Sometimes they close completely, but other times the pores simply shrink to a size too small for oil or dead skin cells to escape like they normally would. At this point, bacteria and oil production come into play.

The oil on your skin (also called sebum) is produced by sebaceous glands in the skin. These glands produce sebum then release it into a duct which reaches to a pore on the surface of the skin. With no inflammation, sebum is typically good for the skin because it provides a layer of protection against any irritants. However, if the skin is inflamed, the sebum doesn’t always make it to the surface of the skin because it gets stuck in the pore instead. If the pore is fully closed, then this becomes a whitehead. If it the pore is slightly open, but the sebum still can’t escape, it becomes a blackhead.

Bacteria are similar to sebum: they only become a problem if they skin is inflamed. The bacteria primarily associated with acne, p. acnes, always live on the surface of our skin, and because sebum is their main food source, they can actually help prevent oil buildup. However, when bacteria get trapped in a pore due to inflammation, they can start a minor infection. This is how pimples form, but it’s also how cysts can develop, depending on how the skin, immune system, and bacteria interact.

How Cystic Acne Forms

When p. acnes bacteria are trapped in a pore with sebum, their main food supply, they can multiply very quickly. Unlike when p. acnes live on the surface of the skin where they can spread out, when they are trapped in a pore they have nowhere to go, so they try to expand to different pores. They do this by releasing special chemicals which bind to the skin cells and make them seem like bacteria cells instead. When the immune system responds and tries to kill off the bacteria, it can be tricked into attacking the skin cells instead of the bacteria. If the bacteria are killed, either because the immune system wasn’t fooled or because it was strong enough to fight the skin cells and kill all the bacteria too, a pimple forms, pops, and goes away. If the bacteria are not killed quickly, that’s when a cyst can form.

When cysts form, the immune system attacks the skin cells until they start to deteriorate, giving the bacteria room to grow even more. Their numbers keep rising as they reproduce unimpeded while the immune system fights itself rather than its intended target, and the infection can spread under the skin. Because the bacteria have room to grow under the skin, and because the immune system isn’t killing bacteria to create pus, the infection isn’t pushed toward the surface, like it is with a pimple. Unlike pimples which form a small head under a very thin layer of skin, cysts do not have a defined head and the layer of skin over them tends to be relatively thick. This can make them more difficult to treat.

Teenagers are More Likely to Get Cysts Than Adults

One of the big questions dermatologists are trying to answer is why do some people develop cysts while others don’t? The process for developing a pimple and developing a cyst are essentially the same, but the result can be very different. Right now, dermatologists aren’t sure exactly what determines whether you are prone to cysts or not, but they have isolated certain populations that are more likely to have them.

Although adult acne is very common, it is much less common for adults to have cystic acne. Studies show that teenagers and those in their early 20s are much more likely to have cysts than those in their late 20s or older. The prevailing theory on why younger people have more cysts, despite having a healthier immune system in most cases, is that their skin is too healthy.

Before your mid-20s, your skin cells are typically produced and replaced very quickly. This is usually a good thing: it can minimize scarring, speed the wound healing process, and help prevent clogged pores. The trouble is, if a healthy new layer of skin forms over a clogged pore that is developing a p. acnes infection, the bacteria can’t escape to the surface of the skin. Instead, they burrow deeper, which creates a cyst.

The good news is that skin cell turnover slows down with age, so even though you have cysts now, there’s a good chance it will decrease or go away entirely as you age.

Certain Factors Can Put You at Higher Risk of Cystic Acne

Age is the best predictor for cystic acne, but there are a few other factors that can have a significant impact. Researchers have found that people with Latinx or Hispanic skin tones are more likely to have cysts, although they haven’t determined why this is. Although studies say “Latinx or Hispanic” skin tones, that is not a very clear explanation of the skin type they are referring to. People in Latin America or Spanish-speaking countries have a very wide variety of skin tones. More specific studies specify that on the Fitzpatrick skin phenotype scale, phenotypes VI and V are more likely to experience cysts.

Newborn babies with minor immune system deficiencies are another population that are more likely to experience cysts. Many babies experience baby acne because of how dry and harsh the air is compared to the womb. Like teenagers, babies have very fast skin cell turnover, so when newborns develop cysts, it is typically a sign of a small immune deficiency. The immune system is being tricked into attacking the skin cells instead of the bacteria, leading to baby cysts. This typically sorts itself out as the baby’s immune system grows and strengthens.

Cystic Acne Babies
Some babies with minor immune system issues can develop cysts, but they typically go away on their own.

Is Cystic Acne Contagious?

This is a popular question with a simple answer: no. If you have cysts, you cannot give someone else cysts. Like any infection, it’s possible to transfer the bacteria to another person, but remember, cystic acne is just like regular acne except for how your skin reacts to the p. acnes infection. If your cyst pops or leaks and someone comes into direct contact with the contents of the cyst, they can receive p. acnes bacteria from you, and there is a small chance they could get a pimple from it. But unless they are also prone to cysts, touching yours will not give them cysts.

This also applies to indirect sharing of bacteria. P. acnes don’t live in your saliva or lungs, only on your skin, so you cannot give someone cysts, or any kind of acne, by sharing a drink with someone, kissing someone, or coughing around someone.

The Three Best Ways to Treat Cystic Acne

Cystic acne can be trickier to treat than some other forms of acne, but that doesn’t mean you don’t have options. There are many effective treatments for cysts, such as tea tree oil, a combination of adapalene and benzoyl peroxide, and a consistent skin care routine.

Tea Tree Oil

  • Tea tree oil can be very effective in preventing cysts because it is antibacterial and anti-inflammatory. It can kill 99% of p. acnes bacteria, and by preventing inflammation, it can help prevent what little bacteria that survive from getting trapped in a pore and creating a cyst.
  • Before buying a product containing tea tree oil, it’s important to look at the concentration if you choose to go this route, though. Some tea tree oil products contain up to 25% tea tree oil, which is much too high. Studies show that 5% can effectively kill nearly all bacteria. If you have cysts and nothing else has helped, it can be tempting to jump straight to the higher concentrations, but these will dry out the skin and could create even more acne. Products with 5% tea tree oil can be very effective in treating cystic acne.
  • If you would prefer to make your own tea tree oil remedy, you can also purchase the essential oil yourself, although it should never be used undiluted. When you buy the tea tree oil, be sure to also buy a carrier oil that won’t clog pores, like jojoba oil. Add 12 drops of tea tree oil to a 1 oz. container of your carrier oil, and apply the mixture to your cysts, or all over, twice a day. If you notice dryness, redness, or itching, go down to once per day.

Adapalene and Benzoyl Peroxide

  • Studies show that combining these two ingredients can significantly reduce cystic acne specifically. On their own, adapalene and benzoyl peroxide take care of one part of the issues that cause cysts, but together they tackle the problem as a whole. Adapalene is a retinoid-like compound, which just means that it helps regulate the skin cell cycle. This works well for cysts because it can prevent new skin cells from being created so quickly that the infection gets trapped under the skin. Benzoyl peroxide, on the other hand, works by killing p. acnes bacteria. It carries oxygen below the surface of the skin, which kills p. acnes because they are anaerobic, meaning they can’t survive in the presence of oxygen.
  • Combined, these two ingredients treat two of the main causes of acne, and studies show it really works. There are some products that include both adapalene and benzoyl peroxide, but using two separate products, one for adapalene and one for benzoyl peroxide is also effective.

The Power of a Consistent Skin Care Routine

  • Most regular skin care routines are not enough to treat cysts, but they can help prevent it. In addition to tea tree oil or adapalene and benzoyl peroxide, a consistent skin care routine can make a world of difference. The trouble is, many acne treatment systems are too harsh. Harsh acne treatments cause irritation, which leads to inflammation and excess oil production. If you are already prone to cysts, irritating the skin and generating more inflammation is not helpful—it may even cause more cysts. Many skin care companies make their products so harsh because they want to promise immediate results, and using ingredients that are too srong can get rid of acne relatively quickly. The trouble is, it comes back just as fast once the skin gets irritated.
  • Instead of getting stuck in this cycle of acne, Exposed Skin Care believes we should create products that are actually good for your skin. That’s why our skin care line contains both strong acne-fighting ingredients, like benzoyl peroxide and tea tree oil, and natural, soothing ingredients, like passion flower extract or green tea extract.
  • If you have cystic acne, we recommend our Basic Kit as a first line of treatment. After a few weeks, when your skin has adjusted to this new treatment and your non-cystic acne has cleared, you can introduce a tea tree oil or adapalene/benzoyl peroxide product into the mix. This slow but steady approach can help get rid of cysts for good.
What to Do About Cystic Acne
The first step toward clear skin is a steady skin care routine.