Cystic Acne

  • Medical Author: Jeffrey John Meffert, MD
  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Read about cystic acne causes and treatments.

Adult Acne Slideshow

Causes and Treatments

Cystic acne is common acne in its most severe form. This form of acne is likely to result in permanent scarring. It is quite rare in adults. Most patients with cystic acne require aggressive medical therapy to prevent blemishes.

What is cystic acne?

Cystic acne is a form of acne associated with long-standing, painful nodules of the face, back of neck, chest, and back.

Adolescent acne goes through certain stages, each of which requires specific therapy. It starts with closed comedos (whiteheads), which may progress to open comedos (blackheads). Unless they are picked, popped, and manipulated, these would only rarely cause scarring. Some of these will progress to what is recognized as acne and, in turn, some of those into pustular acne. Pustules are more likely to scar, especially if they are "popped." Cystic acne is the final stage of progression of acne and left untreated is a significant source of acne scarring. As these are space-occupying collections of inflammatory material, scarring is predictable.

Cystic acne may involve the face, chest, back, or unique combinations of these. Cystic acne may also be part of a syndrome that also involves some combination of acne on the face with draining lesions and boils of the scalp (dissecting cellulitis of the scalp), axilla (hidradenitis suppurativa), groin, or chest. Conglobate acne is a severe form that may present as a severe cystic acne of the face and trunk, which can also have systemic manifestations such as arthritis and other musculoskeletal problems.

Perioral dermatitis is an acne-like problem that usually affects young women and causes small papules on the chin, around the mouth, and along the jawline. Some of these papules may be deep-seated, but this usually does not cause the large, scarring nodules and cysts of true acne.

What are causes and risk factors for cystic acne?

There is a trend that if a parent or older sibling had significant scarring acne, you are more likely to develop it yourself. However, a family history of cystic acne is not universal, even in the most severe cases. Elevations in testosterone, either intrinsic to the body or extrinsic through the intake of anabolic steroids, may precipitate or worsen cystic acne. While most combination contraceptive pills will have a therapeutic benefit in acne, the progesterone-predominant contraceptive types such as progesterone-only mini-pills, progesterone implants, and progesterone-eluting intrauterine devices may worsen acne, although these may serve as effective contraception when isotretinoin use for acne is considered.

Medically Reviewed by a Doctor on 3/4/2016

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