Painful Bumps Won't Clear? Why Cystic Acne Forms & Medical Next Steps

If you're dealing with deep, painful bumps that won't come to a head — and don't seem to respond to regular acne treatments — you may be experiencing cystic acne. Unlike typical pimples, cystic acne develops deep under the skin and can linger for weeks or even months. It's often uncomfortable, frustrating, and sometimes scarring.

The good news: cystic acne is treatable. But because it's more severe than common breakouts, it often requires medical care. Here's what you need to know about why cystic acne forms and what steps to take next.

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What Is Cystic Acne?

Cystic acne is the most severe form of acne vulgaris. It happens when pores become deeply clogged with:

• Oil (sebum)
• Dead skin cells
• Bacteria (Cutibacterium acnes)

This leads to intense inflammation deep within the skin, forming large, tender nodules or cyst-like lesions. Unlike whiteheads or blackheads, these bumps:

• Are deep and painful
• Rarely form a visible white tip
• Feel firm or soft under the skin
• Can last weeks or longer
• Often leave scars

Cystic acne most commonly appears on the:

• Face
• Jawline
• Chin
• Chest
• Upper back
• Shoulders

It can affect teens and adults, especially women in their 20s to 40s.

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Why Does Cystic Acne Form?

Cystic acne develops when several factors combine.

1. Excess Oil Production

Your sebaceous glands produce oil to protect your skin. When hormone levels rise — especially androgens — oil production increases. Too much oil makes pores more likely to clog.

Hormonal triggers include:

• Puberty
• Menstrual cycles
• Pregnancy
• Polycystic ovary syndrome (PCOS)
• High stress levels

2. Clogged Pores

Dead skin cells normally shed and rise to the surface. When this process doesn't work properly, they mix with oil and block pores. If bacteria grow inside the blocked pore, inflammation follows.

3. Bacterial Overgrowth

Cutibacterium acnes is naturally present on the skin. In clogged pores, it multiplies and triggers an immune response. The body reacts with swelling, redness, and pain — leading to deep cyst formation.

4. Genetics

If one or both of your parents had severe acne, you are more likely to develop cystic acne. Genetics affect:

• Oil production
• Inflammatory response
• Skin cell turnover

5. Delayed or Inadequate Treatment

Mild acne that isn't properly treated can progress to deeper inflammation over time.

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How Is Cystic Acne Different From Regular Acne?

Feature	Regular Acne	Cystic Acne
Depth	Surface-level	Deep under skin
Pain	Mild or none	Often painful
Size	Small	Large
Scarring risk	Low	High
Treatment response	OTC often works	Usually needs prescription

Because cystic acne develops deeper in the skin, over-the-counter (OTC) spot treatments often aren't strong enough.

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Why You Shouldn't Ignore Cystic Acne

Cystic acne isn't just cosmetic. Without proper treatment, it can lead to:

• Permanent scarring
• Dark spots (post-inflammatory hyperpigmentation)
• Emotional distress or low self-confidence
• Persistent inflammation

Scars from cystic acne can be difficult and expensive to treat later. Early medical care can significantly reduce this risk.

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What NOT to Do

When dealing with cystic acne, avoid:

• Squeezing or picking (this increases scarring)
• Over-washing your face
• Using harsh scrubs
• Layering multiple strong products at once
• Applying toothpaste or DIY remedies

These approaches often worsen inflammation and delay healing.

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Medical Treatments That Actually Work

Cystic acne often requires prescription treatment. A doctor or dermatologist may recommend:

1. Oral Antibiotics

Used short-term to:

• Reduce bacteria
• Decrease inflammation

These are often combined with topical treatments.

2. Hormonal Treatments

For women, hormonal therapy may help regulate oil production. Options include:

• Birth control pills
• Spironolactone (blocks androgen effects)

These can be especially helpful for jawline or menstrual-related cystic acne.

3. Topical Retinoids

Prescription retinoids:

• Unclog pores
• Normalize skin cell turnover
• Prevent new lesions

They are often part of long-term maintenance therapy.

4. Isotretinoin (Accutane)

For severe or persistent cystic acne, isotretinoin may be recommended. It:

• Dramatically reduces oil production
• Shrinks sebaceous glands
• Prevents scarring
• Can lead to long-term remission

Because isotretinoin has potential side effects, it requires close medical supervision. For many people with severe cystic acne, however, it can be life-changing.

5. Cortisone Injections

For large, painful cysts, a dermatologist can inject a small amount of steroid directly into the lesion. This can:

• Rapidly reduce swelling
• Decrease pain
• Lower scarring risk

Relief often occurs within 24–48 hours.

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Skincare Tips That Support Treatment

While medical care is key, supportive skincare matters.

• Use a gentle cleanser twice daily
• Choose non-comedogenic (non-pore-clogging) products
• Apply oil-free sunscreen daily
• Avoid heavy makeup or occlusive products
• Moisturize — even oily skin needs hydration

Consistency is more important than aggressiveness.

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When to See a Doctor

You should speak to a doctor or dermatologist if:

• Acne is painful and deep
• Breakouts are leaving scars
• OTC treatments haven't worked after 6–8 weeks
• Acne is affecting your mental health
• You suspect hormonal imbalance
• You develop fever, spreading redness, or severe swelling

While cystic acne itself is not life-threatening, untreated severe inflammation can cause permanent skin damage. In rare cases, widespread infection requires urgent care. If you're experiencing symptoms and want to better understand whether what you're dealing with is Acne Vulgaris (Acne), a free AI-powered symptom checker can help guide your next steps before your appointment.

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Could It Be Acne Vulgaris?

Cystic acne is a severe form of acne vulgaris. If you're unsure what type of acne you have, you might consider doing a free, online symptom check. It can help you better understand your symptoms before speaking with a healthcare professional.

This step doesn't replace a doctor's evaluation — but it can help you prepare for one.

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The Emotional Side of Cystic Acne

Cystic acne can affect more than your skin. Research shows severe acne is linked with:

• Anxiety
• Depression
• Social withdrawal
• Lower self-esteem

If your skin condition is affecting your mental health, that's important. You deserve care for both physical and emotional symptoms. A healthcare provider can help you build a treatment plan that addresses both.

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The Bottom Line

Cystic acne forms when oil, bacteria, and inflammation build up deep inside clogged pores. Unlike mild acne, it often requires prescription treatment to prevent scarring and long-term skin damage.

If you're dealing with painful bumps that won't clear:

• Don't squeeze them
• Don't rely solely on OTC treatments
• Don't wait months hoping they'll resolve on their own

Early treatment makes a major difference.

Most importantly, speak to a doctor or dermatologist about persistent, painful, or scarring acne. If you experience severe swelling, spreading redness, fever, or signs of infection, seek medical care right away.

Cystic acne is stubborn — but it is treatable. With the right medical approach, clearer skin is possible.