Acne Lesion

People with cystic acne develop pus-filled acne cysts (pimples) deep under the skin. The acne cysts are often painful and can be large. A dermatologist should treat cystic acne to reduce the risk of scarring and infection. Antibiotics and prescription-strength topical (skin) creams can help clear up your skin.

Cystic acne is a type of inflammatory acne that causes painful, pus-filled pimples to form deep under the skin. Acne occurs when oil and dead skin cells clog skin pores.

With cystic acne, bacteria also gets into the pores, causing swelling or inflammation. Cystic acne is the most severe type of acne. Acne cysts are often painful and more likely to cause scarring.

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Nodular acne and cystic acne are very similar. Both cause deep, painful bumps under the skin. And both can scar. Differences include:

Pores in the skin can clog with excess oil and dead skin cells, causing pimples. Bacteria can enter the skin pores and get trapped along with the oil and skin cells. The skin reaction causes swelling deep in the skin’s middle layer (the dermis). This infected, red, swollen lump is an acne cyst.

A cystic acne breakout may cover a large area of skin. Cystic acne tends to appear on the face, which has a lot of oil glands. But you can also get acne cysts on your:

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Acne cysts can be difficult to treat. Because they can scar, you should seek help from a dermatologist instead of trying over-the-counter acne products. A dermatologist can teach you how to treat cystic acne.

It can take three months or more to clear up acne cysts. Treatment often involves taking oral antibiotics and applying prescription-strength topical gels or creams to the skin.

Opening up acne cysts — by popping or picking them — increases the risk of scarring and bacterial skin infections like cellulitis.

What Is Acne And Why Do I Have It?

Some people develop pigment changes (light or dark) spots at the site of the acne cyst after the skin clears up. These spots may be pink, purple, red, black or brown. They eventually fade away, but it may take more than a year.

Most people with cystic acne can prevent severe breakouts or quickly treat acne cysts to prevent scarring. Often, but not always, cystic acne clears up or diminishes with age, as hormones settle down.

Severe or untreated cystic acne can affect how you feel about your appearance, making you anxious or depressed. If cystic acne bothers you, talk with your healthcare provider about getting help with fostering a positive self-image.

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It’s tempting to want to touch or pick at painful, swollen acne cysts. But cystic acne is more likely than other zits to scar or develop infections. A dermatologist can offer suggestions to prevent cystic acne. This doctor can also treat painful acne cysts, lowering the chances of scarring. Antibiotics and topical (skin) creams are effective cystic acne treatments.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. PolicyAuthor: Reviewed and updated by Dr Amanda Oakley Dermatologist, Hamilton, New Zealand; Vanessa Ngan, Staff Writer; and Clare Morrison, Copy Writer; June 2014.Skin of colour update: Dr Chelsea Jones, Dermatology Research Fellow, The Skin Hospital Westmead NSW, Australia; Dr Monisha Gupta, Dermatologist, Conjoint University of NSW and Western Sydney University, Sydney, NSW, Australia. July 2021

Acne vulgaris is the common form of acne, characterised by a mixed eruption of inflammatory and non-inflammatory skin lesions (see all the acne types).

Histology Of Acne Lesions

Nearly all of us have acne at some time or another. Acne affects both sexes and all races. Although acne mainly affects adolescents, it can affect a wide age range.

Acne most often affects the face, but it may spread to involve the neck, chest and back, and sometimes even more extensively over the body.

Individual lesions are centred on the pilosebaceous unit, ie the hair follicle and its associated oil gland. Several types of acne spots occur, often at the same time. They may be inflammatory papules, pustules and nodules; or non-inflamed comedones and pseudocysts.

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Individual acne lesions usually last less than 2 weeks but the deeper papules and nodules may persist for months. Many acne patients also have oily skin (seborrhoea ).

All characteristic lesions of acne vulgaris can occur in skin of colour, but it usually presents with less discernible redness and more postinflammatory hyperpigmentation (pigmented macules) which persists long after the acne lesion has gone. Post-inflammatory hyperpigmentation is often the major reason for seeking medical attention, causing significant psychological effects.

Pomade acne occurs more commonly in people with skin of colour due to cultural practices with hair styling products in African American and Hispanic populations. The use of greasy hair products leads to follicular plugging and comedones along the hairline.

How Do Acne Lesions Heal?

Some dermatologists assess the severity of a patient's acne more precisely by using a grading scale. The inflammatory lesions are compared with a set of standard photographs to determine the grade, which may be 1 (very mild) to 12 (exceptionally severe) for example.

In clinical trials evaluating acne treatment, the numbers of non-inflamed and inflamed lesions are carefully counted at regular intervals. It is remarkably difficult to count consistently.

Treatment for acne depends on the patient's age and sex, the extent and the severity of the acne, how long it has been present, and response to previous treatments.

What Is Acne? Symptoms And Causes

DermNet does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice.