Cystic acne can affect almost any part of the body but is most common on the face, chest, shoulders, and back. Typically, a person will require medication from a dermatologist to treat it.
Cystic acne is a severe form of acne. Treating cystic acne can take time, but medication and good skin care are effective in most cases. A dermatologist can offer support and advice on how to prevent cystic acne from returning.
Continue reading to find out the causes of cystic back acne and how to treat it.
Cystic acne has the same causes as other forms of acne.
The skin contains sebaceous glands that secrete an oily substance called sebum. When the sebum sticks together with dead skin cells, it can clog pores and attract bacteria.
Cysts form deeper in the skin and tend to be larger than other pimples. They often contain fluid and can be tender or painful. Cysts and the skin around them are usually red and swollen, and these blemishes can cause scarring if a person does not receive treatment.
The face, chest, shoulders, and back tend to contain more sebaceous glands than other parts of the body. As a result, cystic acne is more common in these areas.
Cystic acne is a more severe form of acne, and not everyone with acne will have this type. However, it is still not clear exactly what causes this specific form of acne.
Over-the-counter (OTC) treatments are unlikely to work on cystic acne. Most people will need to seek advice from a dermatologist, who can prescribe an appropriate medication.
Some medications come in pill form, while others are topical, which means that a person can apply them directly to the skin in the form of a cream or ointment.
The treatment for cystic acne generally takes time. It may take 2–3 months before the skin shows any improvement and up to 6 months before acne clears. Due to this, it is important to keep going with medication as a healthcare professional has prescribed, even if there are no signs that it is working. The effects should become noticeable in time.
A dermatologist will ask about a person’s medical history and evaluate the severity of their acne. Doing this will help them work with a person to decide on the best treatment.
The following table gives a list of common acne medications, noting the usual duration of treatment and some possible side effects. However, as everyone is different, a medical professional will give a person specific advice.
| Medication | How long to take it for | Possible side effects |
| antibiotic therapy | 6–8 weeks if topical and 4–6 months if oral | skin irritation, diarrhea, nausea, and vomiting |
| isotretinoin | at least 4–5 months | dry skin and lips, nosebleeds, muscle pain, mood changes, and sun sensitivity |
| low dose prednisolone | 4–6 weeks | burning or stinging, skin irritation, and stretch marks |
| birth control pills (females only) | at least 2–6 months | headaches, nausea, mood changes, and breast tenderness |
| spironolactone (females only) | at least 4–6 weeks | dizziness, fatigue, and headaches |
A dermatologist may also prescribe topical skin cream alongside another medication.
It can be difficult to apply creams or ointments to the back, so a person may need to ask someone else to apply the product for them. Alternatively, they can use a lotion applicator with a long handle to reach all areas of the back.
Treating cystic acne can be a slow process, and this can be frustrating. A dermatologist will give advice on how long treatment must continue.
A person should start to see an improvement within 2–3 months, often with lasting results. It is important to complete the course of prescribed treatment, even if acne improves or clears before the end.
A dermatologist may suggest booking follow-up appointments to check progress and adjust treatment as necessary. A person should also keep track of any side effects during their treatment and seek medical advice if necessary.
Practical measures to avoid making acne worse are useful for anyone with acne on the back, including people with cystic acne. These measures include:
- Washing the back: Washing the back with mild soap and lukewarm water can help.
- Showering after exercise: A person should wash after completing strenuous exercise that caused them to sweat.
- Avoiding scrubbing harshly when washing: Avoid abrasive soaps, cleansing granules, astringents, and exfoliating agents.
- Leaving pimples alone: Try to avoid touching the skin where possible. Picking and squeezing is likely to worsen acne.
- Avoiding rubbing the back: Where possible, try not to wear a backpack or clothing that rubs against the skin on the back.
- Shaving with care: Soften the skin with warm water and use safety razors or an electric shaver.
- Minimizing exposure to the sun: Sun exposure can affect skin health and appearance. It is also important to wear oil-free sunscreen.
- Trying to find ways to lessen unnecessary stress: Stress may trigger or prolong acne breakouts.
Once cystic back acne has cleared, a regular skin care routine and use of OTC treatments may help the skin stay healthy and prevent future breakouts.
Click here to learn more about the best home treatments for acne.
Cystic acne is a serious skin condition. This type of acne can be more likely than other forms of acne to leave scars. Delaying treatment, picking at the skin, or popping pimples can all increase the risk of scarring.
Many different treatments are available to address scars. These include:
- laser treatment
- fillers
- chemical peels
- minor surgery
Click here to learn more about the best ways to get rid of acne scars.
Although a person with mild acne can often treat it themselves with OTC products, cystic acne may require specialist treatment and advice.
A dermatologist will be able to grade the severity of a person’s acne and determine what type they have.
The dermatologist can prescribe oral and topical medications. They may also inject a corticosteroid into or incise and drain large cysts if this is necessary to reduce pain or prevent scarring.
Cystic back acne is treatable, but a person will usually require prescription medication and advice from a certified dermatologist.
Although treatment can take time to work, the skin should show signs of improvement within 6 months.
Treating cystic acne early can help prevent scarring. If cystic acne does leave scars, there are treatments available to reduce their appearance.
A good skin care routine can help keep the skin clear once treatment is complete. Gentle cleansing and OTC products should help ensure that cystic acne does not return.