Acne is a common skin condition with various types of blemishes. Cystic acne is a severe form, often causing discomfort. A frequent question is whether these deep, painful lesions “come to a head” like more superficial pimples. This article explains the unique nature of cystic acne and its recommended management.
What is Cystic Acne?
Cystic acne is the most severe type of acne, distinguished by large, red, and painful lumps that form deep within the skin. These deep-seated lesions commonly appear on the face, but can also affect the chest, back, and shoulders. Unlike milder forms of acne, these bumps are often filled with pus and can be quite tender to the touch, sometimes growing to the size of a pea or even a dime.
The development of cystic acne begins when skin pores become clogged with excess oil, also known as sebum, and dead skin cells. Bacteria then enter these blocked pores, leading to a significant inflammatory response deep within the skin’s middle layer, the dermis. Hormonal fluctuations, genetics, and sometimes stress are underlying factors that can contribute to this severe inflammatory process.
Does Cystic Acne Form a Head?
Cystic acne typically does not form a visible white or black “head” on the skin’s surface, unlike more superficial pimples or blackheads. These lesions are deep, inflamed nodules or cysts that develop far beneath the outermost layer of the skin. Instead of coming to a visible head, they often remain as tender, swollen bumps.
The lesions may feel like a pea or marble underneath the skin, causing pain or tenderness. If they do rupture, this often occurs internally, spreading inflammatory contents within the dermis and potentially leading to further inflammation and a higher risk of scarring. This internal rupture is why they do not resolve by forming a “head” on the surface.
Why Cystic Acne Behaves Differently
The unique behavior of cystic acne stems from its deep-seated nature and the intense inflammatory response it triggers. Unlike superficial acne, which involves blockages closer to the skin’s surface, cystic lesions develop much deeper within the dermis. This depth prevents the typical formation of a visible white or black tip.
Severe inflammation and the rupture of the hair follicle wall deep within the skin are characteristic of cystic acne. When the follicle ruptures, its contents, including sebum, dead skin cells, and bacteria, spill into the surrounding dermal tissue. The body’s immune system reacts strongly to these foreign substances, leading to the painful, pus-filled, yet often “headless” cysts.
What to Do About Cystic Acne
Avoid picking, squeezing, or attempting to “pop” cystic acne lesions. This action can worsen inflammation, introduce more bacteria, and increase the risk of infection, discoloration, and permanent scarring. Over-the-counter products are often insufficient to treat severe cystic acne effectively.
Seeking professional medical help from a dermatologist is recommended. A dermatologist can provide a tailored treatment plan to reduce scarring and manage the condition. Treatment options often include oral medications like antibiotics (to reduce bacteria and inflammation) or isotretinoin (which targets multiple causes of acne). For women, hormonal therapies such as birth control pills or spironolactone may regulate hormone levels. In-office procedures like corticosteroid injections can quickly reduce cyst size and pain, while incision and drainage may be used for large, painful lesions.