What are the symptoms?

Cystic acne shows up as whiteheads, blackheads, papules, pustules and nodules. These can be red and swollen and appear on the face, back, neck or shoulders. Large cysts also form deep underneath the skin, covered by swollen pustules, composed of dead skin cells, bacteria and white blood cells.

How do you get cystic acne?

Cystic acne can strike any skin type at any age. Many factors can contribute to acne, including:

• Genetics. If your parents had cystic acne, you are more likely to experience severe acne yourself, writes Angela Palmer for About. In many cases, acne runs in families.

• Oil. Sebaceous glands produce sebum, or oil. People with cystic acne often have overactive glands that crank out large amounts of sebum. Oil can clog pores, leading to breakouts. Plus, when oil accumulates, it provides the perfect breeding ground for bacteria.

• Bacteria. In particular, Propionibacteria acnes, or P. acnes, bacteria play a large role in causing cystic acne. Bacteria can cause infections in the pores, leading to painful lesions and nodules.

• Inflammatory response. According to Medical News Today, our immune system recognizes these bacteria as a threat and produces inflammatory responses, including pus, white blood cells, swelling, redness and pain. Some people are naturally more prone to inflammation than others, exacerbating cystic acne.

• Poor skin cell turnover. As skin renews itself, old cells die and flake off, replaced with new ones. However, in cystic acne, this turnover process is impaired. Dead skin cells build up instead of flaking off. They block pores and contribute to acne.

• Hormones. Testosterone increases oil production. Its levels rise during puberty. In women, hormonal changes associated with pregnancy and menopause can also trigger breakouts.

What are the treatments?

• Topical treatments. The dermatologist may prescribe retinoid (vitamin A) creams or gels or clinical strength benzoyl peroxide cleansers and treatments.

• Oral medications. If topical treatments aren't enough, your dermatologist may prescribe one of these medications.

  • Antibiotics, like doxycline, erythromycin and tetracycline, are commonly used, because they kill the bacteria that can cause acne.

  • Accutane (isotretinoin) is a very strong oral medication that works well on cystic acne. When taken for a few weeks, it can cause remission of cystic acne for months or even years. "It's the only acne treatment that works on all four factors that predispose a person to acne – excess oil production, clogged skin pores, P. acnes and inflammation," notes the American Academy of Dermatology (AAD). However, Accutane has potentially serious side effects, including: severe birth defects, abdominal pain, difficulty swallowing, joint pain, nausea, vomiting, diarrhea, headache, vision problems and dry skin. It can't be used by women who are pregnant, planning to become pregnant or breast-feeding. If you're taking Accutane, you must "take two pregnancy tests...and use two forms of birth control," according to the AAD.

  • Oral contraceptives are effective treatment options for women. They decrease oil production in the sebaceous glands. Women who smoke, have blood clotting problems or suffer migraines shouldn't take oral contraceptives.

• Steroid injections and extractions. An in-office procedure that's performed by a dermatologist, steroid injections can reduce inflammation of the pustules. But be sure your doctor has experience with this treatment. "The shots can leave permanent depressions in the skin," warns Adrienne Denese, M.D., Ph.D., in her book, Dr. Denese's Secrets for Ageless Skin: Younger Skin in 8 Weeks. Also, your dermatologist can perform an incision and extraction to remove the infected bacteria and pus from a pore.

Product picks

Once cystic acne is under control, many over-the-counter treatments can maintain skin clarity, such as salicylic acid and glycolic acid. Exfoliate regularly and consider microdermabrasion to prevent dead skin cells and clogged pores, recommends Dr. Denese. She suggests glycolic or salicylic acid pads. Here are several products you may be interested in:

• Cleanser. DDF Blemish Foaming Cleanser is a non-irritating product that foams up to remove excess oil and bacteria without drying your skin.

• Treatment. NeoStrata Acne Treatment Solution Pads contain salicylic acid to wipe away impurities and prevent clogged pores.

• Sunscreen. Cosmedicine Speedy Recovery Acne Treatment Daytime Blemish Lotion SPF 15 is a broad-spectrum formula that prevents sunburn and sun damage. Plus, it reduces excess oil, pimples, redness and inflammation. Sunscreen is especially crucial when using acne treatments, most of which can make skin extra sensitive to the sun.

Remember, although you may be tempted to use harsh acne treatments to dry out the pustules, try to avoid such products. Using them can actually over-dry the skin and increase your risk for additional breakouts.

Is scarring preventable?

Severe permanent scars can result from picking at or forcibly extracting deeply-imbedded acne lesions. Other possible complications include dark, rough patches of skin and permanent pits that can only be removed with cosmetic procedures, such as laser resurfacing or dermabrasion.

Even mild cases of acne vulgaris can turn into cystic acne. Cysts can leave behind scars, so the best way to prevent acne is to seek immediate treatment. Don't wait for cystic acne to clear up, as this rarely happens.

To reduce the risk of scars:

• Avoid do-it-yourself extractions. Improper extraction can result in more blemishes or scars.

• Don't pick or pull at these lesions, which can spread bacteria and create more cysts.

Learn everything you need to know about acne-fighting skincare in our Complete Acne Handbook.