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What is the best treatment for severe cystic acne?

Cystic acne is a severe form of acne that is characterized by large, painful, and inflamed cysts beneath the skin’s surface. It can significantly impact a person’s self-confidence and quality of life. While there are many over-the-counter treatments available for mild to moderate acne, severe cystic acne often requires more aggressive and targeted interventions. In this blog post, we will explore some of the most effective treatment options for severe cystic acne, including in-office procedures and oral prescription medications.

In-office treatments for severe cystic acne

Cortisone injections

One of the most common in-office treatments for severe cystic acne is cortisone injections. Cortisone, a potent anti-inflammatory medication, is injected directly into the cysts to reduce inflammation and promote healing. These injections work by dissipating the cyst, flattening it, and relieving pain within a matter of hours.

Cortisone injections provide fast and effective results in reducing the size and inflammation of cystic acne. The injected cortisone decreases the production of collagen, preventing scar formation and minimizing the risk of permanent damage to the skin.

However, it’s essential to note that cortisone injections are a temporary solution and do not address the underlying causes of cystic acne. The effects of the injection typically last for several weeks, and additional treatments may be necessary.

Extraction procedures

Another in-office treatment option for severe cystic acne is extraction procedures. This involves manually extracting the contents of the cyst using sterile instruments and techniques under the supervision of a dermatologist.

Manual extraction is typically reserved for large, pus-filled cysts that are causing significant pain and discomfort. By carefully draining the cyst, the pressure is relieved, and healing can occur more rapidly. This procedure should always be performed by a trained professional to minimize scarring and the risk of infection.

Professional extraction by a dermatologist ensures that the procedure is done in a controlled and sterile environment, reducing the risk of complications. It’s important to avoid attempting DIY extractions, as this can lead to further inflammation, scarring, and potential infections.

Oral prescription medications for severe cystic acne

Birth control pills

For women with severe cystic acne triggered by hormonal imbalances, birth control pills can be an effective treatment option. These hormonal contraceptives contain a combination of estrogen and progestin, which work to regulate hormone levels and reduce sebum production.

By stabilizing hormone levels, birth control pills help minimize the fluctuations that contribute to cystic acne breakouts. They can also reduce the severity of acne by decreasing the size of oil glands and promoting a healthier environment for the skin.

It’s important to note that birth control pills may not be suitable for everyone, and it’s essential to consult with a healthcare professional to determine the most appropriate treatment plan. Additionally, like any medication, birth control pills may have potential side effects, such as mood changes, weight gain, and increased risk of blood clots.


Spironolactone, an anti-androgen medication, is often prescribed to women with hormonal acne. This medication works by reducing the production of androgens (male hormones) responsible for stimulating oil production in the sebaceous glands.

By decreasing oil production, spironolactone helps prevent clogged pores and reduces the risk of cystic acne formation. It is typically prescribed in combination with other acne treatments or oral contraceptives.

Just like any medication, spironolactone may have potential side effects, including dizziness, increased urination, and breast tenderness. Regular monitoring and follow-up with a healthcare professional are necessary while taking this medication.

Isotretinoin (Accutane)

Isotretinoin, commonly known by the brand name Accutane, is a potent oral medication reserved for severe, resistant cystic acne. It works by targeting the underlying causes of acne, including reducing sebum production and preventing the clogging of hair follicles.

Accutane is typically prescribed for a period of 4-6 months, and most patients experience long-term remission of their acne. However, due to its potential side effects, strict monitoring is required throughout the treatment course. Common side effects may include dry skin, chapped lips, dry eyes, and in rare cases, more severe side effects like depression and liver abnormalities.

It’s important to note that Accutane is not suitable for everyone and should only be prescribed by a qualified dermatologist who can assess the risks and benefits based on an individual’s medical history.

Combination treatments for severe cystic acne

In addition to in-office procedures and oral medications, combination treatments can also be highly effective in managing severe cystic acne.

Topical medications

Topical medications, such as retinoids, can be used in combination with oral medications to enhance the efficacy of treatment. Retinoids, derived from vitamin A, work by reducing inflammation, preventing clogged pores, and promoting skin cell turnover.

Applying topical retinoids to cystic acne lesions can help accelerate healing and prevent new breakouts. These medications are available in various strengths and formulations, and it’s essential to follow the instructions provided by a healthcare professional to achieve the best results.

Laser and light therapies

Laser and light therapies can be used to complement other treatments for severe cystic acne. These therapies work by reducing inflammation, killing bacteria, and improving the overall appearance of the skin.

Various types of lasers and light therapies, such as photodynamic therapy and intense pulsed light (IPL), can be used depending on the individual’s specific needs and goals. It’s important to note that these treatments may require multiple sessions, and potential side effects and limitations should be discussed with a dermatologist.

Lifestyle modifications for managing severe cystic acne

In addition to medical treatments, making certain lifestyle modifications can help improve the management of severe cystic acne.

Daily skincare routine

Developing a consistent skincare routine is crucial for managing severe cystic acne. This includes gentle cleansing with non-comedogenic products, toning to balance the skin’s pH levels, and moisturizing to keep the skin hydrated.

It’s important to avoid harsh irritants, such as abrasive scrubs and alcohol-based products, as these can further irritate the skin and exacerbate breakouts. Using non-comedogenic products helps prevent pore blockage and reduces the risk of acne formation.

Diet and nutrition

While diet alone may not cure cystic acne, certain dietary changes can play a role in managing the condition. A balanced diet rich in fruits, vegetables, whole grains, and lean proteins provides essential nutrients that support overall skin health.

It’s also important to identify and avoid any potential triggers or food sensitivities that may worsen acne symptoms. Some studies suggest that foods high in refined sugars and dairy products may contribute to acne breakouts in certain individuals.

Incorporating foods with anti-inflammatory properties, such as omega-3 fatty acids found in fatty fish and walnuts, can help reduce inflammation and support healthy skin.

Stress management

Stress can have a significant impact on acne flare-ups. When we are stressed, our bodies produce higher levels of cortisol, a hormone that can increase sebum production and lead to more frequent breakouts.

Incorporating stress-reducing techniques, such as meditation, exercise, and adequate sleep, can help manage stress levels and potentially improve acne symptoms. Self-care and relaxation techniques, such as taking regular breaks, practicing hobbies, and engaging in activities we enjoy, can also contribute to overall well-being and better skin health.


Severe cystic acne can be challenging to manage, but effective treatment options are available. In-office treatments like cortisone injections and extraction procedures can provide fast and noticeable results in reducing inflammation and promoting healing. Oral prescription medications like birth control pills, spironolactone, and isotretinoin (Accutane) target the underlying causes of cystic acne and provide long-term relief.

Combination treatments, such as topical medications and laser therapies, can further enhance the efficacy of treatment. Additionally, making certain lifestyle modifications, including following a proper skincare routine, maintaining a balanced diet, and managing stress levels, can support overall treatment outcomes.

If you are dealing with severe cystic acne, it is crucial to consult with a dermatologist who can assess your specific condition and recommend the most appropriate and personalized treatment plan for you. With the right interventions and a comprehensive approach, managing severe cystic acne is possible, and clearer, healthier skin can be achieved.


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