Cystic Acne ICD-10: L70.0

Acne / Severe inflammatory skin condition

Often searched as: huge painful pimples under skin, cysts on face that won't pop, deep pimples that leave scars, acne that causes scars, painful lump under skin face, cystic acne treatment, Accutane acne, hormonal cystic acne women…

Clinical urgency level

lowmediumhigh

Systems Affected

skinhair folliclessebaceous glands

Severity Levels

mild

A few deep cysts appearing occasionally, limited scarring risk — requires early dermatologist intervention to prevent progression.

moderate

Multiple recurring cysts on face, back, or chest, post-inflammatory marks, moderate scarring — requires prescription systemic treatment (oral antibiotics, hormonal therapy).

severe

Widespread deep cysts and nodules on face, chest, and back, significant active scarring, severe pain — requires isotretinoin (Accutane) and dermatologist management.

Red Flags

Deep, very painful lumps under the skin that don't come to a head and don't heal for weeks
Active pitting or atrophic scarring forming from current lesions
Acne appearing suddenly and severely in an adult woman — possible PCOS or hormonal disorder
Cystic acne not responding after 3 months of prescription treatment
Signs of psychological distress, social isolation, or depression related to acne
Cysts becoming infected with spreading redness, warmth, and fever (abscess)

Clinical Presentation

Cystic acne — deep inflamed nodules and cysts on the face

Source: Wikimedia Commons (CC BY-SA 3.0 )

Cystic acne image gallery — DermNet NZ

View gallery on DermNet NZ (image gallery reference)

When to See a Doctor

See a dermatologist as soon as possible — cystic acne is the form most likely to leave permanent scars, and over-the-counter treatments are not effective. Don't wait months hoping it resolves on its own. Prescription treatments like isotretinoin, antibiotics, or hormonal therapies have a high success rate when started early.

Differential Diagnosis

Gram-negative folliculitis (after prolonged antibiotic use for acne)
Nodulocystic rosacea (central face, triggered by heat/food — no comedones)
Hidradenitis suppurativa (cysts in armpits, groin — not face/back)
Epidermoid cysts (single, firm, non-inflamed — not true acne)
Furuncles / carbuncles (bacterial — usually with fever)
Demodicosis (Demodex mite overgrowth — pustules)

Comorbidities

Polycystic ovarian syndrome (PCOS) — major cause of cystic acne in women
Hyperandrogenism
Insulin resistance and metabolic syndrome
Depression and anxiety (cystic acne has one of the highest psychological impacts of any skin condition)
Post-inflammatory hyperpigmentation and permanent atrophic scarring

Prognosis

Cystic acne is the most challenging acne type but also one of the most treatable with the right medication. Isotretinoin achieves long-term remission in ~85% of patients after a single course — it is the only treatment that targets all four causes of acne simultaneously. Hormonal therapies are highly effective for women with hormonal cystic acne. Without treatment, cystic acne frequently leads to permanent scarring. Early aggressive treatment is the most important factor in preventing long-term skin damage.

Detailed Overview

Causes, Symptoms, and When to Take Action Cystic acne is a severe form of acne characterized by deep, painful, inflamed cysts beneath the skin. It is less common than mild or moderate acne but can cause significant discomfort and long-lasting skin changes. How It Looks Texture: Large, tender nodules or cysts under the skin surface Color: Red, swollen lesions, sometimes darker depending on skin tone Shape: Rounded or irregular bumps that may merge into larger inflamed areas Location: Most often found on the face, chest, back, and shoulders Why Does It Appear? Cystic acne forms when clogged pores become inflamed and infection develops deep within the skin. Contributing factors include: Excess oil production Accumulation of dead skin cells within pores Hormonal fluctuations Genetic predisposition Should You Be Concerned? Yes. While cystic acne is not dangerous, it often: Causes significant pain and swelling Persists for weeks or months Leads to permanent scarring if untreated or frequently irritated Seeking professional evaluation is recommended when deep, painful cysts continue to appear. Can You Prevent It? Complete prevention may not be possible, but risk can be reduced by: Maintaining a consistent skin care routine Avoiding picking or squeezing lesions Monitoring for early signs of flare-ups 👉 How Piel AI Can Help Piel AI enables you to track the appearance of acne over time. While not a diagnostic tool, it helps you identify changes and patterns worth discussing with a healthcare provider. Summary Cystic acne is a severe type of acne with deep, painful cysts. It is linked to clogged pores, inflammation, hormones, and genetics. It may cause scarring if not properly managed. Early recognition and consistent monitoring are important.

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