This Dr. Axe content is medically reviewed or fact checked to ensure factually accurate information.
With strict editorial sourcing guidelines, we only link to academic research institutions, reputable media sites and, when research is available, medically peer-reviewed studies. Note that the numbers in parentheses (1, 2, etc.) are clickable links to these studies.
The information in our articles is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.
This article is based on scientific evidence, written by experts and fact checked by our trained editorial staff. Note that the numbers in parentheses (1, 2, etc.) are clickable links to medically peer-reviewed studies.
Our team includes licensed nutritionists and dietitians, certified health education specialists, as well as certified strength and conditioning specialists, personal trainers and corrective exercise specialists. Our team aims to be not only thorough with its research, but also objective and unbiased.
The information in our articles is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.
Cystic Acne Treatment that Includes Dietary Changes
February 3, 2023
Have you ever had large, red, painful breakouts? These breakouts can affect both men and women as young as 8 or as old 50. The face is the most common and concerning area of occurrence, but other problem areas can include the chest, back, upper arms and shoulders.
We’re talking about cystic acne, which is way worse than just any old pimple — it’s actually the most severe form of acne possible.
Common medical treatment for cystic acne might work, but some have very serious side effects. A natural way to fight cystic acne is to address the gut-skin connection with the use of probiotics through food, supplements and home remedies for acne. Way back in 1961, a case report found that out of 300 acne patients given a probiotic, 80 percent had clinical improvement.
Read on to learn how you can naturally treat your cystic acne and have clear skin once again.
Related: Adult Acne: How to Get Rid of Hormonal Acne Naturally
What Is Cystic Acne?
Also called nodulocystic acne and similar to nodular acne, cystic acne is an intense form of acne that results in large, inflamed cysts and nodules that appear on the skin. Unlike other milder forms of acne, cystic acne is noticeably painful and occurs when oil and dead skin cells build up deep down in hair follicles or pores.
Cystic acne is most common during puberty for young boys, but sadly, it can continue into the adult years, especially when there is a hormonal imbalance. For adult women, it’s common to to experience cystic acne around their menstrual cycles, especially on the the jawline and chin, which are the common areas for hormonally motivated breakouts.
It’s more serious than hormonal acne, which occurs with both men and women when undergoing significant hormonal changes such as aging, pregnancy or stress. In contrast, cystic acne can happen at any age because of dietary sensitivities and an overproduction of sebum.
Acne vulgaris is the medical name for common acne. Acne conglobata, or cystic acne, is a more serious and more rare form of acne that occurs mainly in young men, but it can affect people of both sexes and various ages.
When you have cystic acne, your skin’s pores get clogged with oil and dead skin cells and become inflamed. It becomes cystic acne when the pore ruptures underneath the skin, which causes the inflammation to spill out into the surrounding skin tissue.
This chain reaction can continue in the skin, triggering wider inflammation, spreading more acne bacteria and more breakouts. Next, your body forms a cyst around the area to stop the inflammation from spreading further.
Symptoms of cystic acne include:
- large, red and painful breakouts on the face, chest, back, upper arms, shoulders and/or thighs
- nodules that appear as raised, red bumps that generally do not have a whitehead showing
- lesions that are usually felt beneath the skin before they’re seen
- more visible acne that produces cysts and nodules in addition to papules and pustules
- breakouts that are painful to the touch or even when not touched
- decrease in self-esteem and mood and increase in psychological distress, especially when cystic acne occurs on the face
The unique appearance of a cystic acne is due to the acute damage to the oil gland causing intense inflammation and irritation, which leads to redness, swelling and soreness. Cystic acne is easy to diagnose by a dermatologist and does not require any special tests.
Cystic acne can be caused by or related to:
- Hormonal changes, including polycystic ovary syndrome
- High levels of humidity and sweating
- Pore-clogging and irritating face and body care products
- Some drugs and chemicals (for example, corticosteroids, lithium, phenytoin, isoniazid), which may worsen or cause eruptions that are similar to acne
Cystic acne often runs in families. If one or both of your parents had severe cystic acne, then you have a greater chance of having it as well.
It’s most common in teenage boys and young men. It’s believed that hormones called androgens can play a part in the development of cystic acne in teens when there is an increase in androgens. This increase leads to changes in your skin that can result in clogged pores and acne.
Cystic acne doesn’t only affect men, though. For women, hormone changes that trigger cystic acne can be brought on by menstrual cycles, pregnancy and menopause.
Cystic acne is the most severe form of acne and the over-the-counter remedies often do little to no good. If any, benzoyl peroxide is a topical antibacterial treatment that is most often used to treat acne and may help less severe cystic acne.
Instead, many people opt to see a dermatologist in order to get diagnosed and then prescribed medications to treat cystic acne.
The most effective conventional medicine for cystic acne is isotretinoin (Accutane), which actually is derived from vitamin A. While most people experience a reduction in acne lesion counts, adverse events are common, especially overly dry skin, mood issues and decreased appetite.
If the cystic acne covers a lot of skin, a dermatologist may want to prescribe oral antibiotics. While these can work against the inflammation and bacteria, they don’t address the excess oil or dead skin cells. Because of antibiotic resistance, they should only be used in the short-term, if at all.
Topical retinoids also may be used and also related to vitamin A, but in general they’re not sufficient to address cystic acne. They can also make your skin red and peel plus make it very vulnerable to sunburn.
Another prescription medication is spironolactone (Aldactone), a diuretic that usually is used for edema as well as high blood pressure. It’s also used for acne but mostly just women who have acne around their jawline. Its side effects can be serious and cannot be taken if planning to become pregnant.
1. Avoid These Foods
- Conventional Dairy: Even if you’re not lactose intolerant, conventional dairy products can be hard on the digestive system. Many people see an improvement in their acne when they cut down or eliminate dairy products like milk, cheese and ice cream. If you want to check if dairy is a culprit, try eliminating it from your diet for two weeks and see if your cystic acne improves. If it does, then you know that dairy is not agreeing with you. You can choose to remain dairy-free, or you can slowly reintroduce dairy back into your diet. Choosing better-quality dairy can be helpful as well.
- Sugar: Sugar and other high-glycemic foods (like breads and pasta) can make inflammation in your body worse. The more inflammation you have, the worse your cystic acne will be. Try natural sweeteners instead. Consuming excess amounts of sugar and grain products can also feed yeast and candida in the body, increasing the presence of acne on the skin.
- Caffeine and chocolate: Many experts like to say that there is no link between caffeine and chocolate consumption and breakouts. However, there is no doubt that caffeine consumption has a direct impact on your hormonal balance. In particular, caffeine overdose can raise the stress hormone known as cortisol. By reducing or eliminating various sources of caffeine like coffee, tea and chocolate, you can help to keep your hormones in better balance and clear up your cystic acne.
- Low-fiber, highly processed foods: Consuming foods that are low in fiber and highly processed has a direct negative effect on your gut health, which negatively impacts skin health. When you consume processed meat products like cold cuts, breakfast cereals and microwave meals, an unhealthy shift occurs in your inner microbial colonies. This sets off inflammation throughout your entire body, which can bring on a cystic acne flare-up or make any current acne even worse.
- Fried and fast foods: These foods are also highly processed and low in fiber. Additionally, they contain a number of ingredients that cause inflammation, including hydrogenated oils, sodium, chemicals, flavorings and sugar.
2. Eat These Foods
- Probiotic-rich foods: The healthier your gut is, the better your balance of good versus bad bacteria. When you consume probiotic-rich foods like kefir and cultured vegetables, the probiotics line your gut and create a healthy, sealed barrier that prevents inflammation that can trigger acne. One Korean study of 56 acne patients found that drinking a Lactobacillus-fermented dairy beverage effectively reduced their total acne lesion count and decreased oil production over 12 weeks.
- High-zinc foods: People with acne tend to be low in zinc so you definitely want to increase your dietary intake of zinc by consuming things like grass-fed beef, chickpeas, pumpkin seeds and cashews to prevent a zinc deficiency. Zinc also supports a healthy digestive tract, which improves skin health.
- Vitamin A-rich foods: Foods high in vitamin A like kale, spinach, sweet potatoes and carrots fight infection and speed healing, two things you definitely need when you’re trying to get rid of cystic acne.
- Fiber-rich foods: Consuming high-fiber foods like vegetables, fruits, nuts, seeds and oatmeal encourages colon cleansing as well as the growth of good bacteria in the gut, both of which can help eliminate cystic acne.
- High-quality protein foods: Grass-fed beef, organic chicken, wild-caught fish and free-range eggs are high in protein and nutrients and help balance blood sugar, a key component in the fight against cystic acne.
- Liver-supportive foods: Since hormones are processed in the liver, eating liver-supportive foods can help clear up acne. Eat more cruciferous vegetables like broccoli and cauliflower as well as leafy greens and high-fiber fruits, such as pears and apple, for improved liver function.
3. Consider Taking These Supplements
- Probiotics (10,000 IU to 50,000 IU daily, typically two to three capsules twice daily) — Taking probiotics can boost your immunity and help your internal fight against cystic acne. You can also use probiotic skin care products, which can provide a protective external shield. Studies show that probiotics may help prevent skin eruptions.
- Omega-3 fatty acids (1,000 milligrams of fish oil /cod liver oil daily or 3,000 milligrams of flaxseed or chia seed oil) — Omega-3 helps reduce inflammation and support hormone balance. One scientific study specifically found that after 10 weeks of omega-3 fatty acid or GLA supplementation, inflammatory and non-inflammatory acne lesions decreased significantly.
- Zinc (25–30 milligrams twice daily) — Research suggests that people with acne have lower blood and skin levels of zinc. Taking zinc by mouth may help reduce acne.
- Vitex (160 milligrams of Vitex/chasteberry) — This herbal remedy is specifically recommended for hormonally induced acne.
- Guggul or guggulsterone (25 milligrams twice daily) — Guggul is made from the sap of a tree native to India. For individuals suffering from cystic acne, a controlled clinical trial found that guggul supplements outperformed 500 milligrams of tetracycline. It’s also been shown to be effective for nodulocystic acne, a similar form of acne that usually targets the face, chest and back.
4. Consider Essential Oils
Essential oils like tea tree and lavender can help fight cystic acne. The best way to use essential oils for acne is to apply two to three drops topically to the area of concern. Tea tree and lavender essential oils are safe for neat (direct) application, but they can also be combined with a carrier oil such as jojoba or coconut oil if you have sensitive skin.
A scientific review of the efficacy, tolerability and potential modes of action in regard to the treatment of acne with tea tree oil states that tea tree products reduce lesion numbers in patients with acne, have tolerability levels that are similar to other topical treatments, and have antimicrobial and anti-inflammatory activities that are associated with the treatment of acne. (8)
Avoid exposure to direct sunlight when treating acne with essential oils. The UV rays can make your skin more sensitive and may lead to skin irritations or redness. If using any of these essential oils causes skin irritation, discontinue use of that oil.
Skin Care Tips
1. No Popping
Whatever you do, please don’t try to pop your cystic acne or any other pimples for that matter. Cystic acne, unlike common acne, typically does not give you “poppable” pimples.
Due to the the depth of cystic acne lesions, picking or squeezing can be completely ineffective and will likely extend healing time from days to weeks. The more you touch an infected pimple, the angrier and more unsightly it’s going to become.
If you try to pop cystic acne, you’re just going to spread the breakout underneath the skin. In addition, you can easily end up with acne scarring that lasts well beyond the pimple, possibly even forever. Two words to remember with cystic acne: Hands off!
2. Ice It
You can apply an ice cube directly to a breakout for several seconds to constrict the small blood vessels feeding the painful cyst. The ice helps immediately decrease the size and redness of the offending acne.
3. Healthy Skin Care Routine
Maintain a simple, calming skin care routine that avoids heavy and scented moisturizers. Before applying moisturizer daily, always make sure that your skin is thoroughly exfoliated and clean. An oil-free and unscented moisturizer is a great choice.
To encourage healthy skin turnover and growth, make sure to use exfoliants that are effective but not harsh and abrasive. Some good options include glycolic acid and fruit enzymes.
When you’re in the sun, the best sunscreens to use are all-natural sunscreens to help reduce the chances of acne scarring. For scars, a natural vitamin C product can help. Some cystic acne scars can unfortunately take months to heal, but don’t lose hope.
4. Don’t Overuse the Mirror
It’s a good idea not to obsess over your cystic acne. The more you stare at it in the mirror, the more likely you will want to pick at it and think negative thoughts, both of which will only make you look and feel worse. Stop yourself from visually and mentally obsessing over your cystic acne, and make sure you’re thinking positive, skin-clearing thoughts!
5. Change Your Towels and Pillowcases
Something you might not think about is what else touches your face daily, like towels and pillowcases. To reduce the chances of irritation and sensitivity, it’s a really smart idea to avoid washing these items with strong detergents and bleaches.
Instead, opt for natural and unscented laundry products. You also want to change your towels and pillowcases frequently to avoid the presence and spread of bacteria, which only make your acne worse.
As with everything health- and beauty-related, stress only makes things worse. Find ways to decrease stress in your life because stress can cause your body to release hormones that only make acne worse. The more you relax, the better your skin will be. Try natural stress relievers to help improve your skin.
Getting proper sleep on a nightly basis can help improve your overall health, including balancing hormone levels and decreasing the inflammation associated with cystic acne. You also give your cystic acne uninterrupted time to heal.
Regular physical activity is excellent for the body’s lymphatic system and detoxifying your entire body. It’s also excellent for your mood and self-esteem, which tend to both take a dip when you’re fighting cystic acne.
Cystic Acne vs. Rosacea
- Acne and rosacea are two of the most widespread dermatological conditions.
- It can be difficult to tell the difference between rosacea and acne.
- In the earliest phases of rosacea, the patient may notice gradual reddening of the skin, often mistaking these changes for acne, sunburn or dermatitis.
- The two disorders may be especially confused when the term “acne rosacea” is used, a phrase that was once frequently used to describe what’s now known as subtype 2 (papulopustular) rosacea, which may include bumps and pimples that appear similar to acne.
- Rosacea is a chronic disorder that occurs primarily in the central portion of the face and usually includes redness, flushing and blushing, and bumps (papules) and pimples (pustules). Rosacea can also involve the eyes and even a bulbous nose.
- Though both conditions may involve bumps and pimples, the causes and biochemical processes are different for each. Cystic acne is a product of many factors, involving the hair follicles, hormonal stimulation of oil gland cells and bacteria. On the other hand, recent research has found that rosacea appears to be linked to a dysfunction of the body’s natural immune system and should thus be treated with anti-inflammatory agents rather than antibacterial agents.
- Cystic acne predominantly affects teenage boys and young men in their 20s (as well as women with hormonal issues), while rosacea predominantly affects women of northern or eastern European descent, especially those who are blond and fair-skinned. With rosacea, women ages 20 to 60 are the predominant epidemiological group.
- Approximately half of all people with rosacea develop eye involvement, called ocular rosacea, with chronic tearing and eye dryness, a gritty sensation within the eye, flaking at the base of the eyelashes (called blepharitis), and recurring sties.
- An anti-inflammatory diet can help both cystic acne and rosacea. Also, changing your diet to remove any allergens, sensitivities or common gut irritants can help both problems.
- People who are predisposed to acne or rosacea can experience flares as a result of a shift in gut bacteria and subsequent inflammation.
- Healthy signals produced by probiotics can stop skin cells from sending “attack” messages to the immune system that result in flare-ups of acne or rosacea.
- Cystic acne is an intense form of acne that results in large, inflamed cysts and nodules that appear on the skin. It can be really challenging to manage, especially when it starts to take a toll on your mood and self-esteem.
- Treatment options usually begin with a trip to the dermatologist. However, medicine for cystic acne can include serious side effects.
- Consider the various natural remedies that include diet and supplementation; also check out the various skin care and lifestyle tips.