What causes cystic acne on your back?

Acne is a skin condition affecting the oil glands and hair follicles. Oil (sebum), skin cells, and the hair follicle can clog together, plugging a skin pore. Trapped bacteria, such as the bacterium Propionibacterium acnes, can then irritate and inflame the plug. This causes swelling. That swelling can lead to:

  • Whiteheads. The clogged pores close and bulge out of the skin.
  • Blackheads. The clogged pores stay open. The top surface can darken.
  • Pimples. The clogged pores have an open wall that seeps its contents under the skin, forming a red bump. The bump’s top is often filled with pus.
  • Cysts. The clogged pores form deeper in the skin. They’re bigger and more painful than a pimple.

When the clogged pores become cysts — tender red bumps filled with pus — you have cystic acne. Cystic acne is the most serious form of acne.

Doctors don’t know what exactly causes acne. But they do know:

  • Proper skin care can keep outbreaks from getting worse.
  • It’s most common in adolescents and young adults.
  • Hormonal changes — such as during puberty and menstruation — can lead to an outbreak.

Over-the-counter acne treatments aren’t strong enough to be effective on cystic acne on your back. Your doctor will probably recommend a dermatologist who can suggest treatments. Treatment may include:

  • Oral antibiotic. Tetracycline or a macrolide antibiotic can reduce bacteria, swelling, and redness.
  • Topical medication. Retinoid, salicylic acid, azelaic acid, or benzoyl peroxide can reduce bacteria and clogged pores. Read more about salicylic acid vs. benzoyl peroxide.
  • Isotretinoin (Accutane). This medication can treat redness, swelling, bacteria, clogged pores, and excess oil. However, Accutane is only used in severe cases due to its side effects.
  • Spironolactone. This oral tablet can reduce excess oil. Only females can use it.
  • Birth control pills. The estrogen and progestin in birth control pills can help treat acne. Females can only use this treatment as well.
  • Corticosteroid. Steroid injections into the cyst can reduce its size and pain.
  • Drainage. Your doctor can cut into and drain the cyst. This is only performed in a medical office to limit risk of infection.
  • Prednisone. In serious cases, low-dose prednisone may be effective.

Check with your doctor about to make sure the following steps are appropriate to include with the treatment for your cystic acne:

  • Wash your back with warm water and a mild soap at least once daily.
  • Avoid sunlight.
  • Use water-based, noncomedogenic sunscreen. It won’t clog your pores.
  • Avoid touching your back and picking at or squeezing the cysts.
  • Shower after activities that caused you to sweat.

Cystic acne and anxiety

Along with physical discomfort, cystic acne on your back can affect self-image and social relationships, leading to stress. And stress may make acne worse. If you find yourself anxious about your case of cystic back acne, consider talking with a mental health therapist.

Cystic acne requires medical treatment. It may potentially take several years to clear if left untreated. If you have acne on your back that features tender, red lumps deeper under your skin, see your doctor.