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How to Clear Cystic Acne

A doctor examining the patient's skin on the right hand

Quick Summary

  • Cystic acne can be severe and disfiguring, and the author notes it may not respond to topical treatments, oral antibiotics, or consistently available intralesional corticosteroids.
  • The post emphasizes isotretinoin as the most effective option for scarring acne or even a single recurrent cyst/“boil,” with the goal of preventing further scarring.
  • A low starting dose was chosen due to summer sun exposure, but noticeable peeling (especially lips) caused embarrassment and a desire to stop.
  • Moisturizers and lip ointment were recommended, and the dosing was reduced to every other day to improve tolerability while continuing treatment.
  • The author reports the patient is clearing well, states side effects are common but manageable, and notes isotretinoin can work for both teens and adults, even after age 40.

Cystic acne is devastating. Fortunately, isotretinoin is literally a lifesaver. I realized this more acutely when my own son kept getting multiple disfiguring facial cysts. They did not respond to topical or oral antibiotics. Intralesional corticosteroids were of temporary benefit, but not always available when we were away visiting family in New York, New Jersey, or Florida. After extensive research and consultations, we sought out various acne solutions in Bellevue, which proved to be incredibly helpful. The dermatologists there offered a range of management options, tailoring treatments to my son’s specific needs. Ultimately, finding the right combination of therapies made a significant difference in his confidence and skin health.

I made him an appointment with my PA-C Jonathan Cyphers. Jonathan has a special touch with kids. We began at a low dose, considering it was summer and there would be a lot of sun exposure. The skin peels on this drug, especially the lips. As it turns out, after one week, the kids at camp and his cousins were commenting on his visibly peeling skin. He was quite embarrassed and wanted to quit the medication. I informed him that this was a typical response and to moisturize his skin with an over-the-counter emollient and any kind of ointment for his lips.

He did so. In addition, I had him take his pill every other day, thereby halving his dose. I felt it essential not to give up, to persist because this medication is curative.

So far he is clearing well and is sure to have spectacular results.

For acne that is scarring or manifests even with one cyst or “boil”, isotretinoin works the best. It prevents further scarring and boosts a child’s self-esteem at a critical time of life, the teenage years. I have treated adults even after age 40 with this medication successfully, so it is never too late. There is a list of common side effects, all manageable. In addition to isotretinoin, many patients benefit from Burien’s effective acne therapies, which may include topical treatments and chemical peels tailored to individual needs. These comprehensive approaches can enhance results and address various acne types, ensuring that both the physical and emotional impacts are minimized. With the right combination of treatments, patients can achieve clearer skin and greater confidence.

Elie Levy, MD, FAAD
Aesthetic and General
Dermatology of Seattle

FAQ - Frequently Asked Questions

How can you clear cystic acne when topicals and antibiotics don’t work?
In the story shared, multiple disfiguring facial cysts didn’t respond to topical or oral antibiotics, and steroid injections (intralesional corticosteroids) only helped temporarily. After research and consultations, the approach that made the biggest difference was starting isotretinoin under a clinician’s supervision. The key point is that for scarring or even a single recurring cyst/“boil,” isotretinoin is described as the most effective option and can be curative.
If you’re getting recurring cystic pimples—especially ones that scar—the post emphasizes not waiting it out and instead seeking a treatment plan that prevents further scarring. The author describes trying antibiotics and occasional steroid injections, but ultimately turning to isotretinoin because it works best for scarring cystic acne. The practical takeaway is to consult a dermatology clinician early when cysts are recurring and disfiguring, since delays can mean more scarring.
The post calls isotretinoin “literally a lifesaver” and “curative,” specifically for acne that is scarring or even presents as a single cyst or “boil.” It’s positioned as the treatment that works best when other options (topicals, oral antibiotics) aren’t enough, and it’s highlighted for preventing further scarring. The author also notes visible improvement early on, with the teen “clearing well.”
The post notes that peeling—especially on the lips—is a typical response on isotretinoin and can be noticeable enough for others to comment. The advice given is to moisturize with an over-the-counter emollient for the skin and use any kind of ointment for the lips. In the example, reducing the dose by taking the pill every other day helped make side effects more tolerable while staying on treatment.
The post frames severity as cystic acne that’s disfiguring, recurring, and not responding to topical or oral antibiotics, especially when scarring is a risk. It also highlights a common decision point: early peeling and embarrassment can make teens want to stop, but the author stresses persisting because isotretinoin can be curative. In their case, side effects were managed with moisturizers and a temporary every-other-day schedule rather than quitting.

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