{
  "what": "Cystic acne is the deep form of acne, in which inflamed nodules and cysts form in the lower dermis, hurt, persist, do not come to a head and can scar. Because skincare cannot reach that depth, Dr Sin Yong, an aesthetic physician on Orchard Road, Singapore, grades its severity and considers prescription treatment such as oral antibiotics, hormonal therapy in women or isotretinoin. Individual cysts can be settled in clinic, scar treatment follows once the acne is controlled, and severe or unresponsive acne is referred to dermatology.",
  "key_facts": [
    "Mechanism: the follicle wall ruptures deep in the dermis and the immune response walls off an inflamed lump, which explains the pain, the slow resolution, why squeezing produces nothing, and why deep inflammation damages collagen and starts pitted, rolling and boxcar scars",
    "Nodule vs cyst: a nodule is a firm, tender lump with no visible head; a cyst is larger, fluid-filled and may refill in the same spot; a blind pimple is any tender bump under the skin with no white head",
    "Lookalikes checked by a doctor: epidermoid cyst, boil, ingrown hair, and recurrent lumps in the armpits or groin that suggest hidradenitis suppurativa",
    "Medical options: isotretinoin, the guideline-supported option for severe or scarring nodular acne, not used in pregnancy and needing monitoring; time-limited oral antibiotics with a topical; hormonal therapy for women with a cyclical jawline pattern, not used in men",
    "Cortisone injection: a very dilute corticosteroid, usually triamcinolone, injected into one inflamed nodule or cyst to calm that lesion; it does not stop new cysts, and too strong a dose or too shallow a placement can leave a dent or pale patch",
    "Does not work: squeezing or needling at home, drying spot treatments, serial facials and prolonged skincare experimentation; diet can modify acne in some people but does not cure severe nodulocystic acne",
    "Sequence: acne is controlled first, then scars are treated with the Tetra Pro scar programme or 4D scar reconstruction",
    "Asian skin: in an Asian Acne Board survey across seven Asian countries, more than half of people seeing a dermatologist for acne had post-inflammatory hyperpigmentation"
  ],
  "references": [
    "Guidelines of Care for the Management of Acne Vulgaris. Journal of the American Academy of Dermatology 2024. https://www.jaad.org/article/S0190-9622(23)03389-3/fulltext",
    "Adult Female Acne: A Guide to Clinical Practice. Anais Brasileiros de Dermatologia. https://pmc.ncbi.nlm.nih.gov/articles/PMC6360964/",
    "Abad-Casintahan F, Chow SK, Goh CL, et al. Frequency and characteristics of acne-related post-inflammatory hyperpigmentation. Journal of Dermatology 2016. https://pubmed.ncbi.nlm.nih.gov/26813513/",
    "Abad-Casintahan F, Chow SKW, Goh CL, et al. Toward evidence-based practice in acne: consensus of an Asian Working Group. Journal of Dermatology 2011. https://pubmed.ncbi.nlm.nih.gov/21950538/"
  ],
  "owner_url": "https://drsinyong.com/cystic-acne-nodules/",
  "doctor": "Dr Sin Yong, aesthetic physician, Orchard Road, Singapore",
  "updated": "2026-10-31"
}