cystic acne treatment clinic in Singapore

What Causes Cystic Acne?

What causes cystic acne? Genetics, stress, diet and hormones are a variety of factors that may play a role in cystic acne formation. Although the condition is more common in men, it can also affect women and cause significant skin damage.

Cystic acne is a severe form of acne vulgaris that is deep seated within the skin. When your acne feels large and gives you a painful throbbing sensation,  and is located near the jawline and chin, chances are you have Cystic Acne.

Cystic Acne can range in different sizes, from a few millimeters (microcyst) to a few centimeters in diameter. They are commonly found in the cheeks, jawline, neck and upper trunk area.

nodular cystic acne treatment clinic in Singapore
Nodular Cystic Acne

How is Cystic Acne Different from Milder Acne?

Acne cysts are located in the deeper layers of the skin unlike milder acne, making off the counter products, medicated acne creams and chemical peels ineffective at treating it.

Cystic acne causes more extensive inflammation and damage within the dermal layer of the skin. They are not ‘poppable’ and often cause pain and distress. Cystic acne have a high risk of scarring if left untreated.

What Does Cystic Acne Look Like?

Cystic acne is a variant of inflammatory acne vulgaris that is characterised by painful, swollen bumps under your skin. On the skin surface, they appear red, feel tender to touch and you may notice pus coming out.

The main difference between nodular acne and cystic acne is the presence of pus. Nodular acne, which is deeply embedded within the skin feels hard and painful. When pressure is applied to a cystic acne lesion, you will often notice pus coming out from the skin.

Nodulocystic acne is a combination of both nodular and cystic acne within the skin.

Several features differentiate Nodulocystic acne from other variants of inflammatory acne:

  • Depth: Cystic and nodular acne are located deeper in the dermal layer of the skin. Papules and pustules are mostly epidermal in origin.
  • Size: Nodular and cystic acne can often reach more than 1cm in size.
  • Location: Nodular and cystic acne are common on cheeks and jawline. They can also be uniquely found on eyebrows and in front of your ears and earlobes.
  • Tenderness: They are often painful to touch and may affect sleep and daily activities.
  • Duration: Nodular and cystic acne may lasts for several weeks to months. They may reduce in size after some time, only to flare up again and this pattern continues. We call this the chronic relapsing-remitting pattern.
Acne treatment and what leads to acne

What Causes NoduloCystic Acne?

Acne is a disease of the hair follicle and sebaceous gland unit. The interplay between increased sebum gland activity, clogged dead skin cells within the hair follicle, inflammation and colonization by C.acne bacteria triggers an immune response.

While a healthy immune response helps clear infections on a daily basis, a chronic inflammatory response can be harmful. Over time, the build up of inflammation within your hair follicles can increase and potentially rupture into the deeper dermal layers of your skin. When this occurs, the resultant inflammatory response within the dermis can lead to the formation of nodulocystic acne skin lesions.

The dermal layer of the skin is mainly composed and supported by a network of collagen, elastin fibers, macromolecules and proteins. We term this supporting network as the extracellular matrix (ECM). Collagen is akin to glue that holds the individual components of the dermis together. When you get inflammation disrupting the wound healing process within the dermis over a prolonged period, this can lead to acne scars and keloid formation.

acne cream and acne treatment

What can I do to Avoid Cystic Acne?

Good question. When treating acne, it is important to start treatment early to avoid worsening of your acne and acne scarring.

While there is currently no clear and direct evidence linking foods to acne, you may want to slow down on high glycaemic index foods (e.g. white bread, biscuits, glutinous rice) and dairy products.

        Skin Care Tips:

  • Avoid penetrating oils such as Lanolin and Isopropyl myristate
  • Go Fragrance Free
  • Use Colour Cosmetics with Caution, especially if it contains Mica and Red dye.
  • Go easy on Eye cream because they have a thicker formulation.
  • Wash, Before and After Work Out
  • Avoid Wax and Petroleum containing Lipsticks and balms as they cause acne around the mouth.

What Treatment Options are Available for Acne Cyst?

The treatment of acne cyst will depend on the severity of your acne, your medical history, allergies, skin type and sensitivity.

  • Intralesional Anti-inflammatory Injections

This procedure is suitable for large, painful and inflammed acne cyst. The acne cyst is directly injected with anti-inflammatory medication, and you will find quick relief in the symptoms over the next few days. Repeated treatments may be necessary at intervals of 4 weeks if the cysts are stubborn.

  • Drainage of Cyst

When there is accumulation of pus from a large cyst, it may be necessary to drain it out. It brings quick relief of pain and discomfort. A small slit under local anaesthesia allows us to tackle cyst that are pus-filled, recovery is excellent and scarring minimal. 

  • Topical Retinoids

Topical retinoids such as topical tretinoin are an effective prescription-only medication to reduce inflammation, comedomes and hyperpigmentation associated with acne. They are more potent than retinols found off the shelves in stores.

  • Oral Retinoids

Oral retinoids is a Vitamin A based medication, and is currently the most effective oral treatment for severe forms of acne, including multiple cystic acne. From studies, patients who are on oral isotretinotin for nodulocystic acne show more than 95% improvement. Most patients after completing a cycle of oral isotretinoin therapy remain clear of the condition. This is due to the profound inhibition of the sebaceous gland size and function. The details of the medication, its side effects and suitability will be discussed during consultation. 

  • Laser Cyst Removal

This is an advanced and precise technique to remove multiple small cysts in a single sitting. The Laser beam is focused to make an entry point onto the skin surface to facilitate extraction of the cyst. Healing time is excellent and is associated with a good cosmetic outcome.

The best cystic acne treatment is one where it takes into account the severity of your acne, your skin type, and your unique individual condition. While many people struggle with acne, the good news is that most individuals will be able to manage their skin better with a clinically effective skin care regime and treatment.

Studies have shown that suffering from acne is associated with a poorer quality of life, lower self-esteem and feelings of distress.

Prompt and effective treatment of nodulocystic acne reduces inflammation, discomfort and scarring potential. Moreover, studies show reduced anxiety and depression in individuals after successful treatment with oral isotretinoin.

Nowadays, clinically effective treatments are there to help improve your acne and thereby reducing the potential for acne scarring.

The first important step towards your recovery is to make an appointment.

A consultation is arranged to understand your unique condition, examine your skin and discuss about the treatment options.

Please get in touch with us using the form below , call us at 6769 6007 or you can simply whatsapp us +65 9855 3022.

This would vary depending on the type of treatment.

  • Active acne treatments with topicals and/or medications: fr $90 onwards per month
  • Injection Steroids aka cortisone injections. fr $90-120 onwards
  • Incision and drainage of cyst. from $120-300 onwards.
  • Carbon laser peel. fr $252 onwards.

Request a CallBack

Get in touch with us with any questions, pricing, or bookings.

Or give us a call at +65 6769 6007 | WhatsApp us +65 9855 3022

Dr Moses Ng dermatologist

cystic acne

Cystic acne cases make up about 30-40% of my acne cases. A lot of individuals with cystic acne experience physical pain and feel troubled over their skin condition. A course of oral isotretinoin is clinically effective for this severe form of acne. Most clear with one course of treatment, with more than 80% maintaining good acne control with only topical creams after treatment.

Dr. Moses Ng

More Information:

  1. Acne – American Academy of Dermatology.
  2. Acne – British Association of Dermatologists.

Related Information:


  1. Lee JW, Yoo KH, Park KY, Han TY, Li K, Seo SJ, et al. Effectiveness of Conventional, Low-dose and Intermittent Oral Isotretinoin in the Treatment of Acne: A Randomized, Controlled Comparative study. Br J Dermatol. 2010 Nov 29.
  2. Davis EC, Callender VD. A review of acne in ethnic skin: pathogenesis, clinical manifestations, and management strategies. J Clin Aesthet Dermatol. 2010 Apr. 3(4):24-38.
  3. Peck GL, Olsen TG, Butkus D, Pandya M, Arnaud-Battandier J, Gross EG, Windhorst DB, Cheripko J. Isotretinoin versus placebo in the treatment of cystic acne: a randomized double-blind study. Journal of the American Academy of Dermatology. 1982 Apr 1;6(4):735-45.
  4. Rubinow DR, Peck GL, Squillace KM, Gantt GG. Reduced anxiety and depression in cystic acne patients after successful treatment with oral isotretinoin. Journal of the American Academy of Dermatology. 1987 Jul 1;17(1):25-32.