So, cystic acne is a type of acne that's characterized by extreme redness and inflammation. It can occur on the face, the chest or the back. But it always occurs very deeply in the skin. The reason it's painful is the cysts are in contact with pain nerve fibers. Please don't try to pop these because they're very deep and you want be able to, and you'll just leave more of a chance that you'll scar, and often does so. Which is why it requires more aggressive treatment. By far the best treatment for cystic acne is Accutane. And other options are birth control pills, spironolactone, those are for women. As well as, antibiotics and photodynamic therapy. If you have a few cysts from time to time, all you need is a dermatologist who can inject them with a little bit of cortisone, which will help bring them down. But, if you have severe cystic acne that's always a problem for you, then it's really time to find a dermatologist that can put you on a good regimen before you get scarring.