Cystic acne Is a type of inflammatory acne that causes deep lumps under the skin that are usually tender, red and painful. “They often arise in large quantities and grow and diminish over time,” says Laura Ferris, dermatologist and associate professor of dermatology at the University of Pittsburgh. Cystic acne appears most commonly on the face, Ferris says, but it also comes out on the back, chest, upper arms and shoulders. It is different from other more superficial types of acne, such as blackheads and whiteheads, because it is deeper in the skin.