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Cystic acne is characterized by long-standing, painful nodules of the face, back of neck, chest, and back. The nose may be spared or significantly involved with pustules and nodules. When these nodules finally recede, they usually leave behind scars. Individual scars may be the classic acne "ice pick" scars, but many of these aggregated together cause a more vermiculate or "worm eaten" scarring. This is especially likely on to occur on the cheeks. While starting as pus-filled pimples, eventually these evolve to inflammatory red papules (bumps) and eventually once treated or in remission may settle down to pink spots.
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