Hi Darren
The large red bumps on the centre of your chest do appear suggestive of cystic acne. I also see there are smaller spots of acne on the upper chest.
For such large cystic acne, topically applied medications are usually insufficient and patients would normally require an oral medication. The most effective medication is oral isotretinoin, a Vitamin A derived medication, which will rapidly dry out the acne and acne cysts within weeks.
However patients on this medication will have to take blood tests to monitor their liver function and cholesterol (just as a safety precaution), and will often get very dry lips and dry eyes.
Another option would be to take a prolonged course of oral antibiotics, which also help to dry out the acne and stop new ones from forming. This medication also has to be taken for at least 2-3 months and the improvement may not be seen till at least 6 weeks after starting. The side effects tend to be mild, and are usually nausea or tummy discomfort.
In addition to the oral medication, topical medication can also be applied to help dry out the acne lesions faster, these include benzoyl peroxide or clindamycin. The largest acne cysts can also be injected with a steroid to hasten their flattening.
Hope you find this information useful!
Wei Sheng
Dermatologist