friend who has cystic acne

I've seen that dead look so many times. Smoking, drinking, bad diet, over washing, not exercising, not getting enough sun (vit D) probably all contribute. He also looks young so puberty and genetics are also in play. Getting rid of the cigs and the alcohol and running shirtless in the sun would be a good first step.

I agree with "Twosteps". However, I personally think that the main culprit is genetics. I used to have acne that looked really similar to that and the reason why for me was genetics. He needs to get rid of cigs and alcohol because not only do they contribute to acne, they also contribute to other health problems. Anyways, tell him to stop smoking and drinking or at least tell him to go see a dermatologist. They'll probably put him on accutane but it's worth it in the end. Good luck with your friend.