Cystic acne: causes, treatment and prevention

  • Cystic acne is the largest and most painful form of acne, causing cysts deep under the skin.
  • Cystic acne can be caused by hormones, genetics, and lifestyle factors like diet and stress.
  • To treat cystic acne, a dermatologist may prescribe birth control pills, retinoids, or steroid injections.
  • Visit Insider’s Health Reference Library for more tips.

Acne is a common skin condition it happens when the hair follicles get clogged with oil and dead skin cells. There are several types of acne, including cystic acne. Cystic acne is deeper and more painful than other forms, but it can be controlled with proper treatment.

Here is what you need to know about the causes of cystic acne, who is most likely to be affected by it, and how to treat it.

What is cystic acne?

Cystic acne appears as large cysts that form under the skin and become raised and tender to the touch, says Annie Gonzalez, MD a dermatologist with Riverchase dermatology.

Compared to other forms of acne, cystic acne causes the biggest blemishes and is the most difficult to master. It tends to respond less to generic acne routines and generally requires more aggressive, long-term treatment, Gonzalez says.

Acne is common, affecting 80% of the American population at some point in their life, but cystic acne is relatively rare, affecting approximately 1% of adult women and 3% of adult men.

In comparison, other forms of acne, such as blackheads or whiteheads, appear on the surface of the skin and usually disappear within a few weeks, according to Michele Green, MD, a cosmetic dermatologist with her own private practice. But cystic acne can linger for months.

Cystic acne most commonly appears on the face, especially the jaw and cheeks, but it can develop anywhere on the body, including the chest, back, arms, shoulders, and neck. Green said.

What are the causes of cystic acne?

Cystic acne is caused by a buildup of bacteria and dead skin cells deep below the skin’s surface, Green says. As the number of trapped bacteria continues to grow, the cyst becomes more swollen, red, and painful.

Skipping your face wash or eating certain foods, like a lot of fat or dairy, doesn’t cause cystic acne, although it can exacerbate it, Gonzalez says. On the contrary, cystic acne seems to be linked to periods of hormonal fluctuations such as during puberty, menopause or menstruation.

One hormone in particular, androgen, which is made in greater quantities during puberty, causes the skin to produce more sebum, which can cause all kinds of acne, including cystic acne.

Genetics can also play a role. A 2020 see again have found that the onset of acne is generally correlated with the onset of puberty, with the prevalence and severity of acne increasing during adolescence. People with a family history of acne had more severe acne, and the prevalence of all types of acne, including cystic acne, decreased in early adulthood.

Stress can also exacerbate cystic acne, says Green. Your body produces cortisol when you are stressed, which can disrupt hormones involved in regulating sebum – an oil produced in the skin. When these hormones are disrupted, sebum can clog in the pores and make acne worse.

People most likely to be affected by cystic acne include:

  • People with oily skin
  • Teens
  • Women
  • Elderly people with hormonal imbalances

Treatment of cystic acne

If you have cystic acne, it’s best to get evaluated by a dermatologist, as it can lead to scarring if left untreated, says Green.

Dermatologists may prescribe oral antibiotics or topical treatments that can help control cystic acne. The sooner you receive treatment, the more reduce your risk of scarring.

Which treatment is right for you will depend on individual factors, but some forms of treatment include:

  • Birth control pills, which can help regulate hormones that cause cystic acne. There are 4 different ones that are approved by the FDA specifically to treat acne.
  • Retinoids, which are prescription topical treatments that help flush bacteria and sebum from inner pores.
  • Intralesional steroids, which are injected into the cysts to decrease the size and decrease the inflammation.
  • Chemical peels, which exfoliate dead skin cells and unclog pores. The best chemical peels for cystic acne include glycolic acid or trichloroacetic acid (TDA), Green says, because these ingredients can help stimulate collagen growth and reduce the appearance of scars.
  • Spironolactone, a prescription oral medication that helps reduce excess oil on the skin.
  • Isotretinoin or Accutane, is an aggressive treatment, but often the most effective, says Gonalez. Accutane is taken orally and shrinks the sebaceous glands which stop the formation of bacteria in the pores and allows current rashes to heal. Usually an Accutane cycle takes six months and works for most people with cystic acne.

Cystic acne can get better with age, but it can be a lifelong problem for many people, which can last for years if left untreated, says Green.

Insider takeaways

Cystic acne is a severe, painful form of acne that presents as large cysts under the skin. It is usually the result of hormonal fluctuations, genetics and stress.

Treatments for cystic acne can include topical and oral prescriptions to help control hormones. If you think you are dealing with cystic acne, see a dermatologist who can suggest the best treatment.


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