• Cystic acne is the largest and most painful form of acne, causing cystic acne located 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 the Insider’s Health Reference library for more advice.

Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. There are several different types of acne, one of which is cystic acne. Cystic acne is deeper and more painful than other forms, but it can be controlled with proper treatment.

Here’s what you need to know about what causes cystic acne, who is likely affected by it, and how to treat it.

What is cystic acne?

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

Compared to other types of acne, cystic acne causes more dark spots and is the most difficult to control. Gonzalez says:

Acne is common, affecting 80% of the US population at some point in their lives, but cystic acne is relatively rare, affecting about 1% of adult women and 3% of men. adult world.

By comparison, other forms of acne, like blackheads or whiteheads, appear on the surface of the skin and usually clear up after a few weeks, says Michele Green, MD, a board-certified cosmetic dermatologist. But cystic acne can persist for months.

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

What causes cystic acne?

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

Skipping washing your face or eating certain foods, such as greasy or dairy, doesn’t cause acne, although it can aggravate acne, says Gonzalez. Instead, cystic acne seems to be tied to periods of hormone fluctuations such as during puberty, menopause, or menstruation.

A particular hormone, androgen, which is produced in greater amounts during puberty, causes the skin to produce more oil, which can cause all types of acne, including cystic acne.

Genetics may also play a role. A 2020 review found that the onset of acne often correlates with the onset of puberty, with the prevalence and severity of acne increasing during the teen years. People with a family history of acne have more severe acne, and the incidence of all types of acne, including cystic acne, decreases in adolescence.

Green says stress can also worsen acne. Your body produces cortisol when you’re stressed, which can disrupt hormones involved in the regulation of sebum – an oil produced in the skin. When these hormones are disrupted, sebum can become clogged in the pores and make acne worse.

Those most likely to be affected by cystic acne include:

  • People with oily skin
  • Teenager
  • Women
  • Elderly people have hormonal imbalances

Treatment of cystic acne

If you’re experiencing cystic acne, it’s best to see a dermatologist because it can lead to scarring if left untreated, Green says.

Dermatologists can prescribe oral medications


or topical treatments can help control cystic acne. The sooner you get treatment, the lower your risk of scarring.

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

  • Birth control pills, which may help regulate the hormones that cause acne. There are 4 different types that are specifically approved by the FDA to treat acne.
  • Retinoids, is a prescription topical treatment that clears bacteria and sebum from within pores.
  • Intentional steroids, injected into the cyst to reduce its size and reduce inflammation.
  • Chemical maskHelps to exfoliate dead skin cells and unclog pores. The best chemical peels for acne, says Green, include glycolic acid or trichloroacetic acid (TDA), as these ingredients can help stimulate collagen growth and reduce the appearance of scars.
  • Spironolactone, an oral prescription medication that helps reduce excess oil on the skin.
  • Isotretinoin or Accutane, is an aggressive, but often the most effective, treatment, Gonalez says. Accutane is taken orally and shrinks the oil glands, preventing the formation of bacteria in the pores and allowing existing pimples to heal. Typically, a course of Accutane takes six months and is effective for most people with cystic acne.

Cystic acne can improve with age, but it can be an ongoing problem for many people, potentially lasting for years if left untreated, Green says.

Lessons from insiders

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

Treatments for cystic acne can include both topical and oral medications to help control hormones. If you think you may be dealing with cystic acne, consult a dermatologist who can recommend the best treatment for you.


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