- 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 such as diet and stress.
- To treat cystic acne, a dermatologist may prescribe contraceptives, retinoids, or steroid injections.
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Acne is a common skin condition which occurs when hair follicles are clogged with oil and dead skin cells. There are several types of acne, one of which is cystic acne. Cystic acne is deeper and more painful than other forms, but can be controlled with proper treatment.
Here’s what you need to know about what causes cystic acne, who is most likely to be affected by it, and how to treat it.
What is cystic acne?
Compared to other forms of acne, cystic acne causes the biggest flaws and is the most difficult to bring under control. It tends to respond less to general acne routines and usually requires more aggressive treatment, in the long run, says Gonzalez.
In contrast, other forms of acne, such as blackheads or whiteheads, appear on the surface of the skin and usually resolve within a few weeks, he says. Michele Green, MD, a cosmetic dermatologist with soy private practice. But cystic acne can persist for months.
Cystic acne most commonly appears on the face, specifically the jaw line and cheeks, but it can develop anywhere on the body, including the chest, back, arms, shoulders, and neck, he says. Green.
What causes cystic acne?
Cystic acne is caused by an accumulation of bacteria and dead skin cells deep below the surface of the skin, Green says. As the number of bacteria that are trapped continues to grow, the cyst becomes more swollen, red and painful.
Skipping your face wash or eating certain foods, such as a lot of fat or dairy products, does not cause cystic acne, although it can aggravate it, says Gonzalez. Rather, cystic acne appears to be linked to periods of hormonal fluctuations such as during puberty, menopause or menstruation.
One hormone in particular, androgen, which is done in larger quantities during puberty, causes the skin to produce more oil, which can cause all types of acne, including cystic acne.
Genetics can also play a role. A 2020 magazine found that the onset of acne typically correlated with the onset of puberty, with the prevalence and severity of acne increasing during adolescence. Those with a family history of acne have had more severe acne, and the prevalence of all types of acne, including cystic acne, is decreased by young adulthood.
Stress can too aggravate cystic acne, Says Green. Your body produces cortisol when you are under stress, which can disrupt the hormones involved in regulating it sebum – an oil made on the skin. When these hormones are disturbed, sebum can clog the pores and aggravate acne.
Those most likely to be affected by cystic acne include:
- People with oily skin
- And women
- Older adults with hormonal imbalances
Cystic acne treatment
If you experience cystic acne, it’s best to be evaluated by a dermatologist because it can lead to scarring if left untreated, Green says.
Dermatologists may prescribe oral antibiotics or topical treatments that can help control cystic acne. The sooner you receive treatment, the lower the risk of scarring.
The correct treatment for you will depend on individual factors, but some common ones forms of treatment include:
- Birth control pills, which can help regulate the hormones that cause cystic acne. There are 4 different ones that are approved by the FDA specifically to treat acne.
- Retinoids, which are prescribed topical treatments that help remove bacteria and sebum from internal pores.
- Intralesional steroids, which are injected into the cysts to decrease size and decrease inflammation.
- Chemical peels, which exfoliate dead skin cells and clog pores. The best chemical peels for cystic acne include glycolic acid or trichloroacetic acid (TDA), Green says, because these ingredients can help stimulates collagen growth and reduces 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 reduces the oil glands that stop the formation of bacteria in the pores and allow the actual blemishes to heal. Usually, an Accutane tour lasts six months and works for you 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.
Take away the Insider
Cystic acne is a severe and 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 may include topical and oral prescriptions to help control hormones. If you think you can be treated with cystic acne, consult a dermatologist who can suggest the best treatment for you.