Cystic Acne: Understanding the Causes, Pain, and Long-Term Effects

Dealing with cystic acne can be both physically painful and emotionally challenging, often leaving lasting scars in more ways than one.

Cystic acne gets its name from the cysts it forms—pus-filled pimples that are typically large, painful, and deeply embedded in the skin. These characteristics make cystic acne prone to scarring, according to the American Academy of Dermatology Association (AAD).

Acne is the most common skin condition in the United States, affecting over 50 million Americans annually. However, cystic acne can be particularly distressing, often causing embarrassment and anxiety for those who suffer from it.

“Please know that acne is very normal and it’s not your fault, and you are in excellent company—about 90% of people struggle with acne at some point in their life, including celebrities,” says board-certified dermatologist Dr. Hadley King. “Acne, unfortunately, is normal and largely out of our control, and it does not define who we are.”

What Causes Cystic Acne?

Cystic acne usually begins during the teenage years or early 20s, but it can persist into adulthood. The primary cause is often hormonal, explains Dr. King, though this doesn’t necessarily indicate an underlying hormonal issue.

“These acne cysts result from the normal fluctuation of hormones,” she says. Some people’s sebaceous glands, which produce oil to keep the skin hydrated, are genetically more sensitive to hormonal changes, leading to increased acne during these fluctuations. Stress, diet, and lack of sleep can also influence hormones and exacerbate acne.

How Can I Prevent Cystic Acne?

Since cystic acne is typically hormone-driven, its treatment often aligns with that of hormonal acne.

The first step in managing any type of acne is daily cleansing. Beyond that, it’s important to consult a dermatologist to determine the most effective treatment, which could include medications like tretinoin, retinoids, or benzoyl peroxide. If these treatments are not effective, your dermatologist may recommend additional options specifically for hormonal acne:

Clascoterone: A newer topical cream, and the first FDA-approved hormonal acne treatment for both men and women, believed to work by blocking the skin’s hormones from producing excess sebum, which can clog pores and lead to acne.

Spironolactone: An oral medication commonly prescribed to women, often in combination with oral contraceptives, to target hormonal acne. According to the AAD, this medication can effectively treat acne on the face, chest, and back.

Isotretinoin: An oral retinoid that can be particularly effective for treating cystic acne, says Dr. King.

Addressing cystic acne can be complex, but with the right guidance and treatment, it is possible to manage the condition and minimize its impact.