Your acne appears around your chin and jawline. One of the telltale signs of a hormonal breakout is its location on the face. If you're noticing inflamed cystic acne on your chin or jawline area—anywhere around your lower face, really—you can bet your bottom dollar that it's probably hormonal acne.
What does hormonal acne look like? Whiteheads, blackheads, papules, pustules, cysts and nodules are all common hormonal acne symptoms. Normally, whiteheads and blackheads do not cause pain, inflammation or swelling, but if they do, then they are most likely forming into cysts and pustules.
On the surface, cystic acne can look like large, red boils. Cysts, like nodules, reside deep underneath the skin's surface. But because they're filled with pus, cysts are softer than nodules. The pimples that define cystic acne burst open, often leading to infection.
What causes hormonal acne? Acne is caused by clogged pores. Hormonal acne develops when hormonal changes increase the amount of oil your skin produces. This oil interacts with bacteria on the pores of your skin where hair grows (hair follicles) and results in acne.
Cystic Acne Treatment
Over-the-counter medicines that treat mild acne don't usually work on cystic acne. Your doctor will probably recommend one or more of these treatments: Oral antibiotics to help control bacteria and lower inflammation. Birth control pills to regulate a woman's hormones.
Cystic acne treatments include: Antibiotic creams, gels solutions and lotions to kill bacteria and decrease inflammation. Azelaic acid (Azelex®, Finacea®) or salicylic acid to kill bacteria and get rid of excess dead skin cells. Benzoyl peroxide to reduce the number of bacteria on the skin.
If ignored, cysts can take anywhere from 1-4 weeks to go away by themselves. Although your body will eventually deal with the inflammation, some cysts can persist for extended periods of time and often leave behind scars.
Hormones stimulate oil production, which leads to the growth of bacteria getting trapped in the pore," she explains. All skin is prone to cystic acne and unfortunately, many of the causes — like age, stress, or genetics — are out of our control, says Shuting Hu, M.D., founder of Acaderma.
Due to the fact that cystic acne is only caused by a change in hormones, genetics, and the oil production level in the skin, it must be treated by a dermatologist. Home skin care remedies as well as over-the-counter topical treatment and medication rarely work and can take a very long time to show any sort of result.
Screening tests include serum DHEAS, total and free testosterone, and luteinizing hormone/follicle stimulating hormone (LH/FSH) ratio. These tests should be obtained during the two weeks prior to the onset of menses to avoid the LH surge associated with ovulation.
Hormonal changes, including those caused by menopause, menstruation, pregnancy, and certain medical conditions like polycystic ovarian syndrome (PCOS), can be triggers for cystic acne.
Acne affects up to 50 million people each year in the U.S. However, severe or cystic acne is far less common — only 1% of adult females and 3% of adult males suffered from severe acne. For many women, cystic acne is the result of hormonal imbalance, meaning they'll likely experience breakouts on or around menstruation.
At its root, adult acne is caused by the same things that cause teen acne: excess skin oil and bacteria. Any changes in hormones, including those brought on by pregnancy and menstruation, can trigger excess oil. Women who smoke also seem to be more prone to acne.
Unfortunately, cystic acne often doesn't go away on its own and requires treatment from a doctor or dermatologist. Cystic acne has psychological effects as well as visible effects on the skin.
“Cystic acne is commonly increased in your thirties as this is when the skin is most susceptible to hormonal changes. The hormonal shifts affect the oil glands and sebaceous glands in the skin,” Dr. Purvisha Patel, board certified dermatologist and founder of Visha Skincare adds.
Adult acne, or post-adolescent acne, is acne that occurs after age 25. For the most part, the same factors that cause acne in adolescents are at play in adult acne. The four factors that directly contribute to acne are: excess oil production, pores becoming clogged by "sticky" skin cells, bacteria, and inflammation.
Given the increase in oil production, she says your skin will usually look greasier and slightly more inflamed. Zeichner adds that stress acne can also look like a combination of blackheads, whiteheads, red bumps, and pus pimples.
Development of Severe Acne
If you suddenly develop a bout of severe acne, seemingly out of nowhere, it could mean that you're suffering from polycystic ovarian syndrome (PCOS). Like endometriosis, PCOS can cause irregular ovulation or lack of ovulation and it can also cause problems with your fertility.
Acne commonly starts during puberty between the ages of 10 and 13 and tends to be worse in people with oily skin. Teenage acne usually lasts for five to 10 years, normally going away during the early 20s. It occurs in both sexes, although teenage boys tend to have the most severe cases.
What Causes Acne Flare Ups in the Summer? “Heat and humidity cause increased sweat and oil production in the skin leading to clogged pores and increased breakouts,” says Morgan Rabach, MD, a New York City-based board certified cosmetic dermatologist.
According to a study published in the Archives of Dermatology, 63% of acne-prone women experience these premenstrual flares. They usually strike about seven to 10 days before the onset of a woman's period and then subside as soon as bleeding begins.