This can result from a combination of bacteria, oil, and dry skin cells that get trapped in your pores. Although anyone can develop acne, cystic acne tends to occur in people with oily skin. It's also more common in teens, women, and older adults with hormonal imbalances. Usually, cystic acne can improve with age.
What causes cystic acne? Pores in the skin can clog with excess oil and dead skin cells, causing pimples. Bacteria can enter the skin pores and get trapped along with the oil and skin cells. The skin reaction causes swelling deep in the skin's middle layer (the dermis).
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.
Hormonal changes, including those caused by menopause, menstruation, pregnancy, and certain medical conditions like polycystic ovarian syndrome (PCOS), can be triggers for cystic acne.
Spironolactone (Anti-Androgen Drugs)
Anti-Androgen Drugs (such as Spironolactone) are another class of oral drugs that help treat hormonal imbalance acne in females. Like oral-contraceptives, Spironolactone treats acne by regulating the hormones that are behind the breakouts to begin with.
Cortisone
If you need a cyst gone fast, or if your cystic pimple won't go away, you can visit a healthcare professional for an injection of a diluted cortisone medication called Kenalog. They'll inject the medication directly into the cyst, shrinking it on the spot.
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. It is associated with poor self-confidence, anxiety, and depression.
Hormones are a common trigger for cystic acne and can sometimes worsen things along the chin and jawline in particular," says dermatologist Jennifer Adams, MD. "There are several different types of acne ranging from the milder comedonal bumps, to papulopustular, to the most inflammatory type called nodulocystic.
“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.
Like other types of acne, you shouldn't try to squeeze out a cyst in order to “pop” it. But there are things you can do at home that can help work the cyst out from deep in your skin so it comes out on its own.
Due to stress's affect on the body, most people experience stress acne breakouts rather than a single blemish. The excess oil production related to stress breakouts can increase the likelihood of developing cystic acne, though the majority of patients experience blemishes nearer to the surface of the skin.
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.
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.
Anxiety, depression, and stress can cause acne breakouts in people who have underlying acne. Again, science doesn't yet fully understand all the reasons why this happens. Here's what the evidence says so far: Stress can increase oil production and possibly hormones (like glucocorticoids), both of which can worsen acne.
Cystic acne can spread across large areas of your face, chest, back, shoulders, or upper arms. If and when the pus-filled clog erupts, the infection spreads, further aggravating the situation, and possibly leading to permanent scarring.
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.
Cystic acne is the most serious type of acne because it is so difficult to treat and because it can leave deep and lasting scars on the skin. There are many myths about its causes, which are unknown. But it should not be treated with over-the-counter ointments, creams or scrubs.
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.
You can tell if acne is hormonal or bacteria by its severity if flare-ups occur during hormonal imbalances, and whether topical treatments resolve the issues, or if systemic medications are needed.
Acne vulgaris typically starts around the age of 12 to 14 years but tends to manifest earlier in female patients. Patients' peak age for severity is 16 to 17 years in female and 17 to 19 years in male patients.
Unfortunately, hormonal acne can still show up much later in your life (and just in time to crash that wedding you were invited to). In fact, hormonal acne is most common in adult women between the ages of 20 and 40.
The condition can cause scarring and is generally painful, and managing symptoms can be difficult. Left untreated, cystic acne can also develop into acne conglobate, another severe form of acne characterized by connected nodules of cysts underneath the skin.
If it's actually getting worse, it's definitely time to call the doctor. Moderate or severe acne should always be seen by a dermatologist. It's more likely to cause scarring than the milder forms, and over-the-counter medications aren't strong enough to affect it.
Why Is Cystic Acne so Painful? Simply put, cystic acne causes pain due to the pimple's size, depth, and inflammation. Because they're so deep in the skin, they're closer to nerve endings, so high amounts of inflammation may be especially painful in certain areas.