What Causes Cystic Acne (And How Can You Treat It)?

Acne is a condition that nearly everyone experiences at some point, even if it is just blackheads on the nose or a few pesky teenage pimples. What if your acne is more than just a few pimples on occasion? If you experience painful, large bumps consistently that are affecting your quality of life, you could be experiencing cystic acne.

Cystic acne is not only physically painful at the moment but can also cause serious self-esteem issues and long-term effects, like scarring. "Cystic acne is a severe form of acne, in which deep pimples form underneath the skin," dermatologist Dr. Joshua Zeichner tells InStyle. "The individual lesions are often bigger than regular acne bumps and persist for a longer duration before resolving," adds board-certified dermatologist Brian Hibler. 

Treating the condition is also no easy task, with it being harder to cure with over-the-counter methods. While many people assume cystic acne has the same cause and treatment as other types of acne, cystic acne is often much more complex.

Causes of cystic acne

Regardless of all the acne myths out there, the reason behind cystic acne is more complex than just an unwashed face (though washing your face is important). "There's so many factors that are involved," board-certified dermatologist Azadeh Shirazi explains in a TikTok video. "It's so important to see a dermatologist or physician that can help you." Some potential factors she lists include hormones, inflammation, bacteria, excess oil, and clogged hair follicles. 

According to Cleveland Clinic, acne is caused by clogged pores — but when "bacteria also gets into the pores," cystic acne can form, leading to painful pimples under the surface level of the skin. Dermatologist Dr. Joshua Zeichner tells InStyle that these bumps are caused by a "structural change under the skin — a 'balloon' or an out-pouching that fills up with oil from your oil gland." Any factor that causes acne has the potential to also cause cystic acne if bacteria is present to enter the pores.

Hormones being off-balance can lead your body to increase oil production, which is why many teens experience cystic acne. Many adults with acne, especially women, may be experiencing a hormone imbalance as well. Drugwatch tells us that "oily or greasy cosmetics, lotions, and even cleansers can be comedogenic, or pore-clogging," which can also cause cystic acne. With the wide array of causes, it is best to visit a dermatologist who can help you pinpoint the factors that are possibly causing your cystic acne and determine the best way to treat the condition.

How to determine if a bump is cystic acne

If you have just developed a new acne spot on your face, it is important to determine if it is an acne cyst before attempting any at-home treatments. Luckily, there are some simple, noticeable differences between a cystic acne bump and a "regular" pimple.

Does the new bump on your face have a white head screaming to be popped? If so, it's likely regular acne. But if the bump is large and deep within the skin with no head, it could be cystic. As dermatologist Matthew Stephany says via Nebraska Medicine, "Cystic acne has deeper lesions than typical whiteheads or blackheads. These don't typically 'come to a head.' They can be tender, so patients attempt to squeeze them."

If you pop a regular pimple, the head will likely burst since it is on the skin's surface — but since the cyst's head is below the skin, nothing will happen. Another way to determine if your pimple is cystic involves how it feels. Medical News Today notes that if the lump is soft, large, and painful, chances are that it is an acne cyst.

Side effects of cystic acne

The effects of cystic acne are one of the biggest reasons it should be treated by a dermatologist. Board-certified dermatologist Dr. Michael I. Jacobs tells Allure that when you attempt to pop a cystic bump, "You increase your risk of infection and scarring." You should be especially careful picking pimples in the "triangle of death," which is "an area of the face that includes the region of the nose and corners of the mouth," infectious disease physician Dr. Amesh A. Adalja says via Healthline. "This area is connected via blood vessels to areas of the skull where infections can spread very rapidly and become more serious." 

The other effects revolve around physical appearance and can be challenging to your overall quality of life. Not only painful and difficult to treat, cystic acne can cause permanent scarring — which, unfortunately, is difficult to completely rid your face of. Cystic acne, like any other type of acne, can affect one's mental health. "Research has shown that patients with acne are at an increased risk of severe depression," Sophie Shotter of the Illuminate Clinic tells Glamour UK. This is why it is best to visit a dermatologist to work on getting cystic acne under control before it begins to cause scars and impact your mental health.

How to treat cystic acne

Treating cystic acne varies from case to case. A dermatologist will confirm the best option for you, with a prescription often being essential. The treatment will often begin mild and increase in strength as needed.

"Topically, it's really hard to treat cystic acne," board-certified dermatologist Dr. Mona Gohara tells NBC. "Over-the-counter products may help mitigate the inflammation and bring it down a bit. But making it go away is a lot trickier, and [OTC products] will not be effective if used alone." Your doctor may also suggest a change in cleansers or a topical treatment to help fight bacteria and remove dead skin. Unfortunately, it can take up to three months to see improvement.

Cleveland Clinic notes that if hormones seem to be the cause of a woman's acne, birth control pills may be the next step to see if hormone regulation will cause improvement. Another solution is an injection to zap your zits. Cortisone shots can be injected into particularly large and painful cysts. The final treatment option doctors look to is the oral retinoid Isotretinoin (AKA Accutane).