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Let’s be honest, all acne is absolutely terrible to deal with, but if you’ve ever had cystic acne, you know it’s its own kind of terrible. And if you’ve never had cystic acne? Well, consider yourself very lucky. Many people struggle with the painful breakouts and have trouble treating it. That’s why it’s super important to look at what causes cystic acne and figure out why you could be getting it.
Surprisingly, making a few simple skincare routine and lifestyle changes can have a huge impact on cystic acne!
I personally struggled with cystic acne for years. It got so bad that I almost had to go on Accutane. Luckily, I had a great dermatologist who let me try everything else possible before taking that leap. And here I am now, cystic acne free, and have the best skin of my life!
So, I’m here to help you figure out what causes cystic acne and how you can treat it and get clear skin, too.
What Is Cystic Acne?
Cystic acne is the most severe form of acne that can often lead to post-inflammatory hyperpigmentation, acne scars, and even indented scars that can be permanent. These breakouts are large, painful, red and often times very swollen and tender to the touch.
Cystic acne tends to also be under the skin, whereas other types of acne are on the surface. It also comes along with a lot of inflammation, and therefore, most spots take a very long time to heal completely.
Personally, I’ve had cystic breakouts that take months to heal. No I’m not kidding!
Cystic acne also usually does not respond to typical acne treatments, and needs more powerful products to fight it.
You can also get cystic acne all over your body. Other common places include your back, shoulders, chest and arms.
What Causes Cystic Acne?
Unfortunately, cystic acne causes can vary from person to person, so it can be hard to pinpoint exactly what is causing your acne. That’s why understanding what causes cystic acne is so important. When you know the common causes, you can look at your routine and lifestyle and make appropriate changes as needed.
However, the usual causes of acne do come into play here as well. Excess oil production, bacteria and clogged pores all contribute to acne and cystic acne.
So, let’s jump right in and learn all about what causes cystic acne!
Certain bacteria are naturally found on your skin is a big culprit for acne. Specifically, the acne causing bacteria, Propionibacterium acnes. The bacteria found on your skin naturally make up your skin’s microbiome and actually keeps your skin healthy and helps defend your body from pathogens.
Bacteria can become an issue when your microbiome is disrupted and when bacteria gets trapped in your pores.
The bacteria on your skin live in a delicate balance, and when this balance gets interrupted, it can cause the bad bacteria, like Propionibacterium acnes, to flourish. When this happens, that means there is more Propionibacterium acnes on your skin and can lead to acne.
When bacteria get trapped inside your pores, the bacteria will multiply inside your pores leading to inflammation and acne.
Your pores can become clogged from dirt, bacteria, oil, skin care products and so much more. When your pores get clogged, it can cause blackheads, acne and cystic acne.
Some oil production is good, believe it or not. Your skin naturally produces oils that protect your skin and keep it hydrated. However, many people have oily skin, which means that your skin is producing too much oil. When this happens, the oils can get trapped in your pores, and when mixed with bacteria and dirt, acne forms.
Hormones are a major cause of cystic acne, and unfortunately can make it tricky to treat. If you have cystic acne and it seems to be tied to hormones, then you have what’s called hormonal cystic acne. Luckily, not all cystic acne is cause by hormones.
Certain hormone fluctuations and imbalances can cause cystic acne, such as:
- polycystic ovarian syndrome
- increased androgen levels
How to tell if you have hormonal acne:
- acne on the lower half of your face (chin, cheeks, jaw and neck)
- fluctuations in acne (it get worse certain days of the month)
- skincare treatments don’t seem to help
If these apply to you, you could have hormonal acne. If you’re not sure, try a skin log where you track your skin each day. Write down how many new breakouts you get, how your skin feels, etc. for a few months and see if you can find a correlation.
If anyone wants a separate post on hormonal acne, let me know! I dealt with hormonal cystic acne for years and would love to help others who are struggling as well.
Many people don’t think that acne can be a side affect of routine medications, but unfortunately, a lot of times medications can make acne so much worse.
Now, there’s a ton of medications that can potentially cause acne, so I’m not going to list them all. However, I do want to make you aware of the common ones.
Common medications that can cause acne:
- Certain birth control
- B Vitamins
If you are taking any of these drugs and think they may be causing your acne, it’s important to talk to your doctor before stopping or switching! Oftentimes there are other equivalent drugs you can try without the side effects.
When we are stressed, certain hormones get released in our body to help our body respond and cope. These hormones trigger inflammation in our bodies, which can lead to acne.
Certain hormones can even increase our skin’s oil production!
Additionally, when we are stressed, we tend to not eat as healthy and not take care of ourselves like we usually do. When I’m stressed, I tend to crave really unhealthy foods and don’t follow my skincare routine as I should.
All of these things combined and exacerbate acne.
Read my post on how stress affects your whole body and how to manage stress better!
Certain Skincare Products
The health of your skin is really dependent on what skincare products you use on it. However, that doesn’t mean you need to have a 20 step skincare product that costs $800 each month.
It really comes down to listing to your skin and using better formulated products for your skin type. Skincare is so individual that it’s hard to make recommendations for everyone.
Certain ingredients may clog your pores or cause a reaction just because your skin happens to not like that particular ingredient. Yet, other people can use it without any problems.
For example, my skin hates sunflower seed oil. I used it for a few days and got a cyst right under my eye! Yet there are thousands of people out there who can use it with no issues.
Check out my post on skincare rules to make sure your routine is perfect!
What Doesn’t Cause Cystic Acne?
Unfortunately, there are a lot of myths and confusion out there about what causes cystic acne and what doesn’t. So, I wanted to clear up some confusion about certain things that do not have a proven correlation to acne.
Things that don’t cause acne:
- greasy foods
- not washing face often enough
Now, it’s true that eating healthy is good for your body and your skin, but having pizza for dinner tonight is not going to make your face breakout.
How To Treat It
Now that we’ve looked at all the causes of cystic acne, let’s talk about wha to do about it. Unfortunately, cystic acne can be hard to treat, which is why it’s so important to take a hard look at your lifestyle and skincare routine to see if you can make any changes. Many times all it takes is a few tweaks and you can see improvement in no time.
However, that’s not always the case!
For me, I had to go to a dermatologist to finally get some relief. And I’m so glad I did! Finally getting to a doctor made all the difference and I finally was able to get clear skin – something I had dreamed of for so long.
Below, I’m going to talk about the most effective cystic acne treatments, most of which I’ve tried myself.
Topical or oral antibiotics are very commonly prescribed for any type of acne, not just cystic acne. They work by killing acne causing bacteria, which will prevent new breakouts.
Antibiotics for acne typically take a few weeks (at least 4 weeks) to see a difference. As with any type of acne treatment, the results aren’t instant, so be patient.
Retinoids are a form a vitamin a, which helps shed dead skin cells so they don’t get trapped in your pores. The most effective retinoids are prescription only, or you can get them through places like Curology and Apostrophe. Differin, which used to be prescription only, is now available over the counter.
Check out my post on retinoids if you want to get started with using them.
If you have hormonal acne, chances are your doctor will prescribe you birth control to treat it. And if you’re already on it, your birth control could actually be the culprit! Make sure to talk with your doctor to see if yours could be causing your cystic acne.
There are also some birth controls that are FDA approved to treat acne, so consider asking your doctor about switching to one of those.
Spironolactone has become very popular in recent years for the treatment of hormonal acne. It’s is a diuretic and used to treat high blood pressure, but it’s off-label use for acne has shown great results in the treatment of hormonal and cystic acne.
So, how does it help acne?
Spironolactone blocks the male hormones (androgens) in your body and prevents them from causing acne.
Benzoyl peroxide has been around for years, and there’s a reason why it’s a staple in many skincare routines! It kills bad bacteria fast and helps with inflammation that comes along with acne.
In my opinion, sulfur does not get enough love. Like, benzoyl peroxide, sulfur kills bacteria and helps with inflammation. Sulfur can also help absorb excess oil, so it’s a great choice for those with oily skin.
I personally find that sulfur is less drying/irritating than benzoyl peroxide and works better for me.
In short, Isotretinoin is an oral form of vitamin a that can kill bacteria, shrinks the sebaceous glands on your skin and stops oil production.
Isotretinoin (Accutane) is only for those with severe acne that does not respond to other treatments. It’s an extremely serious drug that comes along with tons of side effects and precautions.
However, it can work amazingly well. I know people that have taken Accutane and it transformed their skin, not only in terms of acne, but pore size and oiliness as well.
Most dermatologists offer what’s called a cortisone injection. Essentially, it’s a steroid that’s injected right into a cyst to reduce the inflammation and speed up healing.
I’ve personally never had this done, but it can shrink a cyst in just a day or two- much better than weeks!
Cystic acne can be a huge pain – literally! I personally struggled with cystic hormonal acne for over 10 years. The first thing I did was research what causes cystic acne and I found that many of the items on this list applied to me. Once I changed a few things, my acne got much better.
Although my acne improved, my skin just wasn’t getting clear. Luckily, there are great treatment options out there and all it takes is finding what works best for you and your skin. With the help of my dermatologist, I was able to get clear skin.
With this list of cystic acne causes, you’ll be able to pinpoint any factors in your routine or lifestyle that could be causing your acne.