Cystic acne is the most severe form of acne, characterised by deep, inflamed breakouts beneath the skin’s surface. Unlike typical spots or pimples, these painful nodules develop within deeper skin layers and can persist for weeks or even months. For sufferers, the condition often leads to physical discomfort, emotional distress, and without proper treatment, permanent scarring.
At City Dermatology Clinic in London, our specialists including dermatologist Dr Andreea Anton and surgeon Dr Jana Torres-Grau provide expert diagnosis and personalised treatment plans based on the specific underlying causes of each case. Understanding what triggers cystic acne is essential for effective management and prevention of long-term skin damage.
What Is Cystic Acne?
Cystic acne develops when pores become severely blocked with a combination of dead skin cells, excess sebum (oil), and bacteria. Unlike milder forms of acne that affect mainly the skin’s surface, cystic acne forms deep within the dermis, triggering a significant inflammatory response that creates large, painful cysts beneath the skin.
These lesions appear as:
- Red, tender bumps beneath the skin
- Swollen, painful nodules that may feel firm to touch
- Lesions that can be larger than 5mm in diameter
- Persistent spots that may not come to a visible head
While mild acne might respond to over-the-counter treatments, cystic acne typically requires professional medical care. The deep-seated nature of these lesions means that conventional acne products rarely penetrate deeply enough to effectively address the underlying inflammation.
The condition most commonly appears on the face, but can also affect the neck, chest, back, and shoulders. For many patients, the severity and visibility of cystic acne can significantly impact self-confidence and quality of life.
Main Causes of Cystic Acne
Understanding the root causes of cystic acne is crucial for effective treatment. Most cases develop due to a combination of several key factors:
Hormonal Fluctuations
Hormonal changes represent one of the primary triggers for cystic acne development. These fluctuations can occur during:
| Life Stage/Condition | Hormonal Impact |
|---|---|
| Puberty | Increased androgen production stimulates sebaceous glands |
| Menstrual cycles | Cyclical hormone changes affect oil production |
| Pregnancy | Dramatic hormonal shifts can trigger breakouts |
| Polycystic Ovary Syndrome (PCOS) | Elevated androgens lead to increased sebum production |
| Menopause | Hormonal imbalances during this transition can affect skin |
Androgens – male hormones present in both men and women – stimulate the sebaceous glands to produce excess sebum. This overproduction, combined with dead skin cells, can block pores and create the perfect environment for inflammatory acne.
Hormonal cystic acne typically presents a distinctive pattern, often appearing along the jawline, chin, and lower face. This distribution pattern helps dermatologists identify hormone-related triggers and tailor treatment accordingly.
Genetic Factors
Genetic predisposition plays a significant role in determining who develops cystic acne. Several inherited factors can increase susceptibility:
- Family history of severe acne increases personal risk
- Genetics influence sebum production levels
- Inherited differences in skin cell turnover rates
- Genetic variations in inflammatory response mechanisms
- Hereditary factors affecting hormone sensitivity
If your parents or siblings experienced severe acne, you may have an increased likelihood of developing similar conditions. Genetic factors can influence not only the development of cystic acne but also how well you respond to different treatments.
Bacterial Proliferation and Inflammation
The bacterium Cutibacterium acnes (formerly Propionibacterium acnes) naturally resides on skin but can contribute to severe acne when trapped in blocked pores. In the oxygen-deprived environment of a clogged follicle, these bacteria multiply rapidly, triggering an intense inflammatory response.
This inflammation creates the characteristic painful, red swelling associated with cystic lesions. The body’s attempt to fight the bacterial overgrowth leads to increased blood flow and white blood cell activity in the area, resulting in the formation of pus within the cyst.
Environmental and Lifestyle Factors
Several external factors can exacerbate or trigger cystic acne flares:
Stress and Cortisol
Psychological stress increases cortisol production, which can stimulate sebaceous glands and worsen inflammation. Many patients report breakouts during periods of heightened stress or anxiety.
Dietary Influences
While diet affects each individual differently, research suggests that certain foods may trigger or worsen acne in susceptible individuals:
- High-glycaemic foods (white bread, sugary drinks, processed snacks)
- Dairy products, particularly milk
- Foods high in saturated fats
Skincare and Cosmetics
Products containing heavy oils, occlusive ingredients, or irritants can block pores and worsen existing acne. Look for non-comedogenic formulations specifically designed for acne-prone skin.
Environmental Pollutants
Urban pollution, high humidity, and exposure to certain industrial chemicals can compromise skin barrier function and increase inflammation.
Managing and Treating Cystic Acne
Effective management of cystic acne requires a comprehensive approach tailored to the specific causes and severity of each case. At City Dermatology Clinic, we develop personalised treatment plans addressing both the immediate symptoms and underlying triggers.
Medical Treatments
Professional medical treatments form the cornerstone of cystic acne management:
Prescription Medications
- Oral antibiotics (tetracyclines, macrolides) reduce bacterial proliferation and inflammation
- Topical retinoids prevent pore blockage and facilitate skin cell turnover
- Hormonal therapies such as combined oral contraceptives or anti-androgens for hormone-related acne
- Isotretinoin (formerly known as Accutane) – a potent oral retinoid reserved for severe, treatment-resistant cases
In-Clinic Procedures
- Corticosteroid injections rapidly reduce inflammation in large, painful cysts
- Incision and drainage may be performed for particularly large lesions
- Chemical peels containing salicylic acid or glycolic acid can help prevent new lesions
- Advanced light therapies target bacteria and reduce oil production
Supportive Skincare Recommendations
While professional treatments address the root causes, a gentle, consistent skincare routine supports healing and prevents new breakouts:
- Cleanse twice daily with a gentle, pH-balanced cleanser to remove excess oil without stripping the skin barrier
- Treat with prescribed medications as directed by your dermatologist
- Hydrate with non-comedogenic, oil-free moisturisers to maintain barrier function
- Protect skin with broad-spectrum SPF 30+ sunscreen daily (many acne treatments increase sun sensitivity)
Avoid harsh physical scrubs, alcohol-based toners, and occlusive oils that can worsen inflammation or block pores.
Lifestyle Considerations
Addressing lifestyle factors can support medical treatments and improve outcomes:
Stress Management
Regular exercise, adequate sleep, and relaxation techniques like meditation may help reduce stress-triggered breakouts.
Dietary Adjustments
While evidence varies, some patients benefit from reducing high-glycaemic foods and dairy products. A food diary can help identify personal triggers.
Environmental Awareness
Wash your face after heavy sweating or exposure to polluted environments. Choose breathable fabrics for clothing that contacts affected areas.
When to Seek Professional Help
Early intervention by a qualified dermatologist significantly improves outcomes for cystic acne. Consult a specialist if you experience:
- Deep, painful acne lesions that don’t respond to over-the-counter treatments
- Widespread or persistent breakouts lasting more than a few weeks
- Acne that causes significant emotional distress
- Early signs of scarring or post-inflammatory hyperpigmentation
At City Dermatology Clinic, our experienced dermatologists like Dr Andreea Anton provide comprehensive assessments to identify the specific causes of your cystic acne and develop a personalised treatment plan. With the right approach, even severe cystic acne can be effectively managed, reducing both physical symptoms and emotional impact.
Don’t allow cystic acne to affect your confidence or leave permanent marks on your skin. Contact our clinic today to schedule a consultation and take the first step toward clearer, healthier skin.
References
- Barbieri JS, et al. “The influence of androgens on the development and treatment of acne.” Journal of the American Academy of Dermatology. 2020;82(2):320-329.
- Dreno B, et al. “Expert consensus on the management of acne: focus on specific patient populations.” Journal of the European Academy of Dermatology and Venereology. 2021;35(4):860-866.
- Elsaie ML. “Hormonal treatment of acne vulgaris: an update.” Clinical, Cosmetic and Investigational Dermatology. 2021;9:241-248.
- Harper JC. “Acne vulgaris: What’s new in our 40-year understanding.” Journal of the American Academy of Dermatology. 2020;82(2):526-527.
- Kanwar IL, et al. “Microbiome in acne: role, pathways and implications.” British Journal of Dermatology. 2022;186(4):601-610.
- Tanghetti EA. “The role of inflammation in the pathology of acne.” Journal of Clinical and Aesthetic Dermatology. 2021;14(10):17-23.
- Walsh TR, et al. “Systematic review of genetic epidemiology studies in acne vulgaris.” British Journal of Dermatology. 2020;184(1):1-8.
- Zaenglein AL, et al. “Guidelines of care for the management of acne vulgaris.” Journal of the American Academy of Dermatology. 2022;87(1):61-70.
