What is cystic acne?

Acne is a very common skin condition. You might have experienced various kinds of acne that come and go. But if you have large, deep, painful red pimples that are not going away, then you might have what dermatologists call cystic acne.

Cystic acne¹ refers to large, red, and painful acne breakouts that extend deep into the skin. It is a serious type of acne that tends to occur in people with oily skin. Cystic acne may cause permanent scarring.

Cystic acne is named after the appearance of cysts², which are sacs that form in the skin and contain fluid or semisolid material. After forming, these cysts can stay under your skin for months.

You get a pimple³ when a pore in your skin gets clogged, usually with dead skin cells. Sometimes bacteria get trapped inside the pore, causing the area to become more swollen.

Cystic acne happens when this infection goes deep into your skin, creating a red, tender bump that's full of pus. It may hurt or itch. If a cyst bursts, the infection can spread, causing more breakouts. Your face, chest, back, upper arms, or shoulders are all areas that might be affected.

If you have cystic acne and hope to clear your skin, you can go to your dermatologist for medications that can help.

Nodular acne

Nodular acne is not strictly speaking the same as cystic acne, although they are often referred to as the same condition.

Nodular acne is named after the appearance of nodules⁴, which are growths of abnormal tissue. Both acne cysts and acne nodules develop under the skin. However, acne nodules are firmer and not filled with fluid. Nodules also don’t always become red—they might match your skin tone.

Like cystic acne, nodular acne is a severe, painful form of acne that can take a long time to go away.

Cystic acne causes

The cysts that form underneath your skin as a result of cystic acne can be from a combination of the P. acnes bacteria, oil, and dry skin cells that get trapped in your pores. The pore ruptures under the skin, causing the inflammation to spill out into the surrounding tissue. Your body forms a cyst around the pore to stop the inflammation from spreading.

To better understand what causes cystic acne, let’s also look at what causes acne in general.

General acne causes

Acne⁵ is a skin condition that occurs when your hair follicles become clogged with oil and dead skin cells. It often causes whiteheads, blackheads or pimples, and usually appears on the face, forehead, chest, upper back and shoulders. Acne is most common among teenagers, though it affects people of all ages.

Sebum, a natural body oil, helps to prevent skin cells from drying out. The glands that produce this oil are attached to the skin’s pores, where dead cells tend to collect.

Acne occurs when a pore becomes clogged with dead skin cells, natural body oils, and a type of bacteria.

Effective treatments are available for acne, but the pimples can be persistent. These bumps tend to heal slowly, and when one begins to go away, others seem to crop up.

Depending on its severity, acne can cause emotional distress and scar the skin. Treating the acne can lower the chances of these risks. The four main factors that cause acne are:

• Excess oil production
• Hair follicles clogged by oil and dead skin cells
• Bacteria, particularly p. acnes
• Excess activity of a type of hormone (androgens)

Acne typically appears on your face, forehead, chest, upper back and shoulders because these areas of skin have the most oil (sebaceous) glands. Hair follicles are connected to oil glands.

When a clog from oil or dead skin cells prevents a hair follicle from remaining open, the follicle wall may bulge and produce a whitehead. The plug may also be open to the skin’s surface and darken, causing a blackhead. A blackhead may look like dirt stuck in pores, but the pores are actually congested with bacteria and oil, which look brown when exposed to the air.

Pimples are raised red spots with a white center that develops when blocked hair follicles become inflamed or infected with bacteria. Blockages and inflammation that develop deep inside hair follicles produce lumps beneath the surface of your skin. Other pores in your skin, such as the openings of the sweat glands, aren't usually involved in acne.

Factors that may worsen acne

These factors can trigger or aggravate acne:

• Age: People of all ages can get acne, but it's most common in teenagers.
• Diet: Studies indicate that certain dietary factors, including dairy consumption and carbohydrate-rich foods — such as bread, bagels, and chips — may worsen acne.

Chocolate has long been suspected of making acne worse. A small study⁶ of 14 men with acne showed that eating chocolate was related to a worsening of symptoms. However, the relationship between chocolate and acne has not been proven.

• Hormones: Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more oily secretions (sebum). Hormonal changes related to pregnancy and the use of oral contraceptives can also affect sebum production.
• Polycystic ovary syndrome (PCOS): Women with PCOS, a hormonal disorder, are particularly likely to have acne. 20–40%⁷ of women with PCOS also have facial acne lesions.
• Family history: Genetics plays a role in acne. If both parents had acne, you're likely to develop it, too.
• Friction or pressure on your skin: This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.
• Some medications and vitamins: Some drugs that can trigger acne include corticosteroids, testosterone, phenytoin, lithium, or Vitamin B12.
• Stress: Stress does not cause acne but can make it worse.

Nodular acne causes

Unlike cysts (fluid-filled cavities), nodules are firm lumps. The causes of nodular acne are the same as those of cystic acne.