Is cystic acne hormonal?

How do hormones cause deep breakouts?

Androgens, a group of hormones that includes testosterone, stimulate your skin's oil glands. Oil, dead skin cells and bacteria can build up inside a pore. When the resulting inflammation extends deep into the skin, a cyst or nodule develops. Sensitivity to androgens can contribute to acne, too, so hormone levels are not the whole explanation.123

A cyst contains pus and feels softer than a nodule. A nodule is a firmer lump under the skin, and some people have both. Both can hurt and leave permanent scars, which makes early treatment more useful than waiting for a deep lump to disappear.134

What makes a hormonal link more likely?

Breakouts that recur around your period are a useful clue. Hormonal changes during puberty, pregnancy and menopause, or after starting or stopping birth control pills, can also trigger acne. Adult hormonal acne often appears on the chin and jawline, but it can affect other parts of the face, chest, shoulders and back.1567

Tell your doctor if persistent deep breakouts come with irregular periods or increased facial or body hair. An underlying ovarian hormone condition can produce this combination. Skin appearance alone cannot confirm or rule out such a condition; an assessment can include hormone tests or an ultrasound. A bathroom shelf cannot check hormone levels, even if its contents are arranged like a laboratory.27

Family history, stress, greasy hair or skincare products and some medicines also contribute to acne. Mention recent prescription changes, testosterone treatment or stopping birth control at your appointment. If you suspect a prescribed medicine is making acne worse, keep taking it and speak with the prescriber rather than stopping it yourself.57

Does hormonal cystic acne need different treatment?

Treatment depends on severity as well as the hormonal link. Certain birth control pills and spironolactone can help hormonal acne, but not every birth control pill has this effect. Topical treatments can still help even when hormones contribute. A dermatologist can combine treatments rather than choosing between treating hormones and treating the skin.27

Deep, firm nodules need medical treatment; shop bought acne creams are not enough for nodular acne. Prescription options include topical medicines, oral antibiotics and isotretinoin. A dermatologist can also inject an extremely painful cyst or nodule with medication to reduce pain and help it clear faster. Nodules can last weeks or months, and treatment can require different combinations.34

Tell your prescriber if you are pregnant or planning pregnancy before choosing treatment. Spironolactone must not be used during pregnancy because it can harm a developing fetus. Benzoyl peroxide and salicylic acid are generally considered safe during pregnancy and can help mild to moderate acne; they are not substitutes for assessment of deep, painful breakouts.2

What should you do while waiting for an appointment?

• Wash gently morning and night, and after sweating. Do not scrub.
• Remove makeup at the end of the day.
• Choose skincare, sunscreen and hair products labelled non comedogenic or "won't clog pores".
• Do not pick, squeeze or try to pop deep lumps because this increases the risk of scarring.

Skincare packaging offers plenty of vocabulary, but "won't clog pores" is the part worth reading.5

Book a GP or dermatologist appointment for deep, painful spots, scarring or acne that is not improving. Also seek medical help for hot, swollen, red skin or if acne is affecting your mental health. Redness can be harder to see on brown and black skin.6