Why am I getting cystic acne?

What could be triggering your breakouts?

• Hormone changes can increase oiliness during puberty, menstrual periods, pregnancy and menopause. Acne can continue into adulthood.
• Family history matters, including a family history of cystic acne.
• Oily skincare, makeup and hair products can contribute to blocked pores.
• Certain medicines, including steroids and testosterone, and some hormonal contraceptives can worsen acne.
• Heavy sweating, humidity and repeated rubbing or touching can trigger acne.

Persistent, deep breakouts around the chin, jawline or lower cheeks can fit a hormonal pattern. A hormonal condition affecting the ovaries can increase androgens, hormones that drive oil production. Mention accompanying scalp hair thinning or increased facial or body hair to your clinician. Acne's appearance alone cannot diagnose an underlying hormonal condition; hormone tests or an ultrasound are sometimes needed.5

Dirty skin does not cause acne, and stress can worsen acne rather than being its sole cause. Chocolate and greasy foods are not established causes. Refined sugars and dairy might contribute in some people, but the connection remains uncertain.36

What should you do now?

Arrange a medical appointment for recurring deep, painful breakouts rather than relying on shop bought treatments alone. Cystic acne is difficult to treat and carries a risk of scarring. While waiting, use these steps to care for your skin.2

1. 1Wash gently morning and evening with a mild cleanser and lukewarm water. Use your fingers and avoid scrubbing.
2. 2Remove makeup before bed, because cosmetics do not need a night shift. Choose noncomedogenic skincare and makeup, meaning products designed not to clog pores.
3. 3For an individual deep pimple, hold a clean, warm, damp washcloth against it for 10 to 15 minutes, three times daily. Do not squeeze or pop it.
4. 4If using a topical acne treatment, follow its directions and apply a thin layer. Adapalene, azelaic acid, benzoyl peroxide and salicylic acid are options, but topical treatments work better once a pimple reaches the surface.
5. 5Protect exposed skin with broad spectrum, water resistant SPF 30 or higher sunscreen, alongside shade and protective clothing.

What treatment and timing should you expect?

Prescription treatment can include topical medicines, oral antibiotics, hormonal treatment or isotretinoin. A dermatologist can sometimes inject a large, painful cyst to help it shrink more quickly. Acne treatment can take 6 to 8 weeks to show a response; clearing cystic acne can take three months or longer.23

Topical acne medicines can cause redness, dryness and excessive peeling. Pregnancy changes treatment choices: isotretinoin causes severe birth defects, and spironolactone can harm a developing fetus. If you are pregnant or planning pregnancy, discuss treatment choices with your prescriber.35

Seek medical help for worsening acne, scarring, multiple deep painful bumps or acne affecting your mental health. Hot, swollen, red skin can signal infection; redness can be less obvious on brown and black skin.4

Why am I getting cystic acne on my back?

Cysts can develop on the back through the same clogged pore and inflammation process. Sweat, humidity and rubbing can contribute. Wash after sweating and wear loose, breathable clothing when exercising, so your workout clothes can stop applying for the role of a second skin. Deep, painful back breakouts deserve medical treatment too.234