What Causes Cystic Acne?

January 23, 2026 7:04 pm

Cystic acne is one of the most severe and frustrating types of acne. Unlike small pimples that appear on the surface of the skin, cystic acne forms deep beneath the skin and often causes pain, swelling, and long lasting marks. Many people who experience cystic acne try multiple treatments without fully understanding why these breakouts occur in the first place.

Knowing what causes cystic acne is an important step toward managing it effectively. While no single factor is responsible, cystic acne usually develops due to a combination of hormonal changes, excess oil production, bacteria, clogged pores, genetics, and lifestyle factors. This article explains each of these causes in detail and helps you understand how they work together to trigger deep and persistent breakouts.

Understanding Cystic Acne

Cystic acne is a severe form of inflammatory acne. It develops when pores become deeply clogged and inflamed, leading to the formation of large, painful cysts or nodules. These lesions are filled with fluid or pus and are surrounded by swelling and redness.

Unlike whiteheads or blackheads, cystic acne does not stay near the surface of the skin. It forms in the deeper layers, which is why it takes longer to heal and often leaves scars. The depth and intensity of inflammation make cystic acne more difficult to treat than mild or moderate acne.

Hormonal Imbalances

Hormonal changes are one of the main causes of cystic acne. Hormones called androgens increase oil production in the skin. When androgen levels rise, the oil glands become more active and produce more sebum.

Hormonal fluctuations commonly occur during:

• Puberty
• Menstrual cycles
• Pregnancy
• Menopause
• Polycystic ovary syndrome
• Use or discontinuation of hormonal birth control

During these periods, increased oil production makes pores more likely to become clogged. When this happens deep within the skin, cystic acne can develop.

Excess Oil Production

Sebum is the natural oil produced by the skin to keep it moisturized and protected. While sebum is necessary for healthy skin, too much oil can create problems.

When oil production increases, it mixes with dead skin cells and blocks hair follicles. These clogged pores trap bacteria and create an environment where inflammation can grow. In cystic acne, this process happens deep in the skin, leading to larger and more painful lesions.

People with oily skin types are often more prone to cystic acne, especially when combined with hormonal changes or genetic factors.

Clogged Pores and Dead Skin Cells

The skin naturally sheds dead skin cells every day. When this process does not happen properly, dead cells can build up and block pores.

Blocked pores prevent oil from flowing out normally. Instead, oil becomes trapped beneath the skin’s surface. When this trapped oil combines with bacteria, it creates inflammation that can lead to cyst formation.

Using heavy skincare products, wearing makeup that clogs pores, or failing to remove makeup properly can increase the risk of pore blockage.

Bacteria Growth

A type of bacteria called Cutibacterium acnes lives naturally on the skin. In healthy conditions, it does not cause problems. However, when pores become clogged and filled with oil, this bacteria can multiply rapidly.

The immune system responds by sending white blood cells to fight the infection. This response causes redness, swelling, and pain. In cystic acne, the inflammation spreads deeper into the skin, resulting in large and painful cysts.

Genetics and Family History

Genetics play an important role in the development of cystic acne. If your parents or close family members experienced severe acne, you may be more likely to develop it as well.

Genetic factors influence:

• Oil production levels
• Skin cell turnover rate
• Hormonal sensitivity
• Inflammatory response

These inherited traits can make some people more prone to deep and persistent acne, even when they follow good skincare habits.

Stress and Its Impact on Skin

Stress does not directly cause cystic acne, but it can make existing acne worse. When the body is under stress, it releases cortisol and other hormones that stimulate oil production.

Increased oil production can clog pores and increase inflammation. Stress also weakens the skin’s ability to heal, which can prolong breakouts and increase the risk of scarring.

Chronic stress can also disrupt sleep and immune function, both of which play a role in skin health.

Diet and Nutrition Factors

Diet alone does not cause cystic acne, but certain foods may trigger or worsen breakouts in some individuals.

High glycemic foods such as sugary snacks, white bread, and processed foods can cause spikes in blood sugar and insulin levels. These spikes may increase oil production and inflammation.

Some people also notice that dairy products, especially skim milk, can worsen acne. This may be related to hormones present in milk that affect the body’s own hormone levels.

Eating a balanced diet with fruits, vegetables, whole grains, and healthy fats supports overall skin health and may reduce inflammation.

Poor Skincare Habits

Improper skincare routines can contribute to cystic acne development.

Common mistakes include:

• Overwashing the face
• Using harsh scrubs or exfoliants
• Applying heavy or greasy products
• Sleeping with makeup on
• Touching or picking at the skin

These habits can irritate the skin, disrupt the protective barrier, and increase inflammation. They can also push bacteria deeper into pores, making cystic acne worse.

Use of Certain Medications

Some medications can increase the risk of cystic acne by affecting hormone levels or oil production.

These include:

• Steroids
• Certain birth control methods
• Testosterone therapy
• Lithium
• Some antidepressants

If acne develops after starting a new medication, it is important to speak with a healthcare provider about possible alternatives.

Environmental Factors

Environmental conditions can also influence cystic acne.

High humidity and heat increase sweating and oil production. Sweat mixed with dirt and bacteria can clog pores if not removed properly.

Pollution exposes the skin to particles that can settle into pores and increase inflammation. Wearing tight clothing or protective gear that traps sweat against the skin can also lead to breakouts on the chest, back, and shoulders.

Smoking and Lifestyle Choices

Smoking has been linked to increased inflammation and reduced blood flow to the skin. This can slow healing and make acne more difficult to manage.

Lack of sleep also affects hormone balance and immune function. Poor sleep can worsen inflammation and increase stress hormones, both of which contribute to cystic acne.

Regular exercise, proper hydration, and healthy daily habits support overall skin health.

Hormonal Conditions Linked to Cystic Acne

Certain medical conditions increase the risk of cystic acne.

Polycystic Ovary Syndrome

This condition causes hormonal imbalances that increase androgen levels. Higher androgen levels lead to excess oil production and persistent acne, especially around the jawline and chin.

Thyroid Disorders

Hormonal imbalances related to thyroid problems may also affect skin health and oil production.

Insulin Resistance

Insulin resistance can increase inflammation and oil production, contributing to acne development.

The Role of Inflammation

Inflammation is a key factor in cystic acne. When the immune system reacts strongly to bacteria or blocked pores, it causes swelling and tissue damage.

In cystic acne, inflammation extends deep into the skin. This is why cysts are painful and slow to heal. Controlling inflammation is an important part of treatment and prevention.

 

Why Cystic Acne Often Returns

Many people experience recurring cystic acne even after treatment. This happens because the underlying causes such as hormones, genetics, or lifestyle factors may still be present.

Without long term management, pores may continue to become clogged and inflamed. Consistent skincare, medical treatment, and healthy habits are needed to reduce recurrence.

When Cystic Acne Usually Appears

Cystic acne can occur at different stages of life.

Teenagers often develop cystic acne due to hormonal changes during puberty. Adults may experience it later due to stress, hormonal shifts, or underlying medical conditions.

Women may notice flare ups around their menstrual cycle or during pregnancy. Men may experience cystic acne related to high testosterone levels.

The Emotional Impact of Cystic Acne

Cystic acne can affect self confidence and mental health. Many people feel embarrassed, frustrated, or anxious about their appearance.

This emotional stress can create a cycle where stress worsens acne, and acne increases stress. Addressing both physical and emotional aspects is important for long term management.

Preventing Cystic Acne Triggers

While cystic acne cannot always be prevented, reducing triggers can help minimize flare ups.

Helpful strategies include:

• Using gentle skincare products
• Avoiding pore clogging cosmetics
• Managing stress levels
• Eating a balanced diet
• Getting enough sleep
• Avoiding smoking
• Washing sweat off the skin after exercise

These steps support healthier skin and reduce inflammation.

When to Seek Professional Help

Cystic acne often requires medical treatment. Over the counter products may not be strong enough to treat deep inflammation.

You should seek professional help if:

• Acne is painful or severe
• Breakouts leave scars
• Acne does not improve with basic skincare
• Emotional distress is present

A dermatologist can recommend prescription treatments that target the root causes of cystic acne.

Conclusion

Cystic acne is caused by a combination of hormonal changes, excess oil production, bacteria, clogged pores, genetics, and lifestyle factors. Because many causes work together, treatment often requires a comprehensive approach.

Understanding what triggers cystic acne helps you make better choices about skincare, lifestyle habits, and medical treatment. With proper care and consistency, it is possible to manage cystic acne and reduce future flare ups.