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What Causes Cystic Acne?

Anna Denson
Written by
Anna Denson

Getting a pimple is terrible. It’s yucky, distracting, and messes with your confidence and self-esteem.

But getting cystic acne? Oh man, that’s even worse.

On top of being gross and embarrassing, cystic acne is painful. Typically the largest, deepest, and most severe form of acne, cystic acne appears as a sore lump trapped beneath your skin. This lump is actually a cyst, a cavity within your skin that has filled with pus or other fluids. (EWWW.)

A cyst can be absolutely maddening, but trust us — no amount of ill-advised squeezing or prodding will drain it. (Seriously, don’t. The thing won’t pop, you’ll just slow healing and raise your risk of scarring!)

Nope, this blemish doesn’t come to a head like normal acne. If you get an attack of cystic acne, that sucker is going to lurk under the surface and torment you with its throbbing presence for days or even weeks.

You’re left frantically googling for any kind of at-home treatment or miracle cure. Meanwhile, you think back over your recent life choices, wondering what could have caused this disaster.

Maybe you get your Columbo on, start digging deeper. You expect to find some malicious secret behind your cystic acne, some health or lifestyle problem that made your acne so dang extra.


acne causes conspiracy board


The truth is almost anti-climactic.

While doctors can’t say with complete certainty what causes cystic acne, current research points to the usual suspects. We’re talking the same factors that also cause your milder, surface-level breakouts.


Excess Oil

Judging by the blotting papers at the bottom of your purse, this is a familiar problem. And sure enough, an overabundance of skin oil (sebum) can be the root of many skin issues, cystic acne included

Sebum is the oil naturally produced by your sebaceous glands to keep your skin healthy and moisturized. In moderation, it hydrates and protects your skin, but some triggers can throw your oil production into overdrive.


  • Adolescence the dreaded teenage acne years!
  • Stress thanks to stress-induced cortisol
  • Climate and season oil tends to worsen in heat and humidity
  • Too-oily or too-drying cosmetics strike the right balance
  • Genetics sorry, you may have lost the genetic lottery
  • Hormones more info on that below!

If your skin has gone oil-crazy for any of the above reasons, it may be contributing to your acne, whether it’s a mild case or a severe cystic breakout.

Of course, sebum isn’t doing all this damage by itself. 

Meet its partner in crime...


Trapped Skin Cells

Under normal conditions, your epidermis (a.k.a. your skin) happily rejuvenates itself, sloughing off old skin cells to keep your complexion looking fresh and new. 

If you have acne-prone skin, though, those normal conditions go out the window. Those of us plagued with acne may produce four or five times the usual amount of skin cells, and our epidermis just can’t shed them fast enough. 

Remember all that excess oil? When it mixes with this traffic jam of dry old skin cells, the whole mass congeals into a dense plug, clogging up your pores. The plug blocks access to the surface of your skin and turns your pore into an anaerobic environment  an airless, oxygen-free zone.

Which makes your poor pores the perfect living space for…



In particular, bacteria called P. acnes. These guys already live inside your pores, and when you get a nice oily skin clog, it’s like ringing the dinner bell.

P. acnes bacteria multiply inside your plugged pores and feed on the combination of dead skin and sebum stuck inside. And as they consume the sebum, they produce a by-product of inflammatory fatty acids, irritating the surrounding skin.

Tada! Your pore is now inflamed, and you’re officially having an acne breakout.

The severity of your breakout — and whether it turns nasty and cystic — remains to be seen. It may all hinge on the depth of your obstruction and infection.

If your pore is plugged deep within the epidermis, this bacterial inflammation won’t even reach the surface. Cue the enclosed cysts, now playing a painful game of hide-and-seek beneath your skin.

Things may get even worse if your cyst bursts, which can spread the infection and lead to even more breakouts! (So please, please, DO. NOT. SQUEEZE IT.)


Hormonal Changes

We mentioned that adolescence is one cause of oily skin (and thus, acne). It’s not because teenagers are living on a diet of pizza and tacos, or because they are fundamentally incapable of washing their face, though those things may be true.

(Hey, what's wrong with pizza?)


author enjoys a big slice of pizza


No, that extra oil is all thanks to the dizzying cocktail of hormones that strikes during our transition from childhood to adulthood.

Hormonal changes, especially during puberty, are considered one of the main factors behind cystic acne. Particularly, high levels of androgen hormones increase our two biggest acne triggers: oil production and skin cell turnover.

Hormones may also thicken the lining of your pores and hair follicles, which can worsen blockages.

Of course, puberty isn’t the only hormonal fluctuation that can lead to cystic acne. Earlier, we put stress on blast for oil production. This comes back to increased levels of the hormone cortisol, which can kickstart a breakout.

Women may also contract cystic acne in response to pregnancy, birth control, hormone therapy, or the menstrual cycle. (Because we needed one more downside to having a period.)

And we aren’t just talking about the eternally acne-prone. These hormonal changes can cause cystic acne even in people with generally clear skin.

At this point, does it seem like just everything contributes to your cystic acne? Don’t despair. There are plenty of supposed acne-inducers which aren’t that damaging after all.


Myths, Busted

Finally, some good news! Not every skin-ruining villain you’ve heard about is actually dangerous. Some foods and behaviors just get a bad rap.

So if your personal column of “Acne Triggers to Avoid at All Costs” is getting waaay too long, here are a few things you can cross off the list.

Things which are not causing your cystic (or regular) acne:

  • Chocolate (oh thank goodness)
  • Nuts
  • Greasy foods
  • Lack of cleansing
  • Touching your face

    Cystic acne is just plain awful, but ultimately, it’s not your fault. Don’t blame yourself! You aren’t causing the breakouts, and more importantly, YOUR WORTH IS NOT DEFINED BY YOUR SKIN!

    So next time you’re feeling low because of a problem complexion, try to remember: acne or no acne, you’re awesome, and we love you!


    author making love heart with hands

    Anna Denson
    Written by
    Anna Denson
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    Anna is a Copywriter at Averr Aglow. A not-so-secret nerd, she loves books with swords and never gets tired of Alien or Jurassic Park. Also a total foodie, she has an unnecessarily large cookbook collection. When not busy writing, Anna travels the world and dotes on her two spoiled cats, Waffle and Fanta.