We’ve all been there: You go to bed with clear skin and wake up with painful, pus-filled spots around your chin and mouth. What happened? A case of cystic acne.
If you’re struggling with a sudden cystic acne breakout, first know that you’re not alone. Though acne is most common in teens, the American Academy of Dermatology Association (AAD) says adult acne affects up to 15 percent of women. So, what triggers sudden cystic acne? And what can you do about it?
Below, two medical experts unpack the top three causes of cystic acne and how to get it under control.
3 common causes of cystic acne
The first step to treating cystic acne is pinpointing what’s causing it in the first place. According to Arash Akhavan, MD, FAAD, a board-certified dermatologist in Manhattan, the most common sudden cystic acne are hormonal changes, stress, and certain medications.
Hormonal fluctuations
“Top causes of cystic acne are hormonal fluctuations, especially during puberty, menstruation, pregnancy, or conditions like polycystic ovary syndrome,” says Raj Singh, a double-board certified MD and the medical director of RAREV Medical Spa in Las Vegas.
Dr. Akhavan explains that when androgen hormones such as testosterone rise, your skin’s oil glands enlarge and produce more oil. “The sebum also tends to be thicker,” adds Dr. Singh. The result? A high chance of clogged pores and inflammation, which can lead to the telltale deep, painful pimples of cystic acne.
Stress
“When we are stressed, a part of our brain called the hypothalamus initiates a series of signals throughout the body that leads to increased production of the stress hormone cortisol in the adrenal glands,” explains Dr. Akhavan.
He says this cortisol surge can cause cystic acne in a few ways:
According to studies, approximately 50% of women in their 20s, 33% of women in their 30s, and 25% of women in their 40s suffer from acne.
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Cortisol increases oil production in the skin.
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Cortisol decreases the skin’s immune activity, leading to an increase in bacteria that may trigger or worsen acne.
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High cortisol can lead to overeating, and the AAD suggests that eating high quantities of sugary, processed foods may increase breakouts.
Medications
If you suddenly get cystic acne after starting a new prescription, your medication might be to blame.
Medications linked to drug-induced acne include:
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Oral corticosteroids. “One of the biggest causes is oral steroids such as prednisone,” says Dr. Akhavan. “These medications mimic our bodies’ stress hormone, cortisol.” And remember, cortisol contributes to cystic acne in several ways.
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Lithium. This common bipolar disorder treatment is another frequent cause of cystic acne, says Dr. Akhavan. “It is believed that lithium somehow increases both clogging and inflammation in pores.”
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Progestin-only birth control pills. This type of birth control pill can increase acne-triggering androgens. The good news is that estrogen-progestin birth control can help control acne. If you think your sudden cystic acne is caused by your birth control, talk to your gynecologist about switching to a different type of pill.
What are the best treatments for cystic acne?
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Topicals. Prescription retinoid gels and creams are common and effective treatments for cystic acne. Over-the-counter spot treatments and pimple patches can also help bring deep cysts to a head. Just resist the urge to pick at and squeeze your pimples!
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Medications. Some cystic acne cases require treatment with oral antibiotics or isotretinoin (formerly sold under the brand name Accutane). In other cases, says Dr. Singh, anti-androgen medications like spironolactone are more effective.
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Other treatments: Research suggests that light therapy, chemical peels, in-office drainage and extraction, and steroid injections are all effective treatments for cystic acne.
When to see a doctor
Some cystic acne can be managed with over-the-counter spot treatments, gentle cleansers, and moisturizers. But if your breakouts aren’t improving with topical treatments and a little TLC, it’s a good idea to make an appointment with a healthcare professional.
Consult a gynecologist if your sudden cystic acne is accompanied by other signs of hormone imbalance, such as excessive hair growth, sudden weight gain, or male-pattern baldness (hair loss around the temples and crown). Make an appointment to see a dermatologist if cystic acne is your only new symptom.
In all cases, your skin loves a healthy, balanced diet low in added sugars. And as much as it’s in your power, try to minimize stress at work and home.
Cystic acne FAQs
How long will it take for my cystic acne to clear up?
Cystic acne takes time to heal. “With aggressive treatment, [it] can take up to 2-3 months to resolve,” says Dr. Singh.
How do you stop cystic acne from forming?
Unfortunately, it’s not always possible to prevent cystic acne at home, especially if it is caused by hormonal fluctuations.
To lower your risk of future cystic acne breakouts, Cleveland Clinic recommends washing your face in the morning and evening with a mild foaming cleanser and warm (not hot!) water, then applying oil-free, water-based moisturizer and makeup. The goal is to keep your face clean and hydrated with non-comedogenic skincare products.
Is cystic acne hormonal or bacterial?
Cystic acne can be both hormonal and bacterial. If you can time your breakouts according to your cycle, you’re likely dealing with hormone-related acne. However, hormonal acne can be exacerbated by bacteria from touching your face or scrubbing too hard with an exfoliating face wash.
Leandra Beabout is an American freelance writer based in Japan. She writes approachable, science-backed content for health brands like Saatva, Singlecare, and Rescripted. She is also a travel and hospitality journalist whose work has been published in Business Traveler, Reader's Digest, Lonely Planet, and more.
