What Triggers Cystic Acne?


Cystic acne can be a frustrating skin condition. Those deep, painful pimples seem to come out of nowhere and are notoriously difficult to get rid of. Understanding what causes cystic acne is key to both treating it and preventing future breakouts.

What Triggers Cystic Acne

What Is Cystic Acne?

Before diving into what triggers cystic acne, let's first go over what exactly cystic acne is.

Cystic acne consists of large, red, painful breakouts that occur deep within the skin. These pimples are much bigger and more severe than your typical whitehead.

Instead of staying on the surface of the skin, cystic pimples form further below in the dermis skin layer. The inflammation and rupture of cysts deep within the skin cause painful pus-filled lumps to form.

Cystic acne is considered more severe than other forms of acne due to how deep the breakouts are and the scarring they can leave behind.

What Causes Cystic Acne?

Now that you know what cystic acne is, what actually triggers those painful underground pimples? Here are some of the most common causes:

Hormonal Imbalances

Fluctuations in hormones are a leading trigger for cystic acne breakouts.

Hormones like androgens can overstimulate oil glands and hair follicles in your skin, leading to excess sebum production. This oily environment clogs pores and allows acne-causing bacteria to thrive.


Like many skin conditions, genetics play a role in cystic acne. You are more likely to deal with severe breakouts if you have a family history of cystic acne.

Genetics can make you prone to producing excess androgens or make you more sensitive to normal fluctuations in hormones like testosterone.

High Stress Levels

High stress levels cause increased production of cortisol and other hormones that stimulate oil glands. This can lead to excessive sebum production, clogged pores, and more cystic acne.

Stress also impairs wound healing. This can cause cystic pimples to linger longer rather than healing up quickly.


Certain medications are known to trigger breakouts, including cystic acne. Medications with hormones like birth control pills or hormone replacements can lead to acne flares.

Steroids and lithium are other prescription medications that list acne as a common side effect.

Chronic Inflammation

Inflammation is at the root of cystic acne. Chronic inflammation in the body can therefore make you more prone to severe breakouts.

Conditions like PCOS, IBD, and autoimmune disorders cause higher baseline inflammation. This ultimately sets the stage for inflammatory cystic pimples.

Diet and Lifestyle Triggers

In addition to internal factors like hormones and genetics, certain lifestyle factors can also trigger cystic acne for some people. Let's look at some potential acne-causing lifestyle factors.

High Glycemic Diet

There is evidence that following a high glycemic diet heavy in refined carbs and sugar can worsen acne.

Foods with a high glycemic index cause quicker spikes in blood sugar. This leads to higher insulin levels which can stimulate increased androgen production.

These hormonal effects of high glycemic foods may trigger breakouts. Some foods to be mindful of include sugary sodas, fruit juices, desserts, white bread, and processed snacks.

Dairy Consumption

Research is still ongoing, but some studies have linked milk and dairy consumption to increased acne prevalence.

Experts hypothesize that the hormones naturally found in milk products may overstimulate oil glands. The lactose sugar in dairy may also play a role.

If you suspect dairy triggers your cystic pimples, try eliminating it for a month to see if your skin improves.

Not Enough Sleep

Chronic sleep deprivation can throw hormones out of balance. Lack of sleep decreases testosterone while increasing cortisol production.

Without enough sleep, your skin also doesn’t have time to renew itself. This can lead to clogged pores and more severe inflammatory breakouts.

Aim for 7-9 hours of sleep per night. This gives your body time to regulate hormones and repair skin tissue.

Smoking Cigarettes

Smoking tobacco is conclusively linked to an increase in acne severity. The exact mechanisms are unknown, but likely relate to the pro-inflammatory nature of cigarette smoke.

If you currently smoke, work on a plan to quit. This will likely help improve your cystic acne along with your overall health.

Face Touching and Picking

Excessive touching and picking at your face delivers bacteria to pores while also injuring delicate skin tissue. This one-two punch of bacteria and inflammation can definitely trigger new breakouts.

Make an effort to keep your hands away from your face throughout the day. Be mindful of any skin picking habits as well.

Common Cystic Acne Triggers To Recap:

  • Hormonal fluctuations
  • Genetics
  • High stress
  • Certain medications
  • Chronic inflammation
  • High glycemic diet
  • Dairy consumption
  • Inadequate sleep
  • Smoking
  • Face picking

Tips for Preventing Cystic Acne Breakouts

Now that you know what usually causes cystic acne, here are some tips for preventing those painful bumps:

1. Balance your hormones.

Work on balancing out hormones like androgens and insulin that can overstimulate oil glands.

Strategies include managing stress, getting enough sleep, avoiding inflammation, and eating a low glycemic diet.

2. Avoid acne triggers.

Pay attention to your personal cystic acne triggers and try to avoid them. This may mean skipping dairy, cutting out smoking, or switching medications.

3. Cleanse gently.

Harsh face scrubs and excessive cleansing disrupt skin’s protective barrier. This leads to irritation that can worsen acne.

Gently cleanse skin just twice a day with a non-abrasive cleanser. Avoid scrubbing or picking.

4. Use acne-fighting ingredients.

Ingredients like salicylic acid, benzoyl peroxide, and retinoids help unclog pores and fight acne bacteria. Using leave-on creams with these ingredients can prevent breakouts.

5. Take care of skin health.

Nourish skin with antioxidants, use sun protection, and stay hydrated. Promoting overall skin health makes breakouts less likely.

Being aware of the most common cystic acne causes is key. Avoiding triggers and balancing hormones whenever possible can go a long way towards preventing those painful cystic breakouts.

When to See a Dermatologist for Cystic Acne

Severe cystic acne can be difficult to manage on your own. See a dermatologist if you experience:

  • Frequent and painful cystic breakouts
  • Acne resistant to over-the-counter treatments
  • Scarring from cystic pimples
  • Low self-esteem or depression due to cystic acne

A dermatologist has access to the strongest acne medications such as isotretinoin that can help. Procedures like steroid injections can also help shrink down large cystic pimples quickly.

Don’t hesitate to reach out for professional help if your cystic acne is significantly impacting your life. You don’t have to keep suffering through breakout after breakout.

The Takeaway: Pay Attention to Cystic Acne Triggers

Cystic acne forms deep within the skin and can be triggered by a number of different internal and external factors. Hormones, genetics, inflammation, high stress, medications, diet, and lifestyle habits all potentially play a role.

Pay attention to your personal acne triggers and utilize prevention strategies to avoid future breakouts. Keeping excess androgens and inflammation in check is key.

For severe or treatment-resistant cystic acne, see a dermatologist for access to specialized medications and procedures. With persistence and the right treatment plan, you can get cystic acne under control and prevent it from recurring.

Frequently Asked Questions About Cystic Acne

What does cystic acne look like?

Cystic acne consists of large, red, painful breakouts that occur deep in the skin. The pimples are inflamed and can feel like knots under the skin. Cysts often have a white or yellow pus-filled center. The breakouts leave behind dark scars that can last for months.

Where does cystic acne occur?

Cystic breakouts most often develop on the face, especially along the jawline, cheeks, chin, and around the mouth. But cystic pimples can also form on the back, chest, neck, shoulders and upper arms.

What is the difference between cystic acne and regular acne?

Regular acne consists of small whiteheads and blackheads on the surface of the skin. Cystic acne occurs deeper within the dermis skin layer. Cystic pimples are much larger, more painful, and lead to scarring more often than milder whiteheads or blackheads.

Is cystic acne a form of severe acne?

Yes, cystic acne is considered a severe form of acne. It is ranked as the most serious type of acne due to the size of the pimples, how deep they form, and potential to cause permanent scarring. The cysts are also very painful.

Can cystic acne go away on its own?

Smaller cystic pimples may go away on their own within 1-2 weeks. However, most cystic acne will not fully clear up without prescription treatment. The breakouts tend to recur frequently and require diligent treatment.

What is the best treatment for cystic acne?

Prescription medications produce the best results against true cystic acne. Oral antibiotics, birth control pills, isotretinoin, spironolactone, and topical retinoids are often prescribed. Over-the-counter products are usually not strong enough to control severe cystic breakouts.

How can you get rid of cystic acne fast?

Seeing a dermatologist for a cortisone injection can help shrink a large cystic pimple within a day or two. Draining the fluid from a large inflamed cyst using a sterile needle also provides fast relief. However these are temporary measures only.

Can you pop cystic pimples?

It's best not to pop or pick cystic breakouts. The cysts form too deep for effectively draining. Picking can injure the skin and lead to scarring. Apply a warm compress instead to help encourage the cyst to drain on its own.

Does cystic acne go away permanently?

With consistent treatment, cystic acne can go into long-term remission and potentially go away for good. Oral isotretinoin has the best chance of producing permanent clearance of cystic acne. However some people do experience occasional flare ups of cystic breakouts even after successful treatment.

When to see doctor for cystic acne?

See your doctor for evaluation if you suffer from painful cysts that produce scars, don't respond to over-the-counter treatment, or negatively impact your self-esteem. A dermatologist can prescribe stronger medications to help clear cystic acne.

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