Cystic Acne

Asian girl pointing to acne cyst on face

Cystic acne occurs in men, women and teenagers.  It is most often seen as bumps and cysts along the jawline.  These cystic pimples are often recurring. Deep cystic acne can occur anywhere on the face such as the chin, cheeks and forehead or on the body such as the chest, scalp, back and buttocks. What causes cystic acne?  Is cystic acne hormonal?  What are the best treatments for cystic acne? Before we answer these questions, I will explain what cystic acne is. 

Remember, it is always best to shop by your Baumann Skin Type when choosing skin care products.

What is Cystic Acne?

A true acne cyst is a clogged hair follicle filled with bacteria that has been walled off by the body's immune system to keep the acne-causing bacteria from spreading.  When the body's natural inflammation cycle occurs, the pore gets clogged. This causes a comedone.  The closed pore allows pressure to build up inside the hair follicle, stretching out the hair follicle allowing more room for bacteria, pus, keratin and dead keratinocytes. If untreated, the pressure eventually ruptures the wall of the hair follicle leading to scarring.

What is Cystic Acne Filled With?

The hair follicle is lined with epidermal cells called keratinocytes. These keratinocytes make a protein called keratin. (This is why they are called keratinocytes.)

When the pore is clogged and a closed comedone forms, there is a build up of debris inside the the hair follicle. 

The contents of this debris in an acne cyst are :

  • Sebum (oil)
  • Keratin
  • Dead keratinocytes
  • Exudate from immune cells we call pus
  • Acne causing bacteria known as Cutibacterium acnes. (The name was changed from P. acnes to C. acnes)

What Causes Cystic Acne?

Cystic acne starts in the hair follicle which opens as a pore on the skin's surface.

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The hair follicles get clogged hair with dead skin cells and keratin which causes comedones. Why do the hair follicles get clogged? Click here to read more about this.

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When dead skin cells and oil accumulate in the hair follicle, bacteria is attracted to the hair follicle. This triggers inflammation which brings fluid to the area.  Accumulation of the inflammatory fluid, desquamated skin cells,  and keratin protein further increase the intrafollicular pressure.

The pressure caused by the build up of dead skin cells, pus, and fluids breaks the wall of the hair follicle, allowing bacteria into the skin.  The body recognizes this bacteria as foreign and mounts an immune response.  Immune cells surround the bacteria and pus and wall it off to prevent spread of infection to other parts of the body.  This leads to a cyst.

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If you pick at the acne cyst, it can turn into an epidermal inclusion cyst which must be removed by a small surgical procedure.  Scarring can also occur with cystic acne because of damage to the walls of the hair follicle.

What causes cystic acne?

Cystic acne in men and women is caused by a combination of these factors:

  • Hormones
    • Testosterone increases sebum production
    • Affect lipid composition of sebum
    • Affect the skin microbiome
    • Stress hormone cortisol affects insulin and glucose control
  •  Debris such as sunscreen and silicones left on the face
  • Altered keratinization and impaired desquamation
  • Skin microbiome
  • Insulin like growth factor levels
    • influenced by sugar in diet
    • Stimulated by insulin

How to Treat Cystic Acne?

Can you cure cystic acne? Yes but the best way to cure cystic acid is to begin a retinoid.  You can try a topical one first, but if you have severe cystic acne you should see a dermatologist because you may need a prescription for an oral retinoid.

The best way to treat cystic acne is to get on the right products for your Baumann Skin Type.  Let our dermatologists guide you by choosing products based on your Baumann Skin Type.

Vitamins To Use if You Have Cystic Acne

Retinoids are a form of Vitamin A.  You can take Vitamin A supplements to treat acne but you must be careful not to take more than 4,000 IU's per day.  Vitamin A is a fat soluble vitamin which means it is toxic when too much is taken.  Vitamin A can also cause birth defects if taken while pregnant.  It is much safer to see a dermatologist to treat your acne cysts  then trying to manage it naturally by yourself.  Retinoids are a safe way to treat acne cysts but should be carefully monitored by your doctor with blood test that follow your liver function and triglycerides and cholesterol levels.

Vitamins to Avoid if You Have Cystic Acne

If you have cystic acne, avoid Vitamins B6 and Vitamin B12 because they can cause acne breakouts.  These acne cyst causing vitamins are in many body building supplements.

Products to Use and Avoid if You Have  Cystic Acne

The best way to avoid getting cystic acne is to avoid using products with comedogenic ingredients.  You also need to make sure that when you choose skin care products, you shop by your Baumann Skin Type.

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References:

  1. Sally, R. Rieder, E. Ch.16 Acne in Baumann's Cosmetic Dermatology (McGraw Hill 2022)
  2. Harris HH, Downing DT, Stewart ME, Strauss JS. Sustainable rates of sebum secretion in acne patients and matched normal control subjects. J Am Acad Dermatol. 1983;8(2):200-203. doi:10.1016/s0190-9622(83)70023-x
  3. Clayton RW, Göbel K, Niessen CM, Paus R, Steensel MAM, Lim X. Homeostasis of the sebaceous gland and mechanisms of acne pathogenesis. Br J Dermatol. 2019;181(4):677-690. doi:10.1111/bjd.17981
  4. Jahns AC, Lundskog B, Ganceviciene R, et al. An increased incidence of Propionibacterium acnes biofilms in acne vulgaris: a case-control study: Increased incidence of P. acnes biofilms in acne vulgaris. Br J Dermatol. 2012;167(1):50-58. doi:10.1111/j.1365-2133.2012.10897.x
  5. Kim J, Ochoa M-T, Krutzik SR, et al. Activation of Toll-Like Receptor 2 in Acne Triggers Inflammatory Cytokine Responses. J Immunol. 2002;169(3):1535-1541. doi:10.4049/jimmunol.169.3.1535

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