Cystic acne can cause pain, shame and scars. Here’s what causes it.

Dealing with cystic acne can be painful and scarring — physically and mentally.
Cystic acne gets its name from cysts, which are pus-filled pimples. They’re typically large, painful and set deep in the skin, which often leads them to leave scars in the aftermath, according to the American Academy of Dermatology Association (AAD)
Acne is the most common skin condition in the United States and affects upwards of 50 million Americans every year, per the AAD. But cystic acne in particular can often be a source of embarrassment and anxiety for those who are dealing with it.
“Please know that acne is very normal and it’s not your fault, and you are in excellent company — about 90% of people struggle with acne at some point in their life, and this includes celebrities,” board-certified dermatologist Hadley King, M.D., tells USA TODAY. “Acne, unfortunately, is normal and largely out of our control and it does not define who we are.”
Here’s what skin experts want you to know about cystic acne.
Cystic acne typically arises for people in their teens and 20s, but it can last into adulthood as well. The cause is usually hormonal, Dr. King says, with the caveat that it doesn’t necessarily mean there’s something wrong with your hormones.
“They result from the normal fluctuation of hormones,” she says. Some people’s sebaceous glands, which produce oil to prevent the skin from drying out, are genetically more sensitive to these hormones, causing more acne when those levels fluctuate. Things like stress, diet and lack of sleep can also impact hormones and acne.
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Because cystic acne is usually caused by hormones, King notes that treatment is often the same for cystic and hormonal acne.
Daily cleansing is step No. 1 when it comes to any type of acne. It’s best to consult a dermatologist to determine what else would be helpful, be it a tretinoin, retinoid or benzoyl peroxide. If those don’t help, your dermatologist may also suggest some other treatment options for hormonal acne: