what causes cystic ache

Cystic acne happens when deep skin pores get clogged and inflamed, leading to large, painful, under‑the‑skin bumps rather than small surface pimples.

What cystic acne actually is

Cystic acne is a severe form of acne where oil, dead skin cells, and bacteria become trapped deep in the hair follicle and trigger a strong inflammatory reaction in the dermis (the deeper skin layer). This reaction produces swollen, tender nodules or cysts that can last for weeks and often risk permanent scarring if not treated properly.

Main causes of cystic acne

Think of cystic acne as a “perfect storm” of several factors working together rather than one single cause.

1. Hormonal fluctuations (one of the biggest drivers)

Hormones—especially androgens (present in all genders)—stimulate the sebaceous glands to produce more sebum (skin oil). When levels rise or fluctuate, oil production ramps up, pores clog more easily, and deep, inflamed lesions are more likely.

Common hormonal triggers include:

• Puberty in teens (surge in androgens).
• Menstrual cycle changes, especially the week before a period.
• Polycystic ovary syndrome (PCOS) and other androgen‑raising conditions.
• Pregnancy and postpartum hormone shifts.
• Starting, changing, or stopping hormonal birth control.
• Perimenopause and menopause.
• High stress levels, which can alter several hormone pathways.

In many adults who “suddenly” develop cystic breakouts, underlying hormone imbalance or sensitivity of oil glands to normal hormone levels plays a key role.

2. Genetic predisposition

Cystic acne often runs in families: if one or both parents had severe acne, their children have a higher chance of developing it. Genes influence how much oil your glands produce, how your skin sheds dead cells, and how strongly your immune system reacts to bacteria in pores. Some people simply inherit more active sebaceous glands and a more inflammatory skin response, so the same triggers cause deeper, more aggressive breakouts for them.

3. Bacteria and deep inflammation

A skin bacterium called Cutibacterium acnes (formerly Propionibacterium acnes) lives normally on everyone’s skin and is usually harmless. When a pore is blocked with oil and dead cells, this bacterium can multiply in the trapped environment and provoke a strong immune response. That immune reaction causes redness, swelling, and pain; if intense, the follicle wall may rupture deeper in the skin, forming the large, tender cysts typical of cystic acne and sometimes damaging nearby tissue enough to leave scars.

4. Excess oil (sebum) production

Sebaceous glands are meant to keep skin moisturized and protected, but in cystic acne they often go into overdrive. Too much oil mixes with dead skin cells and forms a sticky plug that blocks the follicle opening. Factors that can increase oil production include hormonal changes, genetic tendency, certain medications, and stress.

5. Pore‑clogging skin products and friction

Anything that physically or chemically clogs pores can make cystic breakouts more likely if you are already prone.

Examples:

• Heavy, oily, or “greasy” cosmetics, sunscreens, and moisturizers (non‑comedogenic products are less likely to clog).

• Thick hair products that touch the face (pomades, heavy leave‑ins).

• Tight clothing, helmets, or straps that rub the skin and trap sweat and oil (jawline, shoulders, back, etc.).

• Not cleansing after heavy sweating in humid environments.

6. Environment and lifestyle factors

Certain external conditions push the skin further toward breakouts, especially when combined with hormonal and genetic factors. Contributors include:

• High humidity and heavy sweating, which swell pores and trap oil.

• Occupations or sports that involve oils, greases, or occlusive gear on the skin.

• Chronic stress (partly via hormonal effects and possibly by influencing skin immune response).

Diet is still being studied; some people notice links with high‑glycemic foods or dairy, but these are often individual and not the sole cause.

7. Medications and underlying health conditions

Some medications can either trigger acne‑like eruptions or worsen existing cystic acne in predisposed people.

Reported culprits include:

• Corticosteroids (systemic).

• Lithium.

• Certain anti‑seizure drugs such as phenytoin.

• Isoniazid and some other specific drugs.

• Hormone‑related treatments and some forms of birth control.

Underlying conditions such as PCOS or other endocrine disorders can also present with recurrent cystic acne as one of the visible signs.

Common myths (what does not cause cystic acne)

People with cystic acne often blame themselves for “bad habits,” but several widely believed triggers are not supported as main causes. Evidence‑based sources highlight that these do not cause acne by themselves:

• Poor face washing alone (over‑washing can actually irritate skin).
• Sexual activity or masturbation.
• Eating chocolate or greasy/spicy foods in general.

These factors might influence breakouts indirectly for some people, but they are not the core drivers in the way hormones, genetics, and pore blockage are.

Why cystic acne feels so stubborn

Cystic lesions form deeper than typical whiteheads or blackheads, so topical products often struggle to penetrate to the root of the problem. Because inflammation is intense and sits in the dermis, the skin can respond by laying down scar tissue once the cyst heals, leading to pitted or raised scars. Many people also get recurring cysts in the same areas (jawline, cheeks, back, chest), often where oil glands are densest and more hormonally sensitive.

When to see a dermatologist

You should seek professional help if any of these are true:

• Painful deep nodules that last for weeks or keep returning.
• Dark marks or scars forming after spots heal.
• Breakouts affecting self‑esteem, mood, or social life.
• Suspected hormonal issues like irregular periods, excess hair growth, or sudden weight changes.

Dermatologists can use stronger options (like oral medications, targeted hormone treatments, or procedures) that can prevent scarring and calm deep inflammation more effectively than over‑the‑counter products.

Quick FAQ style wrap‑up

• What causes cystic acne most often?
  A mix of hormonal shifts, genetic susceptibility, excess oil, and deep bacterial inflammation in clogged pores.

• Is cystic acne always hormonal?
  Hormones are major, but not the only factor—genetics, medications, and skin products often add to the picture.

• Is it my fault for not cleaning enough?
  No. Normal cleansing is important, but over‑focusing on “dirty skin” ignores the deeper hormonal and inflammatory drivers.

Information gathered from public forums or data available on the internet and portrayed here.