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Cystic Acne vs Hormonal Acne

Written by Andrew Le, MD

UpdatedMarch 8, 2024

Cystic acne and hormonal acne are two types of acne, with different causes, symptoms, and treatment options In this article, we will explain the differences between cystic acne and hormonal acne, how to recognize the symptoms, and the best way to treat each condition.

What Is Acne?

Acne is a skin condition that causes pimples, blackheads, cysts, and other lesions. It develops when your sebaceous glands become clogged with excess oil, dead skin cells, and bacteria.

What Are the Different Types of Acne?

There are many different types of acne. Inflammatory acne appears as red, swollen bumps such as papules and pustules that are caused by bacteria, excess oil production, and inflammation in the skin pores.

Blackheads and whiteheads form when pores become clogged with oil and dead skin cells.

Nodules and cysts are a more severe form of acne that tend to be deeper in the skin, are larger than other blemishes, and are more difficult to treat.

Cystic Acne

Cystic acne is the most severe type of acne. It’s when large pus-filled lesions develop deep within the skin and are inflamed. Acne cysts can be painful to the touch and may cause scarring if you attempt to pop them. Cystic acne doesn’t have a predictable pattern, but flare-ups often occur in cycles that can last for weeks or months.

Hormonal Acne

Hormonal acne is triggered by hormonal fluctuations that occur during the menstrual cycle, pregnancy, or menopause. The change in hormone levels increases the amount of oil (sebum) your skin produces, leading to clogged pores and acne. Hormonal acne can appear as whiteheads, blackheads, pustules, or even cysts, and tends to appear on your cheeks, jaw, and neck.

What Causes Acne?

A variety of factors can cause acne. When sebaceous glands produce too much sebum and clog hair follicles, whiteheads, blackheads, and other types of pimples can form. Hormonal changes, stress, dietary habits, and genetics can make acne symptoms worse. Inflammation can make your skin more prone to bacterial infections, leading to more severe lesions such as papules, pustules, and cysts.

Cystic Acne Causes

Cystic acne occurs when bacteria gets trapped in a clogged pore and forms a pimple that becomes infected. The skin’s reaction causes swelling and infection, resulting in a painful pus-filled cyst deep in your skin. Having a family history of cystic acne, overproducing sebum, and hormonal imbalances are all potential causes of cystic acne.

Hormonal Acne Causes

Hormonal acne is caused by fluctuating hormone levels, and most commonly affects women during menstrual cycles, pregnancy, and menopause (men and teens are less commonly affected). The shifting of hormones triggers excess oil production, which leads to clogged pores and creates an ideal environment for acne.

What Are the Symptoms of Acne?

Acne’s most visible symptoms are whiteheads, blackheads, red and inflamed pimples, and painful cysts and nodules. Acne may also cause tenderness, sensitivity, and burning. Long-term symptoms include skin discoloration, scarring, and thickening.

Cystic Acne Symptoms

Cystic acne looks like large red bumps, some of which develop a white or crusty head. The painful, inflamed cysts grow from deep within the skin and are pus-filled. Cystic acne is also tender to the touch and can cause scarring.

Hormonal Acne Symptoms

Hormonal acne can show up as whiteheads, blackheads, pustules—even cystic acne—that cause breakouts around the chin, jawline, and cheeks. Hormonal acne doesn't respond well to traditional acne treatments, so ongoing flare-ups are another sign that acne is hormonal.

What Are Acne Treatment Options?

Acne treatment isn’t one size fits all; different kinds of acne require different treatments that target the root cause of the acne. For instance, antibiotics may work for bacterial infections, while hormonal and fungal acne both require entirely different treatments. Whatever kind of acne you have, keeping your skin clean and moisturized with non-comedogenic ingredients and avoiding harsh skincare products can go a long way toward healthy skin.

Cystic Acne Treatment Options

Prescription antibiotics such as isotretinoin along with in-office procedures like corticosteroid injections are commonly prescribed for severe cases of cystic acne. Dermatologists may also recommend products with benzoyl peroxide or salicylic acid to help reduce inflammation.

Hormonal Acne Treatment Options

Getting to the root of hormonal acne may require addressing the underlying hormonal imbalance. You may also need to change your skincare routine to target excess oil production and inflammation with ingredients like salicylic acid and benzoyl peroxide. A dermatologist can help address severe hormonal acne by prescribing oral contraceptives or spironolactone, or recommend laser therapy. Lifestyle adjustments such as managing stress levels, maintaining a balanced diet, and staying hydrated may also help regulate hormone levels and minimize acne flare-ups.

How Are Cystic Acne and Hormonal Acne Similar?

Both cystic acne and hormonal acne can be triggered by hormonal changes. Hormones such as testosterone, estrogen, and progesterone can increase sebum production, which can lead to clogged pores and inflammation, and cystic or hormonal acne. Another similarity between cystic and hormonal acne is that both can cause severe scarring if they’re not properly managed. A dermatologist will be able to prescribe targeted, effective treatments to help improve your acne.

Frequently Asked Questions

What is the difference between cystic acne and hormonal acne?

Cystic acne is a severe form of acne that appears as large, painful, and deep cysts underneath the skin. Hormonal acne, on the other hand, looks like smaller, pink or red bumps on the chin, jawline, and cheeks. Hormonal acne is caused by hormonal imbalances and typically occurs in women during their menstrual cycle, pregnancy, or menopause.

What are the causes of cystic acne and hormonal acne?

Cystic acne is caused by clogged pores and excess oil production, often due to genetics or hormonal fluctuations. Hormonal acne, on the other hand, is caused by an overproduction of androgens, such as testosterone, which can lead to excess oil production and clogged pores.

How can I tell if I have cystic acne or hormonal acne?

Cystic acne is typically characterized by large, red, and inflamed cysts that are deep under the skin and can be painful to the touch.

Can cystic acne and hormonal acne be treated?

Yes, both cystic acne and hormonal acne can be treated. Cystic acne may require stronger medications, such as oral antibiotics or isotretinoin, while hormonal acne may be treated with birth control pills, spironolactone, or topical retinoids.

What are some lifestyle changes that can help with cystic acne and hormonal acne?

Some lifestyle changes that can help with cystic acne and hormonal acne include maintaining a healthy diet, reducing stress levels, avoiding harsh skincare products, and practicing good hygiene.

Is it possible to have both cystic acne and hormonal acne at the same time?

Yes, it is possible to have both cystic acne and hormonal acne at the same time. In fact, hormonal imbalances can often lead to cystic acne breakouts. Consult with a dermatologist to determine the best treatment plan for both types of acne.