Hormonal cystic acne

What hormonal cystic acne is

Hormonal cystic acne is deep acne that follows hormone shifts, with hard, painful lumps under the skin. It means the breakouts sit too deep for most store products. The cause of hormonal cystic acne is androgens such as testosterone pushing oil glands to make more sebum; a deep blockage then swells into a hard, painful cyst. Doctors call deep acne nodulocystic acne. Nodules and cysts are the deepest, most painful kind of acne, and they can scar.

Women with deep, tender acne on the lower face, jawline or neck that other treatments missed are the classic group for hormonal therapy.

• In a survey of 400 women, 44% said their acne flared before their period.
• In 208 women aged 25 and older seen at one clinic, 48.1% had PCOS. That is a clinic sample, not everyone with acne.

Common Triggers

Triggers of hormonal cystic acne are the things that raise androgens or make skin react to them.

Hormonal Shifts

Periods, pregnancy, perimenopause, menopause, and starting or stopping the pill can all set off deep breakouts.

Underlying Conditions

PCOS (which the NHS now calls polyendocrine metabolic ovarian syndrome, or PMOS) affects seven to ten percent of women of childbearing age, and sixty to eighty percent of them have too much androgen. Signs include irregular periods, extra hair and severe acne that may be hard to treat.

Stress

Stress makes the body produce more androgens, which can push oil glands harder during busy, tense weeks.

Genetics

Acne tends to run in families, so a parent with deep acne raises your own odds.

Medicines such as steroids or testosterone, and whey supplements, can also set off deep acne.

Medical & Professional Treatments

Medical treatment for hormonal cystic acne works on hormones and deep lumps together. Ask your doctor about each option.

Topical Medications

Retinoids, azelaic acid and benzoyl peroxide help, but alone rarely clear cysts.

Oral Medications

• Spironolactone: women only; no pregnancy while taking it. In a 410-woman trial it beat placebo at twelve and twenty-four weeks.
• Oral contraceptives: some are FDA-approved for acne; change takes two to three months.
• Oral antibiotics: paired with a cream and kept short.
• Isotretinoin: for severe or scarring acne; about 85% clear for good after one course, in a monitored program because it causes birth defects.

In-Office Procedures

A corticosteroid injection shrinks one large, painful cyst quickly; draining is another option. Unsure how bad yours is? A photo analysis grades it.

If you are past your teens and the lumps keep coming back, an overview of adult acne treatment lays out every step from creams to pills.

One cyst tonight

1. Hands off. Never squeeze or drain a cyst at home; that invites infection.
2. Keep using your regular acne treatment over the whole area. Small surface pimples are a different job; the usual steps for how to get rid of pimples work on those, not on cysts.
3. If it is large and painful, book a dermatologist for an injection.
4. Watch the mark it leaves. The flat brown or purple mark a cyst leaves behind is usually one of the acne dark spots that fade with time and sunscreen, not a scar.

When to see a dermatologist

• Any cyst or nodule: you need a dermatologist's help, and the sooner treatment starts, the fewer scars.
• Signs of PCOS alongside the acne, such as irregular periods or extra facial hair.
• Acne that affects your mood or makes you avoid people.
• Deep acne that started after a new medicine or supplement.