As discussed above, acne is characterized by a blockage of the skin pores because of the overproduction of sebum, or skin cells, combined with inflammation triggered by the bacterium P. acnes. Cysts are the most inflamed, ruptured form of these comedones.
The biggest factor causing acne is the hormonal change in adolescent teenage years. During puberty, levels of circulating androgen hormones increase dramatically leading to increased sebum production and greater proliferation of skin cells.1,2
Acne is not confined to teenagers, however, and other factors are involved, including an inherited tendency for acne, alongside:1,2
- Hormonal changes – related to puberty, the menstrual cycle, pregnancy,birth control, the use of hormone therapy, and stress
- Occlusive, greasy cosmetics, cleansers, lotions, and clothing
- High levels of humidity and sweating
- Some drugs and chemicals (for example, corticosteroids, lithium, phenytoin, isoniazid), which may worsen or cause eruptions that are similar to acne.
There are numerous myths about the causes of acne, with blame wrongly assigned to factors that have been roundly dismissed by scientific research.
Acne, including cystic acne, is not caused by:
- Chocolate, nuts, or greasy foods
- Most other dietary choices – research has found an association between intake of milk products and acne, as well as a high glycemic index diet and acne
- Poor hygiene or inadequate face washing
- Masturbation or sex.Acne produces symptoms familiar to all of us – 70-80% of people are affected at some time,3,4 and we have all seen faces affected by acne.Cystic acne is even more visible because it is the severe form that produces cysts and nodules in addition to numerous inflammatory papules and pustules.3 Acne can also cause visible scarring.
All forms of acne can affect self-esteem and mood, but the risk of psychological distress is higher for cystic acne as it typically has a greater impact on the appearance of the face and disproportionately affects young adults who may be more socially sensitive.
Most forms of acne do not produce physical symptoms felt by the person themselves, but the skin’s appearance can cause emotional distress. In cystic acne, however, the distress may be higher, and the cysts may be painful.1
The importance of treatment is underlined by the risk of scarring from long-term cystic acne. This can produce long-term and permanent damage in the form of:1
- ‘Ice pick’ scars (small, deep pits)
- Larger pits
- Shallow depressions
- Hypertrophic scarring (red, raised scars).