Cystic vs. Hormonal Acne: Key Differences & How Dermatologists Treat Them

Not all acne is created equal — and that’s why a one-size-fits-all treatment doesn’t always work. If you're struggling with painful, deep cysts, turning to over-the-counter salicylic acid washes meant for surface-level pimples is futile. Cystic acne lives far deeper than what a topical wash can reach. It's the same with hormonal breakouts, which can likely get worse with harsh, drying skincare solutions. Comparing the triggers and symptoms between cystic vs. hormonal acne is the first step toward finding the most effective treatment.

What Is Cystic Acne?

Cystic acne is caused by an infection in the dermis when pores are clogged with oil, dead skin, and bacteria. Acne cysts often develop on the face, but they can also appear on the back, chest, buttocks, and shoulders. Fluctuating hormones and genetics make some people more prone to this skin problem.

The symptoms are hard to miss. Inflammatory acne often appears as deep, painful cysts filled with pus that may last for weeks.. Swelling leaves the skin tender. They're painful to the touch, slow to heal, and carry a high risk of scarring if left untreated. Cystic acne often requires dermatologist-guided treatments to prevent acne scarring and control flare-ups.

What Is Hormonal Acne?

Hormonal acne is a type of breakout triggered by hormonal fluctuations. It's common in adult women, especially those diagnosed with polycystic ovary syndrome (PCOS). However, it also affects teens, appearing as painful blemishes that take time to heal.

Its leading causes are stress and hormonal imbalance during menstruation, pregnancy, and menopause. Hormonal shifts stimulate the oil glands, resulting in excessive sebum production. When oil mixes with dead skin cells inside the pores, it leads to clogging and inflamed breakouts in the T-zone. This area includes the nose, chin, and forehead, but pimples can also appear along the jawline.

Symptoms typically include cyclical flare-ups that worsen at certain times of the month. Hormonal breakouts develop into tender, cyst-like bumps. While mild to moderate cases may improve with OTC solutions, dermatological treatment is often required for long-term control.

Key Differences: Cystic vs. Hormonal Acne

This table summarizes the difference between cystic and hormonal acne. 

Hormonal acne typically improves once hormone levels stabilize. For cystic acne, skin redness and inflammation are deep-rooted and require professional treatment. 

Dermatologist Treatments for Cystic Acne

When at-home options aren’t doing the trick, visiting your dermatologist for acne treatment is the next best course of action. They can prescribe treatments to ease the cysts and ramp up the healing process. 

• Oral antibiotics: Medications like sarecycline target acne-causing bacteria, reducing inflammation and soothing other symptoms during flare-ups. You’ll notice improvement in your skin within a few weeks of treatment. 
• Corticosteroid injections: These are a quick solution for flattening cystic acne and relieving pain. Within 24-72 hours, the acne shrinks and lesions improve in 3-7 days.
• Isotretinoin (Accutane): It’s an oral medication prescribed for severe and recurring cystic acne. You may notice your acne worsening during the first few days of treatment, but this improves after 7-10 days.
• In-office procedures: Your dermatologist may recommend drainage, chemical peels, or laser treatment to reduce the size of the painful cysts. Effects can be seen in a few days or weeks. 

These cystic acne treatment options can offer short-term relief and long-term control for inflammatory acne. 

Dermatologist Treatments for Hormonal Acne

Hormonal acne is a bit tricky to treat, but several effective treatments can help stabilize fluctuating hormones. 

• Oral contraceptives: For women, birth control pills are the first line of hormonal acne treatment. They regulate estrogen and lower testosterone levels to reduce sebum production. It may take three months to see improvements. 
• Spironolactone: Spironolactone is initially approved to treat high blood pressure, but is often prescribed off-label as an oral medication for acne. It can reduce breakouts by 50%-100%, and results are noticeable within a few weeks. 
• Topical retinoids: Examples are tretinoin (Retin-A) and tazarotene (Tazorac). They're vitamin A derivatives that help unclog pores, reduce inflammation, and speed up skin cell turnover. Noticeable improvements usually occur within several weeks, though optimal results may take a few months.
• Lifestyle and diet guidance: Lifestyle factors impact the condition of your skin. Your dermatologist may recommend learning stress management techniques, along with maintaining a balanced diet, exercising regularly, and getting sufficient sleep to support skin health.

By combining lifestyle habits with medication, you can effectively manage hormonal acne. 

When to See a Dermatologist

Knowing when to seek expert help is crucial for controlling acne and preventing scarring. Consult your doctor if:

• OTC treatments have failed
• Breakouts are persistent, and inflammation is worsening
• Severe acne increases the risk of scarring
• Acne is taking a toll on your self-esteem and mental health
• You have PCOS or other underlying conditions triggering skin problems

If left untreated, the inflammation can intensify, making acne harder to control.