What Causes Deep Acne That Never Comes to a Head
Deep acne that stays trapped under the skin without forming a head is called cystic acne. It feels like a painful, swollen lump that lingers for weeks or longer. Unlike surface pimples that pop easily, this type burrows deeper into the skin layers.
The problem starts when pores get blocked by excess oil, known as sebum, mixed with dead skin cells. This creates a plug deep inside the hair follicle. Bacteria called C. acnes then grow in that trapped space, sparking a strong inflammatory reaction. The inflammation pushes down into the dermis, the skin’s deeper layer, forming a cyst filled with pus and debris that cannot break through to the surface.[1]
Hormones play a big role in triggering this. Androgens, which are male hormones present in everyone, boost oil production when levels rise. In women, this often happens before periods due to progesterone surges, or from conditions like PCOS that raise androgen levels. Puberty, pregnancy, menopause, and stopping birth control can all cause similar shifts. Stress adds to it by releasing cortisol, another hormone that ramps up oil.[1][2][3][5]
Genetics make some people more prone. If family members had severe acne, you might too, as it affects how your skin handles oil and inflammation.[1]
Diet can worsen things for certain folks. High-sugar foods, white carbs, dairy, and processed items spike insulin and hormones, leading to more oil and clogs. Whey protein shakes are a common culprit.[1][2][3]
Other factors include medications like steroids or some birth control pills that mess with hormones. Using thick, pore-clogging skincare or makeup traps oil deeper. Overwashing strips the skin barrier, prompting more oil production. High humidity, sweating, and poor sleep also contribute by increasing inflammation.[1][2][3]
This deep acne rarely heals on its own and can scar because it damages skin tissues below the surface. Seeing a dermatologist helps target the root causes.
Sources
https://londondermatologyclinics.com/cystic-acne-your-guide-to-causes-and-management/
https://drankitmehra.com/blogs/hormonal-acne-causes-treatment-dermatologist-guide
https://www.tuftsmedicine.org/about-us/news/acne-over-30
https://scottsdalenaturopathic.com/cystic-acne/
https://www.ladbible.com/news/health/skincare-warning-dermatologist-never-pop-cystic-acne-spots-109571-20251221
