Cystic acne is caused primarily by the blockage of hair follicles with excess oil (sebum) and dead skin cells, creating an environment where acne-causing bacteria can thrive and cause infection. This infection triggers the body's immune response, leading to inflammation and the formation of painful, pus- filled cysts deep under the skin

. Key factors contributing to cystic acne include:

• Overproduction of sebum: Excess oil clogs pores and hair follicles

• Bacterial infection: Bacteria trapped in clogged pores cause infection and inflammation

• Hormonal changes: Androgens, hormones that increase during puberty, pregnancy, menstrual cycles, or conditions like polycystic ovary syndrome (PCOS), stimulate sebum production and contribute to cystic acne

• Other triggers: Certain medications, high humidity or sweating, and underlying health conditions can exacerbate cystic acne

Cystic acne is more common in people with oily skin and tends to affect teenagers and young adults, but it can occur at any age

. Genetics also play a role, as having a family history of severe acne increases the risk

. In summary, cystic acne results from a combination of excess oil, clogged pores, bacterial infection, and hormonal influences that cause deep, inflamed cysts under the skin