Cystic acne, whether chronic or intermittent, is one of the most frustrating types of acne lesions to deal with. Not only are cystic acne breakouts painful, but the extent of damage they're capable of inflicting often goes beyond the reach of topically applied products. Cystic acne is typically triggered by a surge in hormones, such as occurs during a woman's menstrual cycle. For some unknown reason, the skin's oil glands become hypersensitive to this cascade of hormones, and react by overproducing sebum--so much, in fact, that the oil gland itself becomes engorged, swollen, and hardened with the excess. Unable to push the extra oil into the lining of the hair follicle (which leads to the surface of the skin via pores), the gland bursts underneath the skin. This causes acute inflammation and irritation, and leads to the redness and soreness of cystic acne. Because these lesions start so deep in the skin, scarring is an all-too-common side effect.