If the wall breaks deeper beneath the skin, acne nodules or cysts form. This is called cystic acne . It's the type most likely to lead to scars. Both boys and girls get acne. But it may be worse in boys because they have more skin oils.
Heredity plays a role in who gets acne.
If your mother or father had bad acne, you may too. Your immune system also plays a role. Some people are extra sensitive to the bacteria that get trapped in the hair follicles. This can cause very bad acne. Foods don't seem to be related to acne.