Cystic Acne: What Is It, And How Do You Treat It?
Dr. Angel Rivera
Cystic acne is a type of acne that causes cysts to form deep in the skin. These cysts are often painful and may take weeks or months to heal. If you have cystic acne, then you may need a dermatologist's help. In this article, we will answer all your questions about cystic acne, what it is, who can get it, how do you diagnose it, how do you treat cystic acne, and more.
Cystic acne is a type of severe acne that causes cysts to develop most commonly on the face, neck, chest, and back. These cysts are deep in your skin and can cause serious infections if they break open. The cyst may last for months or even years as they do not disappear on their own. The cysts consist of hardened dead skin cells, bacteria, and sebum, which is the natural oil your body produces. Cystic acne usually occurs in people who have oily skin. It is also most common in teenagers but can continue into adulthood. Women or people with hormonal imbalances are the most likely adults to get cystic acne.
Some of the most common factors that cause cystic acne are high levels of hormones or hormonal changes that are usually caused by age, genetics, and stress. Some cystic acne can be caused by drugs that are corticosteroids or lithium. You may also have cystic acne if you have a bacterial infection, such as the bacteria called Propionibacterium acnes (P. acnes). The acne forms in the same way as other acne in that the pore of your hair follicle becomes blocked with sebum, skin cells, and bacteria. The difference is that the dermis, or middle layer of the skin, becomes inflamed with cystic acne and this forms a cyst.
The cysts of cystic acne are large and deep in the skin and will often look similar to boils. It can be an itchy and painful acne cyst, especially when you touch it. The cysts usually form on your face but they may also appear around your neck, back, chest, shoulders, buttocks, and upper arms.
What is the difference between cystic acne and acne vulgaris?
The difference between cystic acne and acne vulgaris, which is the most common type of acne, is that cystic acne forms large, deep cysts in the skin pores. Acne vulgaris can cause severe pimples but it does not form cysts. Instead, acne vulgaris forms bright red or dark acne nodules, also called comedones. When a comedone is considered open, that means it is a blackhead and when a comedone is closed, then it is a whitehead pimple. Both are a form of acne that are caused by the same reasons as cystic acne but affect the skin at a different layer.
Who can get cystic acne?
As noted above, anyone can get cystic acne, but it is most common in teenagers. Women or people with hormonal imbalances are the most likely adults to develop cystic acne because of changes caused by age, genetics, or stress.
If your dermatologist suspects that your cysts are caused by a bacterial infection, they will take a sample from the cyst and send it to a laboratory for testing. If the results come back negative then usually no further treatment is required as cysts tend to go away on their own after a few years. If the lab results come back positive, then you will need to take antibiotics for cystic acne treatment.
There are several different treatments available to you if you have cystic acne. Please note that most over-the-counter products, or OTC, are not strong enough to treat cystic acne so it is recommended that you see your healthcare provider or dermatologist if you believe you have cystic acne. Some of the most common treatment options are:
Antibiotic pills and creams
Once your doctor knows that your cysts are caused by an infection, then they can prescribe oral antibiotic pills or creams to help reduce and eliminate any infection you have. This will help reduce the inflammation by killing acne-causing bacteria, but will not stop your body from producing sebum.
Benzoyl peroxide or salicylic acid
These topical solutions are available in OTC medications for the treatment of acne. However, doctors also have prescription-strength doses which they can prescribe. A benzoyl peroxide product or salicylic acid product typically come in the forms of topical creams, gels, serums, or lotions that also help reduce skin inflammation. Azelaic acid can also be used for this purpose.
Formerly called Accutane, this is a strong dose of Vitamin A that comes in the form of an oral pill. It also reduces cystic acne inflammation and helps to reduce sebum production in the oil gland, also called the sebaceous gland. Pregnant women should avoid taking isotretinoin.
This is a type of vitamin A that you apply topically to cysts on your skin. Retinoids help by removing the dead skin cells and unclogging your pores. They are often used in conjunction with antibiotics.
Injecting a corticosteroid directly into cysts on your skin can help reduce inflammation and cyst size. This is usually only used if other cystic acne treatments have failed or are not possible because of pregnancy, breastfeeding, or age limits.
Incision and drainage
In its most severe forms, if cystic acne cysts are causing you significant pain or discomfort, your dermatologist may decide to drain the cyst before treating it. They will make one small incision that opens up the cyst and allows for all of its content to be drained at once.
Contraceptive pills or spironolactone
If cystic acne cysts are caused by hormone imbalances, your dermatologist may prescribe a birth control pill or spironolactone for female patients. These medications help reduce the number of androgens, or male hormones, in a woman's body which can lead to overactive sebaceous glands that produce more oil than necessary. Men will not be prescribed either of these drugs.
Please note that you should never play with or pop your acne. It can cause an acne scar or make your acne worse.
There is no known way of preventing cystic acne. However, if you know that stress and hormones cause cysts for you then it can be helpful to avoid these triggers as much as possible. It will also help if you maintain a daily skin routine to prevent your pores from clogging. This should include washing your face twice a day with warm water and mild soap, using a makeup remover before you go to bed at night, exfoliating once or twice a week, and avoiding harsh soaps which can strip away the natural oils from your skin. Also, it is very beneficial to your skin if you wear sunscreen every day as this will help prevent sunburn which can ultimately lead to skin cancer.
Cystic acne is a type of acne that is different from acne vulgaris. It will develop in your dermis, or middle layer of skin, from a clogged pore and become a cyst. It is usually caused by age, genetics, stress, or hormonal imbalances which are usually caused by age. Anyone can get it, however, it is most common in teenagers or adults with hormonal imbalances. Your doctor or dermatologist can easily diagnose you by looking at the cyst or even taking a sample. To treat cystic acne, doctors can prescribe a number of medications, some taken orally while some are applied topically to your skin. Draining the cyst or injecting steroids into it are also options. There is no known way to prevent cystic acne but if you know stress or hormones are the cause then you should avoid those triggers if possible. It will also help to keep a daily skin routine to maintain a healthy complexion. Should you have any further questions, we recommend that you speak to your doctor or dermatologist to determine the most effective treatment for you.
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