We all have had the dreaded feeling when we wake up with a huge pimple on the day of an important event. You feel the whole world sees nothing else on your face! Unfortunately, for those with cystic acne, the situation is a lot more extreme than an unwelcomed breakout. Cystic acne can have serious, long-term effects, and requires medical attention from a dermatologist. I often tell my patients, acne is transient, but scarring is forever. It is very important to intervene early to clear your skin fast and prevent permanent scarring.
What is Cystic Acne?
Cystic acne is the most serious type of acne. Most pimples occur when a pore gets clogged with oil, dirt, or dead skin cells. Sometimes bacteria can also get trapped inside the pore, creating a localized infection that makes the area red and slightly painful. Although these pimples should not be popped, they are easier to deal with or treat and will usually go away after some time.
Cystic acne, on the other hand, does not go away by itself. It occurs when bacteria causes inflammation deep in the skin, creating large cysts filled with fluid. Unlike normal pimples, these cysts don’t have a poppable ‘head’, and are regularly found underneath layers of skin on the face, neck and back (although cystic acne can be found anywhere on the body). Often, the surface of the skin will have swollen, red bumps that are incredibly painful to touch, as the cysts underneath are inflamed.
If ignored, cysts can take anywhere from 1-4 weeks to go away by themselves. Although your body will eventually deal with the inflammation, some cysts can persist for extended periods of time and often leave behind scars. Acne scarring is due to the inflamed cyst rupturing deep under the skin, causing damage to the surrounding tissue. Additionally, some scars are caused by surface trauma, when we inevitable try to pop these “un-poppable monsters”, damaging the overlying skin. Acne scars can come in different forms, but usually cause both changes in pigmentation (dark marks) and changes in skin texture (ice pick scars or pock marks).
What Causes Cystic Acne?
Like all other acne, the cause of cystic acne is often multifactorial. Often it is due to a combination of genetics, hormones, and lifestyle.
Scientists have been searching for a dietary cause of acne for years. Some studies have shown that breakouts can be triggered by excess processed sugar consumption or a change in diet. I never recommend specific “acne diets”, but I do always recommend a healthy diet and for patients to pay close attention to certain behaviors that they believe may trigger their breakouts. If you think diet might be affecting your skin, try cutting out certain food groups. Other causes can include make-up or cosmetics that clog pores or poor skin hygiene.
- Hormones Another cause of acne is hormones. Increased testosterone during puberty (or artificially due to anabolic steroids), or menstruation-related hormones can result in an increase in cysts. Testosterone fluctuations may cause acne breakouts in women, for example, in certain medical conditions such as polycystic ovarian syndrome (PCOS). If you notice that your acne worsens around your period, you have excess/unwanted hair growth, or your periods are irregular, it is important to address this with both your gynecologist and your dermatologist.
Sometimes, you just don’t win the genetic lottery. Although children of parents who had cystic acne can have perfectly clear skin, there is a high chance that they will develop cystic acne at some point in their lives. These people are advised to establish good skin care habits from a young age so they can do their best to avoid pimples. I also recommend that they see a dermatologist to intervene early if breakouts start.
How is Cystic Acne Treated?
Because cystic acne is one of the worst types of acne, it cannot be treated with simple over-the-counter creams or face washes. If you have cystic acne, it’s important that you go to a dermatologist as soon as possible to decrease the likelihood of permanent scarring. Dermatologists often recommend the following treatments for cystic acne:
Oral antibiotics help control the bacterial breakouts and reduce redness and inflammation. The most common antibiotic family used to treat acne is tetracycline (doxycycline and minocycline). This class of antibiotics is given at a lower dose than that used to treat infection. It targets the bacteria found in the clogged pore and also treats inflammation. However, antibiotics are often a short-term solution (3 months maximum), and may not be safe to use over long periods of time due to antibiotic resistance.
- Birth Control/Hormonal Treatments
For women, birth control pills can help regulate hormonal changes that effect cystic acne. Additionally, there are other hormonal treatments, such as a pill called spironolactone, which can block the effects of testosterone on the skin.
- Retinoid Creams
Retinoid is a form of vitamin A that is often used exfoliate the skin that clogs the pores of someone with cystic acne. Retanoid creams are an important part of any acne regiment. However, they can often be irritating, so it is important to use oil free/non-comedogenic moisturizers.
Accutane is now known as Isotretinoin, but is available under many brand names. Isotretinoin is an oral medication (high dose vitamin A) that treats all types of acne and is often used when other treatments have failed. It is considered a “cure” for acne. It works by decreasing the oil gland production and reducing the ability for skin cells to clog pores/hair follicles. It is a particularly strong drug with possible side effects, so it is important for you to have a serious conversation with your dermatologist before considering this medication.
It’s important to remember that anyone can get cystic acne at any point in his/her life and it can have a serious impact on self-esteem. Schedule a visit with one of our experts at Siperstein Dermatology Group to treat your acne and radiate confidence with clear skin.