Cystic Acne

What is cystic acne?

Cystic acne is a type of acne with inflamed painful bumps under the skin which are full of pus. Like normal acne in which follicles become clogged with dead skin cells and oil/sebum, in cystic acne, there is infection and swelling of skin pores. The pus-filled lumps called cysts are often large and painful. The condition is harder to treat than mild or moderate acne and can lead to permanent scarring.

Who can develop cystic acne?

It is possible to develop acne at any age although teenagers are more commonly affected as their hormone levels are changing. While acne is common, cystic acne which is more severe is rarer. Like normal acne, it is possible to develop cystic acne on the face and sometimes back and chest. Men have a higher prevalence of the condition than women. When women have cystic acne it is likely to affect the lower half of their face.

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Do I have cystic acne?

The symptoms of cystic acne are usually apparent as the cysts are large and inflamed. The condition can cause a lot of psychological distress for some people, as the look of their face can be affected. The cysts can be tender or even painful. There may be the presence of scars including:

Ice pick scars - deep and narrow scars
Boxcar scars - round crater-like scars with defined edges
Rolling scars - broad depressed scars leading to an uneven skin surface
Atrophic scars - thin and flat/depressed scars
Keloid/ hypertrophic scars - large bumps on the skin’s surface

What can cause cystic acne?

Hormones called androgens are an important factor in causing acne as they lead to excess sebum production, clogging pores. For this reason fluctuation in hormones can be responsible for triggering acne breakouts. This may be due to hormonal changes in the menstrual cycle, pregnancy or menopause or due to a condition called polycystic ovarian syndrome (PCOS). The mini-pill which contains progesterone only can aggravate the condition. An unhealthy diet high in refined sugars and fat content may be involved in causing acne. Such diets also increase inflammatory responses in the body as well. While there is no definitive cure for acne there are many treatments that can help to ease the condition.

How is cystic acne treated?

WIth cystic acne, it is likely that over the counter preparations will have little impact. You should contact your doctor for them to prescribe prescription medications that are appropriate based on the severity of your acne and medical history. Different treatments will be available such as:

Oral antibiotics - This will help to stop the infections in the cysts and reduce swelling and inflammation. It will likely take at least 6 weeks before results are seen.
Topical retinoids - Retinoids are a variant of vitamin A and work by exfoliating dead skin cells, preventing them from clogging pores. A six-week course is usually required.
Isotretinoin - This is a treatment that comes in capsules. It has multiple effects including controlling sebum production, preventing pores clogging, decreasing bacteria and inflammation. However, there can be various side effects associated with this medication. It is contraindicated if you are pregnant.
The pill for women - The combined oral contraceptive pill can work for some women. However, it may take up to a year before the complete benefits are apparent.

Your doctor will discuss with you the medications they recommend the most for you and will be able to explain the benefits and side effects of each of these treatments.

How can I take better care of my skin?

In general, we recommend taking good care of your skin to keep it healthy and reduce breakouts. This can include avoiding harsh cleansers that strip your skin of moisture, avoiding picking any spots and wearing sunscreen. With regards to make-up use non-comedogenic products and remember to remove your make-up before bed. It will benefit you to stick to a balanced diet and avoid stress. Clean your face regularly but not excessively that your skin becomes dry.

Summary

Cystic acne can be troublesome physically and mentally. Do not let your acne control your life. Despite the fact that cystic acne is severe, there are many treatment options that can be tailored to you. Speak to your doctor about trying to resolve your cystic acne and if you are feeling distressed by it.