Acne is a common skin problem and one that can be disfiguring. It’s most common in adolescents and teens, but adults can get it too. In some cases, the bumps and papules that are so common with this skin problem become inflamed, leading to a diagnosis of cystic acne, the most serious form of the disease and the one that’s most likely to lead to scarring.
As the name implies, people with cystic acne don’t just have blackheads and red bumps. They also develop cysts that can become quite large and painful and be felt as tender, swollen nodules on the surface of the skin. Needless to say, these tender inflamed nodules that fill with puss are uncomfortable and embarrassing from a cosmetic standpoint.
Like non-cystic acne, acne with cysts begins within the hair follicle. Skin cells inside the follicle are constantly being shed. Alongside the hair follicle is a sebaceous gland that produces an oily substance called sebum. People with acne produce too much sticky sebum. This causes the skin cells being continuously shed to clump together and block the opening of the hair follicle called the pore. Bacteria feed on the sebum and dead skin cell. This leads to an inflammatory response as they body tries to destroy the bacteria. In people with cystic acne, the inflammatory response is so great that it breaks the wall of the pore and a membrane forms around it leading to a cyst. Multiple cysts can form, and cysts can fuse together to form larger cysts that are filled with pus and bacteria.
It’s not clear why some people develop cystic acne, while others don’t, but those who do are at greater risk for scarring since the cysts damage healthy skin tissue. Scarring is more likely to happen to people who pop the cysts or pick at them.
Never try to open up the cysts since this increases the risk of scarring. Twice-daily cleansing with an oil-free cleanser helps to remove excess oil and bacteria that clog pores and make the problem worse. Choose a product that is oil-free and contains salicylic acid, an ingredient that helps to slough off dead skin cells and clean up clogged pores. After cleansing, follow up by applying a treatment containing benzoyl peroxide. This is an ingredient proven to fight bacteria that contribute to cystic acne. Used daily, it helps to prevent new acne lesions and cysts from forming.
Dermatologists sometimes prescribe antibiotics for people with severe cases of cystic acne. Antibiotics are effective for killing bacteria and controlling inflammation, but they have side effects. In many cases, the symptoms can be controlled without using them. There’s also the risk that the bacteria will become resistant to the antibiotic. Another medication that doctors sometimes prescribe for women with cystic forms of acne is an oral contraceptive. Sebum production is driven by hormones and regulating hormone levels with these pills helps to reduce acne outbreaks.
In many cases, dermatologists recommend retinoids found in products like Retin-A to treat cystic forms of acne. They work well, but the majority of people experience significant redness, flaking and skin irritation with these products. In the most severe cases, doctors prescribe an oral form of retinoid called Accutane. This treatment is effective but carries with it the risk of serious side effects including liver injury and an elevation in cholesterol and triglyceride levels. Women who take it must have a negative pregnancy test and agree to use birth control since Accutane causes birth defects. That’s why it should be an option only when other treatments have failed. Fortunately, most people can treat acne without using this medication.
Cystic acne is one of the most disfiguring forms of acne and can lead to permanent scarring. That’s why it’s important to treat the problem as early as possible. Fortunately, there are treatments to help control the cysts and inflammation and prevent scarring.