Acne outbreaks are frustrating, unpredictable, and often devastating to self-esteem. Who enjoys looking in the mirror and seeing a face full of pimples and blackheads? But there’s one form of acne that’s even more disfiguring. It’s called cystic acne and it can be a recurring problem for years and is more challenging to treat.
Dermatologists divide acne into four types: popular, pustular, comedonal, and cystic. As the name implies, cystic acne is where painful cysts form on the skin. Although adults and adolescents both develop cystic acne, it’s more common in teens and adolescents, likely due to hormonal factors. It’s also the most severe form of acne and the hardest to treat using topical treatments you apply to the surface of the skin. However, treatment is important since it carries a higher risk of scarring, but treatment is challenging.
Topical Treatment of Cystic Acne and Why It Doesn’t Always Work
Most people treat acne from the outside with an appropriate cleansing routine and topical agents, but cystic acne doesn’t always respond to these measures. That’s because cystic acne has a strong inflammatory component and inflammation is more than skin deep. You can’t stop inflammation by applying a treatment to the surface of the skin. If you could see acne cysts, you’d be surprised at how deeply they are embedded in skin tissue and they don’t connect to the surface. Therefore, it’s hard to get topical treatments to the root of the acne lesion.
Most dermatologists still recommend topical treatments, like retinoids and benzoyl peroxide, but these alone may not be enough to clear up cystic lesions and prevent their recurrence. In severe cases, a dermatologist might recommend oral antibiotics to control the cystic outbreaks or they may recommend retinoids in oral form.
Oral retinoids are effective but they’re highly teratogenic, meaning they cause birth defects in an unborn child when people take them during pregnancy. That’s why you must prove you’re not pregnant by taking a pregnancy test before a doctor will prescribe them to you in oral form. However, oral retinoids, like Accutane, are a more definitive answer to the problem as they dry up the oil glands enough to stop cystic outbreaks and acne.
The Role of Antibiotics
Oral antibiotics don’t just help cystic acne by killing bacteria that contribute to the lesions, but also by reducing inflammation. The two most common antibiotics dermatologist prescribe for cystic acne are erythromycin and tetracycline, as both have anti-inflammatory benefits independent of their anti-bacterial effects. A drawback of taking antibiotics is they disrupt the gut microbiome and it may take months or even years for it to fully recover. If you take antibiotics, consider taking a probiotic to replace some of the bacteria the antibiotic destroys. Most dermatologists recommend taking the antibiotic for six months to a year.
Despite the fact that some oral contraceptives worsen cystic acne, there are certain types of oral contraceptives that improve cystic acne because they block hormones called androgens that worsen acne symptoms. If you have severe symptoms and you’re female, it’s another option to discuss with your dermatologist.
What to Avoid
Some lifestyle habits that can aggravate cystic acne are hormonal changes, taking certain medications, being in a humid environment, and using cosmetics that further block the pores and worsen acne. It’s also important to wear loose clothing if you have cystic acne on your body to allow the air to circulate around the surface of your skin.
An example of a type of medication that can worsen cystic acne are medications used to control seizures. If you’re taking medications, talk to your physician about whether it could be contributing to the cysts and whether there’s a substitute. Oral contraceptives and corticosteroid medications also commonly worsen cystic acne.
Although there are few studies looking at the role of diet in cystic acne, it makes sense that eating an anti-inflammatory diet might have benefits. Research shows a traditional Mediterranean diet that emphasizes fruits, vegetables, nuts, whole grains, fish, and healthy fats, like olive oil, might be effective. Avoid foods high in sugar and refined carbohydrates.
Other Tips for Dealing with Cystic Acne
• Don’t pop cystic lesions. Doing so can lead to scarring.
• If you have swelling around an acne cyst, apply a cold pack to the area.
• Apply benzoyl peroxide combined with 1% hydrocortisone once per day to bring down surface inflammation.
• Use a gentle cleanser and avoid scrubbing or rubbing your face, chest, or other areas with an outbreak.
The Bottom Line
Cystic acne is the most serious and difficult-to-treat form of acne and one that can lead to scarring. Therefore, it may need treatment that goes beyond good skincare and topical treatments. It’s important to see a dermatologist if you think you have it. See Also: Don’t Believe These 5 Common Myths About Skin Aging
- MacGill, M. (2017, December 4). Everything you need to know about cystic acne. Medicalnewstoday.Com. Retrieved March 17, 2022, from https://www.medicalnewstoday.com/articles/103258
- Cherney, K. (2019, March 8). What Is Cystic Acne and How Is It Treated? Healthline. Retrieved March 17, 2022, from https://www.healthline.com/health/beauty-skin-care/cystic-acne
- Ayer, J. (2006). Acne: more than skin deep. Postgraduate Medical Journal, 82(970), 500–506. https://pubmed.ncbi.nlm.nih.gov/16891439/