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Home > Skin & Beauty > Acne > Cystic Acne: Causes, Symptoms, and Medical Treatment

Cystic Acne: Causes, Symptoms, and Medical Treatment

December 23, 2020 - Updated on January 20, 2022
6 min read
By Akanksha Shah Sanghvi, MD, Clinical Dermatology

In this article:

  • How Common Is Cystic Acne?
  • How Does Cystic Acne Form?
  • Causes of Cystic Acne
  • Symptoms of Cystic Acne
  • Medical Treatment for Cystic Acne
  • Diagnosing Cystic Acne
  • Risk Factors for Cystic Acne
  • When to See a Doctor
  • Final Word

The formation of large acne lesions deep within the skin is medically known as cystic acne. It is a severe form of acne, which is often painful. These lesions, known as cysts or nodules, form due to severe inflammation of a blocked skin pore.

cystic acne

Due to their appearance as large, red bumps on the face, cystic acne is often a source of low self-confidence and self-esteem for those affected. (1) However, various medical treatments are available to help manage cystic acne.

How Common Is Cystic Acne?

Acne, one of the most common skin conditions, affects 40–50 million people in the United States alone. (2)(3) Fortunately, cystic acne is less common, affecting 12% of adult females and 3% of adult males. (4)

How Does Cystic Acne Form?

formation of cystic acne

Cystic acne generally appears when the skin pores are plugged with sebum, bacteria, and dead skin cells, further causing inflammation and infection. As a result, the skin cell wall might weaken and rupture, enabling the spread of infection, which causes more acne.

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While the exact cause behind the development of cystic acne is not known, it is suggested that androgen hormones play a role. As the androgen hormones increase during puberty, sebum production and the growth of skin cells increase, raising the risk of cystic acne.

Causes of Cystic Acne

Aside from the influence of androgen hormones, the following factors may contribute to the development of cystic acne:

  • Hormonal imbalance in women around menstruation
  • Pregnancy-related hormonal fluctuation
  • Reaction to skin products such as cosmetics, lotions, and cleansers
  • Sweating and humidity
  • Exposure to toxins or chemicals
  • Certain medicines such as lithium, phenytoin, corticosteroids, and isoniazid

Several other causes are popularly thought to cause acne, including nuts, greasy food, chocolate, and sexual intercourse. However, scientific research dismisses these claims.

Symptoms of Cystic Acne

Cystic acne manifests as persistent and painful nodules that appear on the face, neck, back, and chest. The cysts are around 5 mm in diameter, soft, and filled with fluid.

Cystic acne, when resolved, can often cause long-term damage to the skin, such as:

  • Shallow depressions on the skin
  • Ice pick scars that are small, deep pits
  • Large pits on the skin surface
  • Raised scars

Medical Treatment for Cystic Acne

treatment for cystic acne

It is vital to consult your doctor for cystic acne as it is a severe skin condition that requires intense systemic interventions.

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One treatment may work for someone, but it may not work for you. Therefore, you need to be patient and work with your doctor to find the right treatment or combination of treatments for your condition.

Some common treatment methods include:

1. Oral antibiotics

These are often the first treatment method prescribed to those with cystic acne. Antibiotics help control the infection; however, they must be used for only a short term to prevent the development of bacterial resistance. You may also be given topical products along with oral antibiotics.

2. Isotretinoin

This is a derivative of vitamin A that can help inhibit the flow of sebum. (5) Isotretinoin can help control excessive oil production, clogging of pores, bacterial growth, and inflammation, all of which contribute to cystic acne.

Isotretinoin is found to have a permanent effect in around 85% of patients. (6) However, it may have side effects.

3. Oral contraceptives

Women can take birth control pills for acne caused by hormonal imbalance. These are generally used along with antibiotics in the case of cystic acne.

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4. Surgery

This involves the excision of acne cysts to help drain out the pus and to remove the infected skin cells.

5. Corticosteroid injections

Injecting steroids into the acne lesions can help manage the inflammation and thus help reduce pain.

6. YAG laser

A YAG laser beam works by vaporizing the scarred tissue off the top skin layer. The energy absorbed by the skin also helps stimulate collagen production.

7. Chemical peels

This treatment method involves the application of mild alpha and beta hydroxy acids on the face for a few minutes. This helps remove the epidermal skin layer, revealing newer, smoother skin. Treatment may be repeated until desired results are seen.

Diagnosing Cystic Acne

Cystic acne can generally be diagnosed through a physical exam, which involves looking for inflammatory lesions or the pink scars. However, a dermatologist may take a closer look to rule out other conditions that produce similar physical symptoms, including folliculitis, rosacea, milia, and perineal dermatitis.

Risk Factors for Cystic Acne

The following factors can predispose you to the development of cystic acne:

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  • Adolescence
  • Family history of cystic acne
  • Hormonal changes during puberty or pregnancy
  • Friction on the skin, caused by tight collars, backpack, helmet, cellphones, and other similar items
  • Contact with or use of oily substances such as creams and lotions

When to See a Doctor

when to consult a doctor regarding cystic acne?

Since cystic acne can cause permanent scars, it is suggested to visit a dermatologist in all cases, especially if the acne is severe.

What you may ask your doctor
  • What treatment options would be suitable for me, and do they have any side effects?
  • Do I need to make changes to my diet or skin care routine?
  • What skin products can I continue to use?
  • When can I expect my acne to clear upon starting treatment?
  • Can I take any self-care measures to help treat the acne?
What your doctor may ask you
  • When did you first notice the appearance of the acne?
  • Are you on any medications or contraceptives? Have you tried any OTC medications for the acne?
  • What skin products do you use?
  • Is the acne affecting your confidence or social life?
  • Does anyone else in your family have cystic acne?

Final Word

While acne is common, you should feel free to consult your doctor if it is affecting your quality of life, especially if the problem is severe. Cystic acne is often accompanied by feelings of anxiety and depression.

Various medical treatments can help manage cystic acne and thus help rebuild your confidence. Make sure to be patient with your treatment to observe results and follow up with your doctor regularly to find the course of treatment best suitable for you.

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Continue Reading Continue ReadingHome Remedies for Cystic Acne and Self-Care Tips
References
  1. Hazarika N, Archana M. The Psychosocial Impact of Acne Vulgaris. Indian journal of dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5029236/. Published 2016.
  2. J; K. Review of the innate immune response in acne vulgaris: activation of Toll-like receptor 2 in acne triggers inflammatory cytokine responses. Dermatology (Basel, Switzerland). https://pubmed.ncbi.nlm.nih.gov/16205063/.
  3. Al-Hammadi A, Al-Ismaily A, Al-Ali S, et al. Topical, Biological and Clinical Challenges in the Management of Patients with Acne Vulgaris. Sultan Qaboos University medical journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868513/. Published May 2016.
  4. Tanghetti EA, Kawata AK, Daniels SR, Yeomans K, Burk CT, Callender VD. Understanding the burden of adult female acne. The Journal of clinical and aesthetic dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935648/. Published February 2014.
  5. Endly DC, Miller RA. Oily Skin: A review of Treatment Options. The Journal of clinical and aesthetic dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605215/. Published August 2017.
  6. Ryan-Kewley AE, Williams DR, Hepburn N, Dixon RA. Non-antibiotic Isotretinoin Treatment Differentially Controls Propionibacterium acnes on Skin of Acne Patients. Frontiers in microbiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524737/. Published July 25, 2017.
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