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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.
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?
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.
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
It is vital to consult your doctor for cystic acne as it is a severe skin condition that requires intense systemic interventions.
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.
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.
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:
- 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
Since cystic acne can cause permanent scars, it is suggested to visit a dermatologist in all cases, especially if the acne is severe.
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.