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What Is Cystic Acne and How Is It Treated?

Why cystic acne develops

Cystic acne is the most serious type of acne. It develops when cysts form deep underneath your skin. This can result from a combination of bacteria, oil, and dry skin cells that get trapped in your pores.

Although anyone can develop acne, cystic acne tends to occur in people with oily skin. It’s also more common in teens, women, and older adults with hormonal imbalances.

Usually, cystic acne can improve with age. However, the stubborn and painful bumps won’t go away on their own. If you suspect you have cystic acne, your dermatologist is your best line of defense. They can prescribe the medication necessary to help clear your skin.

Keep reading to learn how to identify cystic acne and navigate your treatment options.

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Identification

How to identify cystic acne

Aside from being the most serious form of acne, cystic acne also tends to be the largest in size. It’s also deeper within the skin. All other types appear to rest on top of the skin’s surface.

Cystic acne often looks like boils on the skin. Other identifying characteristics include:

  • large pus-filled cyst
  • large white bump
  • redness
  • tender or painful to the touch

Acne cysts are perhaps most noticeable on a person’s face. But they’re also common on the chest, neck, back, and arms. Cystic acne may even develop on the shoulders and behind the ears.

Picture

Picture of cystic acne

cystic acne
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Treatment

Treatment options

Due to the severity of cystic acne, over-the-counter (OTC) treatments for acne aren’t strong enough. This means you’ll need to see a dermatologist for prescription medications. Depending on the type of treatment used, you may not see full results for up to eight weeks.

Talk to your doctor about the following methods used to treat cystic acne. Some cases require combination therapies.

Isotretinoin

Isotretinoin (Accutane), a powerful prescription medication, is considered the most effective treatment measure for cystic acne. It’s derived from a powerful form of vitamin A, taken in tablet form every day.

About 85 percent of people who take it experience improvements within four to six months. Despite the efficacy, there are some serious risks associated with isotretinoin.

Talk to your doctor if you experience any of the following:

  • new or worsening mood disorders
  • inflammatory bowel disease
  • persistent headaches or nosebleeds
  • bruising
  • skin inflammation
  • blood in your urine
  • muscle and joint pain

Oral antibiotics

Oral antibiotics may be used to treat cystic acne if it covers a large area of your skin. These work by decreasing bacteria and inflammation that could be contributing to cystic acne formation. However, antibiotics don’t alleviate excess oil and dead skin cells.

Antibiotics should only be used in the short term, due to concerns over bacterial resistance. If antibiotics aren’t effective, then your doctor will likely recommend you start taking isotretinoin.

Possible side effects of oral antibiotics may include:

  • abdominal pain
  • diarrhea
  • nausea
  • sun sensitivity
  • vomiting

Learn more: The myth of antibiotics and birth control »

Topical retinoids

Topical retinoids are also derived from vitamin A. However, these don’t have quite the strength of isotretinoin. These work by unplugging hair follicles to remove and prevent severe acne.

Retinoids are sometimes used in conjunction with topical antibiotics to make them more effective. Topical retinoids can be used on a daily basis and come in the form of creams, gels, and lotions.

While one OTC retinoid (adapalene) is currently available, cystic acne is usually only responsive to prescription-strength formulas.

These include:

  • Avage
  • Avita
  • Differin
  • Retin-A
  • Tazorac

Using topical retinoids can make your skin red and can also cause it to peel. These side effects are usually temporary as your skin gets used to the medication. Retinoids can also make you more susceptible to sunburn, so be sure to wear sunscreen.

Spironolactone

Spironolactone (Aldactone) is another possible prescription treatment measure for cystic acne. Traditionally, it’s used as a diuretic to help treat edema and high blood pressure. In terms of acne, this medication can work by managing excess androgen levels that could be contributing to inflammatory acne. It’s typically only effective in women with acne on their jawline or lower face.

Spironolactone may cause birth defects, so you shouldn’t take it if you’re planning a pregnancy. People with kidney disease also shouldn’t use this medication.

Researchers in one 2012 study found that doses of 50 to 100 milligrams (mg) per day work best. However, it isn’t uncommon to go as high as 200 mg daily.

This also reduces the risk of side effects, such as:

  • breast tenderness
  • dizziness
  • fatigue
  • headaches
  • high blood potassium (hyperkalemia)
  • menstrual irregularities

Oral contraceptives

Oral contraceptives are a viable option for cystic acne in some women. This method is especially effective if you tend to develop acne cysts during hormone fluctuations related to your menstrual cycle.

Birth control pills contain estrogen, which can help regulate overall hormone levels and possibly reduce acne.

Still, oral contraceptives aren’t for everyone. These medications may not be appropriate for you if you smoke, have blood clots, or are trying to get pregnant.

Acne scars

Will scarring develop?

Out of all types of acne, cystic acne is the most likely to scar. You can reduce the risk of scarring by leaving all cysts alone. This means you can’t ever pick or pop cysts. Picking at this type of acne can also spread infections.

Though it’s best to prevent acne scars in the first place, there are some treatments you can try to reduce the appearance of acne scars. However, it’s important to treat active acne first and address scars after the acne is under control.

These include:

  • chemical peels
  • dermabrasion from a dermatologist
  • laser resurfacing from a dermatologist
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Skin care tips

General skin care tips

Taking care of your skin is the best way you can help prevent cystic acne.

Aim to:

  • Wash your face once a day in the evening. Use a cleanser that removes excess dirt and oil, but isn’t excessively harsh or drying. Scrubs can irritate existing inflammatory acne and make it worse.
  • Avoid picking at your skin. Even picking less severe forms of acne can lead to cystic buildups.
  • Select makeup products that are labeled “noncomedogenic” and “oil-free.” These are less likely to clog your pores.
  • Never go to bed with makeup on.
  • Wear sunscreen every day. This will help prevent sunburn from acne medications that may sensitize you to sun exposure, as well as skin cancer.

Some of the following lifestyle changes can also impact your overall skin health and reduce cystic acne from forming:

  • Try to find ways to alleviate unnecessary stress in your life. Stress is linked to acne breakouts.
  • Avoid foods that have high glycemic levels. These include white breads, pastas, and rice, as well as sugary treats.
  • Wash your face and body after working out to remove oil and bacteria.

Keep reading: Guide to taking care of your skin »

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See your dermatologist

See your dermatologist

In most cases of cystic acne, you’ll need to see a dermatologist to clear it up. Whether it’s a prescription medication or surgical removal, your dermatologist is your best resource. Acne cysts are so difficult to treat at home. Cystic acne can also lead to significant scarring.

In addition to medical treatments, your dermatologist can also help you prevent recurring cases of acne. Keep in mind that any new skin care regimens can take several months before you see significant results. Leaving the cysts alone can also help prevent them from coming back.

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