What is Cystic Acne?
Cystic acne is a form of acne associated with long-standing, painful nodules of the face, back of neck, chest, and back.
Adolescent acne goes through certain stages, each of which requires specific therapy. It starts with closed comedos (whiteheads), which may progress to open comedos (blackheads). Unless they are picked, popped, and manipulated, these would only rarely cause scarring. Some of these will progress to what is recognized as acne and, in turn, some of those into pustular acne. Pustules are more likely to scar, especially if they are “popped.” Cystic acne is the final stage of progression of acne and left untreated is a significant source of acne scarring. As these are space-occupying collections of inflammatory material, scarring is predictable.
Cystic acne may involve the face, chest, back, or unique combinations of these. Cystic acne may also be part of a syndrome that also involves some combination of acne on the face with draining lesions and boils of the scalp (dissecting cellulitis of the scalp), axilla (hidradenitis suppurativa), groin, or chest. Conglobate acne is a severe form that may present as a severe cystic acne of the face and trunk, which can also have systemic manifestations such as arthritis and other musculoskeletal problems.
How Is It Treated?
Over-the-counter medicines that work on milder acne often have little effect on cystic acne. A dermatologist will likely recommend one or more of the following:
- Oral antibiotics help control bacteria and lower inflammation. Sometimes your acne may not respond to antibiotics, though. Or you may find they don’t work as well after a few years.
- Birth-control pills help some women by regulating their hormones.
- Prescription-strength creams, lotions, or gels with retinoid, a form of vitamin A, can help unplug your pores and help antibiotics do their job.
- Isotretinoin (formally known as Accutane but now available as the brands Claravis, Sotret, Myorisan, Amnesteem, and Absorica) attacks all causes of acne.
The recommended dosage for most of these medications is to take a pill once or twice daily for about 5 months. For most people, this clears the skin completely and permanently. If it recurs, you can repeat the treatment. Women should avoid becoming pregnant while taking this drug. Spironolactone is a medication that helps you get rid of unneeded water, but also is effective for cystic acne in women. Learn more by setting up a consultation with a dermatologist.
Advice from Dr. Blatnoy: “Do not pop the zits or deep acne. Cystic acne is much deeper and you could risk spreading the infection further into your skin. Popping these zits can cause scarring and further difficulties.”
For a fast, short term remedy one may apply ice directly to the pimple for several seconds which will constrict blood vessels feeding the cyst which reduces swelling and redness. The only way to reduce the occurrence of cystic acne is to see a dermatologist for antibiotics, prescription strength medication, and Accutane. Normal treatments and over the counter medications will have little to no effect on this condition.