What is cystic acne?
When a pore gets clogged from skin cells, oil, and bacteria, it can become infected, leaving a red and swollen bump. Cystic acne occurs when this infection goes deep into the skin, creating a bump that can be painful to the touch.
Cystic acne tends to occur more often in people with oily skin, but anyone can develop it. It’s also more common in teenagers and young adults, although it can develop later in life, especially in women.
Cystic acne may improve over time, but in some cases, it can last for years and affect large areas of the skin. Recognizing the signs of cystic acne is the first step toward clearing your skin and healing the marks left behind.
Symptoms of cystic acne
As cystic acne tends to be severe and difficult to treat, it’s important to know the difference between cystic acne and other forms of acne, like whiteheads or blackheads. Signs of cystic acne include:
In addition to being the most serious form of acne, cystic pimples tend to be larger in size. Whiteheads can range in size from being barely noticeable to around 5 millimeters in size. Cysts, however, tend to be larger and elevated into a noticeable bump. Some may even appear more like boils on the skin.
While other breakouts appear to rest on the skin’s surface, cystic acne exists deeper within the skin. These fluid-filled lumps may feel more inflamed and extend deeper beneath the skin’s surface.
Painful to the touch
In addition to the depth of the lumps, cystic acne is more likely to be painful. When touched, the lump may feel tender or sore. In some cases, you may feel pain even when the lump hasn’t been touched.
Difficult to extract
Cystic acne may be harder to extract than a regular pimple. When fully developed, other forms of acne may develop a “white head,” or a raised white point that can be squeezed to release pus from the clogged pore. Cystic lumps may not develop a white head. This is also called a “blind pimple”.
Causes of cystic acne
Acne isn't necessarily a sign of poor hygiene — other underlying causes can lead to acne developing even if someone washes their face regularly and has a thorough skincare routine. Some studies have found that diet, particularly levels of sugar, can increase signs of acne. However, there is no direct link between cystic acne and diet.
It isn’t clear what causes cystic acne, but in many cases, hormones may play a role. During the adolescent years, the levels of androgen (a group of reproductive hormones) can rise, which leads to changes in the skin. Hormone imbalances during puberty or later in life can lead to cystic acne. Other causes can include:
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Treatments for cystic acne
Cystic acne can be hard to get rid of, but it’s treatable with patience and care. Due to the severity of most forms of cystic acne, over-the-counter treatments like benzoyl peroxide, salicylic acid, or adapalene (common acne medications) may not be enough.
A dermatologist can prescribe prescription treatments for severe cases of cystic acne. Some methods may not work for everyone, and it may take some experimentation to find out what works for you. Depending on the treatment, you may not see results for eight to twelve weeks.
Here are some treatments a dermatologist might recommend:
Around 85% of people who have taken isotretinoin reported improvements in their skin condition within several months of taking it. While it’s proven to be effective, there are some serious risks associated with taking it, including organ damage, high blood pressure, and loss of vision. When taken in low doses, there is a low risk of serious side effects. However, you should still talk with a doctor before use.
Oral antibiotics can kill bacteria and reduce inflammation that could be at the root of your cystic acne. This treatment is most effective when combined with a topical retinoid or another exfoliant. Antibiotics should only be taken in the short term to avoid developing bacterial resistance.
Like isotretinoin, topical retinoids are also derived from vitamin A. However, instead of swallowing them, they’re applied to the skin. Retinoids can unclog pores and stimulate faster turnover of skin cells, which helps even out the skin and reduce the size of cystic bumps. Adapalene is an over-the-counter topical retinoid, although cystic acne may respond better to prescription-strength retinoids.
For cystic acne linked to hormone imbalances or hormone fluctuations, oral contraceptives can be a viable option. Birth control pills contain estrogen, which can regulate hormone levels and reduce acne. However, it doesn’t work for everyone and can lead to changes in the menstrual cycle.
Spironolactone can help manage androgen levels and reduce inflammatory acne. It’s most effective in women with acne on the lower half of their face, including the jawline. One study found that 50 to 100 milligrams of spironolactone daily can help reduce acne.
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American Academy of Dermatology Association: "HOW LONG CAN I TAKE AN ANTIBIOTIC TO TREAT MY ACNE?"
American Academy of Dermatology Association: "Skin conditions by the numbers."
American Academy of Dermatology Association: "STUBBORN ACNE? HORMONAL THERAPY MAY HELP."
American Academy of Dermatology Association: "The prevalence of acne on the basis of physical examination."
Anais Brasileiros de Dermatologica: "Adult female acne: a guide to clinical practice."
DermNet NZ: "Topical retinoids."
Indian Journal of Dermatology: "Safety and Efficacy of Low-Dose Isotretinoin in the Treatment of Moderate to Severe Acne Vulgaris."
Informed Health: "Skin care for acne-prone skin."
Mayo Clinic: "Acne."
National Health Service: "Acne."
The Journal of Clinical and Aesthetic Dermatology: "Oral Spironolactone in Post-teenage Female Patients with Acne Vulgaris."
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