Cystic Acne: Not All Blemishes Are Created Equal

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Dermatologist Dr. Derek Chan with Advanced Dermatology PC offers Tips on Understanding Cystic Acne

Dr. Derek V. Chan

Large, red, painful bumps that are deep under the skin might be cystic acne, a more serious form of acne that won't respond to a quick fix and may linger for weeks or months.

Few of us get through our teen-age and young adult years without at least some experience with acne. The red bumps, whiteheads, and blackheads that pop up just before a big date or an important job interview are among the facts of life and most fade with time and with over-the-counter products that help us mask and treat them. But not all acne is so benign. “Large, red, painful bumps that are deep under the skin might be cystic acne, a more serious form of acne that won't respond to a quick fix and may linger for weeks or months,” says Dermatologist Derek V. Chan, MD, PhD, with Advanced Dermatology P.C. “It isn't likely to clear up on its own and may cause scarring if left untreated. Working with a dermatologist to explore treatment options is the best approach to managing cystic acne.”

What is cystic acne?
The groundwork for acne is laid when the sebaceous glands overproduce the oil (sebum) that normally lubricates the skin. The excess oil combines with dead skin cells that are usually sloughed off to clog the pores, creating an environment in which bacteria thrive. The clogged pore may result in a whitehead or, if the pore is open to the air, a blackhead. If bacteria infect the pore, inflammation results, causing a pimple. Surging hormones during the teen years cause overproduction of oil and thus a prevalence of acne in young people. Cystic acne occurs when blockage and infection occur at a deeper level under the skin and affects adults as well as teenagers. Cystic acne creates a red, tender, pus-filled bump that may hurt or itch. It does not come to a head like a pimple but if it bursts, the infection can spread and cause more eruptions. A bacterium in the skin, Propionibacterium acnes, also contributes to acne pathogenesis by breaking down sebum, thereby creating byproducts that promote acne formation. Additionally, it stimulates the immune system, and the resulting inflammatory response can lead to worsening inflammatory/cystic acne.

What causes cystic acne? Who gets it?
As with milder acne, the primary trigger for cystic acne is hormonal activity as surging levels of androgen at puberty cause overproduction of sebum. But hormonal changes due to the menstrual cycle, pregnancy, birth control, and even stress can also be involved as well as other factors including genetics; risk increases if a parent has had cystic acne. It is not caused by chocolate, nuts, greasy foods or other dietary choices – although dairy products can cause outbreaks in some people -- or by improper face-washing. Cystic acne is more common in men.

How is it treated?
Cystic acne is not generally responsive to over-the-counter acne medications. A dermatologist might recommend one or more of the following treatments:

  • Oral antibiotics can help control bacteria and reduce inflammation.
  • Isotretinoin, a prescription medication, is an effective treatment but has significant side effects and is particularly dangerous during pregnancy.
  • Birth control pills, which regulate hormones and suppress sebum production, help some women. A drug called spironolactone, a synthetic steroid that suppresses androgen production, may be prescribed with the pill.
  • Prescription-strength lotions and creams that contain retinoid, a form of vitamin A, can help unclog pores, and reduce the risk of infection.

In addition to the treatment plan recommended by a dermatologist, Dr. Chan provides tips for care that can help prevent or minimize outbreaks:

  • Don't pick, pop, scratch, or squeeze a cyst. It won't help, it can make the infection worse, and it can make scarring more likely.
  • Don't wash too often or scrub harshly. Use only mild soap or cleanser – no abrasive, astringent or exfoliating products – and pat dry gently.
  • Don't use heavy makeup or anything greasy on the skin.

“Treatment is important to reduce the risk of scarring that results from long-term cystic acne and to reduce the emotional distress that accompanies it,” says Dr.Chan. “Following a healthy diet and getting plaenty of sleep and exercise will help. With the advice of your doctor, breakouts can be treated and cystic acne can be effectively managed.”

Derek V. Chan, M.D., Ph.D, has particular interests in psoriasis, cutaneous neoplasms, and lasers/cosmetic dermatology.

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies.

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