Cystic acne? 5 Comprehensive Questions Answered by a Dermatologist

While acne is a common skin disease, it is often difficult to treat severe acne, like the nodulocystic form. Also known as cystic acne or nodular acne, such severe forms can cause significant damage to the skin and affect one’s self-esteem.

Is my acne mild or severe?

If you find that you have only one or two pimples appearing at a certain time of the month, it is considered physiological acne and it is mild. The occasional outbreak you experience is often resolved on its own.

However, if the original blackhead or whitehead becomes badly infected by surface bacteria that it triggers the skin’s inflammatory response, a cyst wall may form around the original site of inflammation.

How do I know if I have cystic acne?

Cystic acne, or nodular acne, are larger and more severe than the typical pimple. These nodules feel like stubborn, firm bumps under the skin and can last for months. You can get them on the face, neck, back, chests or shoulders.

What causes cystic acne?

Cystic acne develops from milder forms of acne. Oil and dead skin skins that clog the oil gland also traps bacteria within, causing inflammation. You may also be genetically disposed to developing cystic acne, if your parents had severe nodules, you are more likely to get it.

Hormones are also another major cause for cystic acne, which may explain why they can develop during puberty. Hormonal changes that take place during pregnancy can also trigger cystic acne.

What happens when your cystic acne is not treated?

Treatment of cystic acne can be challenging as topical treatment is usually less effective. If left untreated, your cystic acne may become a permanent scar. This can be painful, red and get secondarily infected over time. If the condition worsens, an abscess will develop, that is a collection of pus under the skin.

Do not squeeze or pick the pimple, as it introduces more bacteria to an already infected cyst. Extraction of the cyst with sharp objects by non-medical professionals should also be avoided, as they are not safe and sterilized in a medical environment. Doing so only introduces potential for bacteria to affect you, even if you are not acne prone.

For example, we have been referred patients who had what started as an ordinary pimple, infected by a rare infection known as atypical mycobacteria. The bacteria originated from tap water with use of an unsterilized instrument by a facialist, leading to granulomatous infection of the skin and led to a sequence of biopsies as well as several months of oral antibiotics for treatment.

How should you treat cystic acne?

When you develop a single bump that becomes large and painful, it is a sign that your acne may be severe. If the acne does not disappear after a maximum of 2 months, it is unlikely that it is just normal physiological acne. This warrants medical treatment before the cystic acne worsens. Over-the-counter acne treatments are less effective against cystic acne and it is best to visit an accredited dermatologist as soon as possible.

Under the care of a dermatologist for assessment, one would expect an injection of triamcinolone, a steroid that can reduce swelling and inflammation, leading to the resolution of the cyst wall.

Another common therapy is oral isotretinoin, known for its efficacy for cystic acne. Severe acne tends to be unresponsive to drugs such as oral tetracycline or topical adapalene/benzoyl peroxide. It helps to fight acne by reducing the size and activity of your oil glands and reducing acne-causing bacteria.  However, isotretinoin also has side effects, limiting its usefulness for certain patients. Side effects include liver damage, depression, behavioural change and risk of causing serious birth defects. Isotretinoin can also make your skin feel very dry. Your eyes will also feel drier than normal.

Cosmeceuticals should also be used in tandem with oral medications. Use moisturizers regularly, such as Multi-CERAM™ Moisturizer for a healthy and hydrated skin barrier. Vitamin C serums have anti-acne abilities and help to accelerate healing scars. An anti-bacterial cleanser is also essential to allow a thorough cleanse, consider a gentle cleanser such as Miel Honey™ Cleanser.

To treat scars, chemical peels and laser resurfacing can be considered.

Visit a dermatologist to get a professional diagnosis, who will be able to pick the best form of treatment to suit the severity of your acne and reduce scarring.