understanding cystic acne

Acne is a skin disorder that presents in varying degrees. Cystic acne is the most severe form of acne and presents as large nodules beneath the surface of the skin, as well as papules, pustules and comedones. These nodules often rupture in the follicle wall, leading to inflammation and tissue destruction, which all too often results in permanent scarring. Acne of this severity does not respond to over-the-counter acne treatment and can be hard to control without medical intervention. Cystic acne can affect anyone, but seems to be more common in teenage boys. There also seems to be a tie to genetics as well. For example, if both parents suffered from cystic acne, it is more likely their children will too.

Photo courtesy of homoeopathy-books.blogspot.com.

Photo courtesy of homoeopathy-books.blogspot.com.

causes and effects

  • Increased sebum production  and keratinization (excess of dead cells) within the follicle
  • Proliferation of propionibacteria acnes (p. acnes) – the bacteria that causes acne
  • Hormone imbalances and hormone-related disorders (e.g. polycystic ovarian syndrome)
  • Inflammation and painful nodules that can remain for weeks or months
  • Depth and inflammation of lesion can destroy the follicle and often results in scarring
  • Usually presents as systemic, appearing on other areas of the body, including arms, chest and back
  • Sufferers of cystic acne often experience self-esteem issues along with social withdrawal

diagnosis and treatment

Only a dermatologist can diagnose and treat cystic acne. Prescription strength treatments include:

  • Retinoids, which help to increase cellular turnover
  • Topical and oral antibiotics, which decrease p. acnes bacteria proliferation and may reduce inflammation
  • Oral contraceptives (used off-label by women), which control sebum production and regulate hormonal fluctuations
  • Combination therapy of oral and topical medications
  • Surgical excision and drainage performed in-office by a dermatologist
  • Doctor administered corticosteroid injections directly into the infected nodule
  • In-office treatments delivering oxygen to the skin, which help decrease p. acnes bacteria

It may take several tries to find the treatment or combination of treatments that manage cystic acne.

treating scars and managing post-inflammatory hyperpigmentation (PIH)

  • Regular, gentle exfoliation with superficial chemical peels
  • Laser resurfacing for deeper scars to break up scar tissue and encourage healthy collagen production
  • Radio frequency treatments to breakdown damaged tissue and allow for new collagen formation
  • Regular use of products that contain blends of effective melanogenesis inhibitors, including hydroquinone, arbutin, kojic and lactic acids, as well as resorcinol derivatives
  • Continued use of retinoids, which are proven melanogenosis inhibitors and encourage regular cellular turnover
  • Daily use of broad spectrum sun protection to decrease the risk of post-inflammatory hyperpigmentation (PIH) from increased sun sensitivity caused by many acne treatments

It is strongly recommended that a patient consult with his or her physician before receiving any treatments to address scarring, in order to avoid any further skin complications.

Feel free to call us at 877.PCA.SKIN [722.7546] or email us at info@pcaskin.com with questions about treating cystic acne.


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