Acne and cystic acne causes & treatment

Whether you call them zits, blemishes, spots or pimples – all these names describe a common, often uncomfortable and sometimes embarrassing skin condition known as acne. Acne can appear during childhood or adulthood. It can show up anywhere on the body, but it usually appears on the face, neck, shoulders, upper back and chest.

Acne affects the skin's sebaceous (oil) glands, which can become clogged, forming red spots, comedones (blackheads and whiteheads) or deep papules, pustules, nodules or cysts. The most severe form of acne, which usually requires medical treatment, is cystic acne.

Fortunately, there are a variety of topical, oral, procedural and cosmetic treatment options to help get rid of cystic acne and acne so you can get back to looking and feeling your best.

Types of acne

There are two main types of acne: noninflammatory and inflammatory. Noninflammatory acne occurs when the pores become clogged with oil and dead skin cells, resulting in a whitehead or blackhead.

When bacteria enter the clogged pores and get trapped along with the oil and skin cells, it causes swelling deep inside the skin. The result is inflammatory acne.

Noninflammatory acne

• Whiteheads: Small blemishes with white-colored heads that appear when follicles become clogged with oil
• Blackheads: Very small, black spots on the skin that are caused by oil build-up in an open follicle, and then darkened due to oxidation

If you have noninflammatory acne, your doctor may recommend over-the-counter benzoyl peroxide and salicylic acid products to remove excess bacteria and dead skin cells.

Inflammatory acne

• Papules: Tender, reddish bumps that may appear swollen or inflamed
• Pustules: Similar to papules, pustules are inflamed red bumps that contain yellow or white-colored pus
• Nodules: Large, inflamed and sometimes painful acne breakouts – often referred to as severe acne or nodular acne
• Cysts: A form of severe acne, called cystic acne, produces large, deep, painful, pus-filled acne cysts, or cystic pimples, on the skin

Cystic acne

Cystic acne, a type of severe acne, is characterized by conical-shaped growths, often with a visible whitehead.

Cysts that are not caused by acne are called sebaceous cysts. These cysts grow into moveable, sometimes significantly large (up to two inches in diameter) masses beneath the skin. Sebaceous cysts can grow and develop in weeks, months or even years.

Cystic acne scars

When you have cystic acne on your chin, forehead, nose, back, shoulders or chest, it compromises the skin and the tissue beneath it. As the acne cyst begins to clear up, your body fights to repair the damage. Cystic acne scars appear as red, dark spots or textured areas where the surface of your skin has been affected.

In order to repair the damage, the body produces collagen. If your body produces too little or too much collagen during this process, you’ll notice an acne scar.

While some people are more prone to scarring than others, any of the following can increase the risk of developing acne scars:

• Deep, severe acne: Swollen cystic acne and nodules are more likely to leave behind acne scars.
• Relatives who also had acne scars: Genetics tend to play a big role in the presence of acne and acne scars.
• Delay in acne treatment: The longer you've had untreated inflammatory acne, the greater the risk of scarring.
• Picking or squeezing acne spots: Popping or picking at acne creates skin inflammation, which increases the risk of acne scars.

Ways to prevent acne

It's not always possible to prevent acne, especially if you have a family history or are going through hormonal changes. However, sticking to a doctor-recommended acne skin care regimen is a good first step. You also can lower your risk of acne breakouts by:

• Applying oil-free moisturizer if your skin feels dry
• Avoiding foods with refined sugar
• Washing your hair regularly and keeping hair (which can be oily) away from your face
• Using noncomedogenic (water-based) makeup and facial products
• Always removing makeup before going to sleep
• Avoiding picking or popping pimples or scabs
• Keeping your hands away from your face
• Trying to avoid oily environments, such as working in a restaurant kitchen

Causes of acne

Acne is a common condition, especially in adolescence. Because of this, it can be difficult to pinpoint a specific cause for each individual case of acne. However, the most common acne causes include:

• Hormonal changes when starting puberty and entering adulthood
• Medications such as corticosteroids, androgens or lithium
• Continuous pressure or friction against the skin
• Genetic predisposition

People often get acne during puberty, when hormonal changes cause the oil-producing glands under the skin to become more active. Though acne is most common from ages 11 to 30, some people (especially women) develop acne later in life. Adult acne may be caused by hormonal changes, birth control, stress and certain medications.

Treatment options for acne

There are a variety of treatment options for acne, with different treatments working better for different skin types. Your doctor will advise beginning with a skin care regimen that includes thorough, gentle cleansing at least twice a day to remove excess oil and bacteria. The goal of any acne treatment is to minimize scarring, reduce your acne, improve your skin’s appearance and help you feel your best.

Topical acne treatments

The following are applied directly to the skin:

• Antimicrobials such as benzoyl peroxide, topical erythromycin, topical clindamycin and topical dapsone
• Retinoid medications
• Azelaic acid
• Salicylic acid
• Sodium sulfacetamide

Oral acne medications

These are taken by mouth and used mainly for cystic acne treatment:

• Antibiotics: Doxycycline, minocycline, trimethoprim-sulfamethoxazole or erythromycin>
• Spironolactone: Used only in adult women for cystic acne treatment. Targets hormones that can contribute to acne.
• Isotretinoin: Used only for severe acne that doesn’t respond to other treatments (formerly known as brand name Accutane).

Procedural acne treatments

These treatments are performed in your doctor’s office to help diminish and prevent acne cysts and nodules. It’s best to avoid these treatments in the summer months and to use a strong SPF sunscreen afterward to prevent damage to the newly exposed and very tender skin layers.

• Salicylic acid peel: This liquid treatment is applied to the skin to remove or exfoliate the surface layers of the skin. Salicylic acid breaks the bonds that hold the skin's cells together, causing them to shed away or peel. It also helps unclog pores and reduce the amount of oil on the skin.
• Pyruvic acid peel: This liquid treatment is applied to the skin to remove dead and damaged skin cells. It also improves skin brightness, fades discolored areas and reduces excess oil in the skin.
• Photodynamic therapy: After applying a topical photosensitizer, a medical light source is focused on the skin to activate it. Combined with the photosensitizer and the presence of oxygen, the light helps destroy acne cysts, nodules and bacteria. This treatment also reduces the size and activity of oil-producing glands on the skin.

Cosmetic acne treatments

These treatments help minimize scars left behind by severe cystic acne breakouts.

• Dermabrasion: This procedure removes acne scars and gives skin a smoother look. During the process, your provider uses a special surgical scraping tool to remove the layers of skin that cover the collagen layer.
• Laser resurfacing: This procedure uses a wand-like laser instrument to remove the upper layers of skin from acne scarring. It is sometimes referred to as laser peeling because it removes old skin cells in order to reveal new, more youthful-looking cells.
• Radiofrequency resurfacing: The treatment uses tiny pins that safely deliver energy through the skin's surface. This creates tiny wounds that initiate a natural healing process and accelerate the formation of new, healthy tissue. The result is an improved skin tone and texture and smoothing of acne scars.

Treatment locations

Our dermatologists offer acne treatment at locations throughout eastern Wisconsin and northern Illinois, with clinics in:

Brookfield
Burlington
Greenfield
Gurnee, IL
Kenosha
Menomonee Falls
Mequon
Milwaukee*
New Berlin
Plymouth
Sheboygan
Summit
Waukesha

*multiple locations

Choose the acne clinic nearest you or find a nearby dermatologist.