Cystic acne

Cystic acne is a severe type of acne. It causes big, painful bumps filled with pus or fluid to form under your skin. Unlike the milder forms of acne, cystic acne can be tough to manage because these blemishes are large and deep.

Acne is a common skin condition that can impact your quality of life, but severe cystic acne can lead to more self-esteem issues. Since cystic acne often leaves scars, it's important to consult with a dermatologist to find the best treatment plan for you.

Cystic acne scars

Cystic acne affects both the skin and the tissue underneath. When an acne cyst begins to heal, your body starts to repair the damage.

During the repair process, your body produces collagen, a protein that keeps your skin elastic, full and hydrated. If your body makes too little or too much collagen, it can result in skin thickening and scarring.

Cystic acne scars can appear as red or dark spots or textured areas on your skin. Some people are more likely to scar than others, but delaying treatment or picking at cysts can increase the risk of scarring.

What's the difference between cystic acne and nodular acne?

Nodular acne is also a severe form of inflammatory acne. These nodules are large, deep and painful. Unlike cystic acne, nodular acne lesions are firmer because they are not filled with pus or fluid.

What causes cystic acne?

Cystic acne is usually triggered by hormonal changes, which can ramp up oil production in your skin. It's common during puberty, but adults can get it too, especially women during their menstrual cycle, pregnancy or menopause. Other causes of cystic acne include:

• Family history of severe acne
• Using oily makeup or skincare products
• Certain medications, such as birth control

How do you get rid of cystic acne?

Cystic acne can be difficult to treat. It's crucial to see a dermatologist early for a diagnosis and treatment plan. Early treatment can help prevent scars and reduce the emotional stress often linked with severe acne. A dermatologist can diagnose cystic acne by examining your affected skin.

Improvement may take time, and you might need to adjust your treatment plan several times. During this period, avoid over-the-counter acne products, including those with salicylic acid and benzoyl peroxide, unless they are part of your treatment plan, as they may worsen your acne.

Should you squeeze cystic acne?

While it might be tempting to try to pop a cystic pimple to relieve pressure or reduce its appearance, doing so can make your acne worse. Here’s why you should avoid popping cystic acne:

• Risk of Infection: Popping a cyst can introduce bacteria, increasing the risk of infection.
• Worsening inflammation: Squeezing the cyst can push the contents deeper into the skin, leading to more inflammation and a larger, more painful cyst.
• Scarring: Cystic acne is already prone to leaving scars, and popping the cyst increases the likelihood of permanent scars or dark spots.
• Delayed healing: Interrupting the natural healing process can prolong recovery time and cause more skin damage.

For painful cysts, applying a clean and warm compress at home may help reduce swelling and promote drainage naturally.

Cystic acne treatment

With any acne treatment plan, it's important to follow a gentle skin care routine that doesn't irritate your skin. Your dermatologist will likely recommend using non-comedogenic (oil-free) skincare products along with a combination of oral or topical treatments for cystic acne. Eating a balanced diet low in excess sugar and oil, as well as managing stress, may also be suggested, as these factors can make acne worse.

Common treatments for cystic acne include:

• Topical creams: Prescription creams or gels with retinoids or antibiotics help fight your skin infection. Topical retinoids also remove dead skin cells, which helps unclog skin pores.
• Oral medications: Antibiotics to reduce inflammation, hormonal treatments like birth control pills or spironolactone for women, or isotretinoin (Accutane) for severe cases.
• Cortisone injections: To quickly bring down inflammation and pain in specific cysts.
• Chemical acid peels: Chemical acid peels can be applied to the skin to remove or exfoliate the surface layers of the skin. Salicylic acid or pyruvic acid both break the bonds that hold the skin's cells together, causing them to shed away or peel. It also helps unclog pores by reducing the amount of oil on the skin and improves skin brightness.
• 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 and bacteria. This treatment also reduces the size and activity of oil-producing glands on the skin.

Cystic acne scar treatments

These cosmetic 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’s sometimes called laser peeling because it removes old skin cells to reveal new, more youthful-looking cells.
• Radiofrequency resurfacing: Using tiny pins, this treatment safely delivers 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.