Cystic Acne 101: What are they, what are the causes, and how do we treat them?

Disclaimer: This article is only a supplementary reading about cystic acne and is not a substitute for medical advice. We strongly suggest that you consult and work with  a dermatologist and/or a reproductive endocrinologist regarding your cystic acne.

If you’ve ever had pimples, chances are that you’ve also experienced getting cystic acne. These pimples occur deep in the skin, making them extremely painful and also very difficult to get rid of. Worst of all, they often last for weeks and can’t be treated with your normal routine. Don’t feel desperate though; we’re here to help!

Unlike your usual pimples which are caused by blockages in your pores (acne vulgaris), cystic acne is technically a type of Acneiform eruption, a disease of the skin. They are usually caused by infections, hormonal problems, metabolic disorders, genetic disorders, and even drug reactions. Apart from the face, your chest, back, and upper arms of the body can be affected as well.

Cystic acne can be permanently damaging to the skin by leaving atrophic or hypertrophic scars. An atrophic scar leaves an indent on the skin and creates a crater-like appearance, while a hypertrophic scar is a thickened, wide, and often raised on the skin. The chance of scarring often increases because people with cystic acne often delay consulting with a dermatologist, in the hope that the cysts would go away on their own. Because of possible permanent damage, it’s best to seek out and follow specialized medical treatment. Waiting too long before seeing a doctor can cause your condition to worsen and require more advanced treatment.

Image via rd.com

Image via rd.com

These acne cysts are not only physically painful, but can take a toll on mental health as well. People with severe cystic acne may experience anxiety, depression, low self-esteem, insecurity, and social isolation. Their appearance can cause them to fear or even refuse to attend school or work. Some may also have difficulty in securing jobs or experience bullying from peers. Cystic acne isn’t just a cosmetic issue - it’s a serious health concern that should be addressed immediately.

Ready to see a doctor? Your dermatologist will ask you to recount your history: How long have you been experiencing cystic acne? How do they occur? How does it affect you? Try to recall all relevant details so that they can make an accurate diagnosis. In case hormonal problems are the suspected cause of your cystic acne, they may refer you to a reproductive endocrinologist to address the hormonal issues. Otherwise, oral antibiotics, conventional topical treatment, and periodic corticosteroid injections are usually prescribed to keep cystic acne under control.

Clinical Dermatology (Figure 7-3) by Thomas Habif, MD

Clinical Dermatology (Figure 7-3) by Thomas Habif, MD

Cystic acne requires moderate to severe treatment following your doctor’s prescription, so don’t attempt to self-medicate as the wrong treatment can potentially put your health at risk. Commonly prescribed medications include benzoyl peroxide, retinoids, isotretinoin, and oral contraceptives.

  • EPIDUO Anti-Acne Gel (2.5%) (P1,450 at Watsons) is an adapalene benzoyl peroxide product that helps to reduce the size and inflammation of cystic acne.

  • Oral contraceptive pills that contain Cyporterone acetate, an anti-androgen medication, controls excessive oil formation, excessive hair growth, and acne. Althea pills (around P500 from Mercury Drug) is one example.  

  • The Ordinary Granactive Retinoid 2% is an effective treatment for me as well. You can read my experience here. I purchased mine for £8 from CultBeauty.co.uk (they offer free shipping worldwide) but you can also get it locally for P850 at calyxta.com

  • Retin-A is P266.50 for 5g and available from any drugstore.

Photo by Karla Aguas

Photo by Karla Aguas

Isotretinoin (oral medication, Rx), tretinoin (Rx), and retinoids are derivatives of vitamin A that are effective against cystic acne. These products contain active ingredients so make sure to ask your doctor about the right way to use them.

You can also ask your dermatologist about getting corticosteroid injections. This office procedure can instantly reduce the size, inflammation, and pain of your cystic acne, and doesn’t take too long to administer. It’s very useful if you have an important event coming up and you don’t want cystic acne to ruin it.

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Optional: You might want to put a pimple patch on it! It’s not a treatment and might not necessarily help in draining the fluid out (since cystic acne is much more complicated than just pus and comedones) but it can help protect the affected skin and keep you from touching it. Don’t attempt to pop cystic acne as it can result in a worsened infection and cause deep scarring. It’s especially dangerous for acne on and around your nose, as getting an infection in this area can actually lead to blindness or stroke. Better safe than sorry!

We hope you find this article useful, and if you have cystic acne, do see a doctor for proper treatment soon!