Acne was annoying, yet expected during the teen years. But dealing with it as an adult is even more frustrating. Shouldn’t it be buried in the past along with Tamagotchis and butterfly clips? There are different types of acne, but cystic acne in particular can be especially hard to treat. Unlike the odd pimple that pops up every now and then, cystic acne tends to cover more of the face, particularly around the jawline and chin. It can be painful and hard to cover up. So what do you do? Fortunately, it’s something dermatologists see on a regular basis so they have a firm understanding of what causes it and how to treat it—all of which is explained below.
What causes cystic acne?
“Cystic acne is a severe type of inflammatory acne characterized by pimples that are filled with pus, painful, and form deeper within the skin,” explains dermatologist Carol Cheng, MD. According to dermatologist Hadley King, MD, hormonal cystic acne is commonly seen in adult women and is most often seen in a bearded distribution on the face. But, she adds, it can also affect any area of the face, as well as the back, shoulders, neck, and chest. “Acne is almost entirely not our fault and not caused by poor hygiene,” Dr. King says, emphasizing that it’s primarily caused by genetics and hormones. Dr. Cheng explains that one-way hormones can cause cystic acne is because androgens (a group of sex hormones that includes testosterone), can cause the sebaceous glands (small, oil-producing glands) to produce more sebum. This can clog pores and increase inflammation. “Patients with abnormal hormone levels, such as those with PCOS (polycystic ovarian syndrome) may experience acne as part of their symptoms,” she says. And again, that’s not something someone can control. While it’s important to keep in mind and no one should be blamed for their cystic acne, both experts say that there are lifestyle factors that could make symptoms worse. One is diet. “There are studies showing that foods with a high-glycemic index, dairy products, and diets rich in animal products and fatty foods can exacerbate acne,” Dr. Cheng says. Stress could also potentially make cystic acne worse—just like it tends to make everything else in life worse. “While it is unlikely that it is the primary reason for acne, stress has been shown to exacerbate acne,” Dr. Cheng says. It may also be difficult to pinpoint if stress is causing cystic acne or if stress is a result of experiencing it, a bit of a “chicken or the egg” situation. Okay, so now you know what causes cystic acne. Next, comes the big question: How do you get rid of it?
How to say goodbye to cystic acne for good
As with anything that’s affecting your skin, the first step to treating cystic acne is booking an appointment with a dermatologist. It bears repeating that cystic acne is something they see and treat regularly, so they can help determine the best course of treatment for you. At your appointment, Dr. Cheng says that you can expect the dermatologist to ask about your history with acne, including when you first started experiencing it and what treatments you’ve tried (including what seemed to help and what didn’t). Then, they may ask you if you have any other medical conditions or are taking any medications, as these could also be contributing factors. Your dermatologist will likely ask you about your regular activities and diet. Last, they will perform a physical examination and carefully examine any areas of the face and body affected by acne to determine the type of acne and if there have been any scarring or pigment changes. Both experts say that cystic acne can be difficult to treat because of its severity, and Dr. King says topical retinoids often used to treat acne often won’t work. Often, it takes a combination of a few different treatment methods. One common treatment is intralesional cortisone injections. “[They] can be very helpful for treating individual acne cysts, but to treat more frequent or extensive breakouts, systemic options should be considered,” she says. Sometimes, Dr. King says, a dermatologist may prescribe oral antibiotics, although she says this is decreasing in popularity because antibiotics should only be used for a short period of time and other treatment options are proving to be more effective. “For women, hormonal options are often extremely effective for cystic acne that is hormonal, either oral contraceptives or a medication called spironolactone,” Dr. King says, adding that this is not a suitable option for men. “The gold standard for treating scarring acne in both men and women remains isotretinoin,” Dr. King says. She explains that isotretinoin is an oral retinoid that essentially shuts down the oil glands. “It does have potential adverse effects [pregnant women should not take isotretinoin as it has been linked to birth defects], but when used and monitored properly it is generally well-tolerated and delivers dramatic, and usually long-lasting, results,” she says. If isotretinoin isn’t for you, Dr. King says another option is photodynamic therapy. “In this treatment, a light-sensitizing medication is applied to the skin and then the skin is illuminated with a specific kind of light,” she says. “The result is a decrease in oil production by the oil glands, and acne subsequently improves.” Also, since foods that are high-glycemic, have dairy, are primarily from animals, or are high in saturated fat have been linked to making cystic acne worse, both experts say it may be worth it to minimize these foods to see if you notice a difference.
What to keep in mind with your skincare routine if you have cystic acne
When it comes to your skincare routine, both experts say there are a few guidelines to keep in mind. “I would recommend a cleanser that contains an active ingredient used to target a component of acne,” she says, adding that benzoyl peroxide is a good one to look for. “Some other over-the-counter ingredients that can be effective for acne include salicylic acid, AHAs, and sulfur. However, a cleanser alone will not adequately treat cystic acne but is usually part of a more comprehensive regimen,” she says. For moisturizers, Dr. Cheng recommends using an oil-free facial moisturizer with SPF. “[This helps] offset any dryness or irritation that may occur with some acne treatments,” she says. What Dr. Cheng most wants people to know that no one has to live with severe acne. “While cystic acne may be more difficult to clear, the best chances are to seek treatment with a board-certified dermatologist to discuss options,” she says. “Many studies show that treatment for cystic acne not only clears the skin of active acne, but also prevents scars and boosts a person’s mood and self-esteem.” With the help of a qualified dermatologist, your acne will be left behind and you can move forward as your most confident self. Next up, learn more about hormonal acne, including what it is and how to stop it.
Sources
Carol Cheng, MD, board-certified dermatologist with UCLA DermatologyHadley King, MD, board-certified dermatologist who specializes in medical and cosmetic dermatology; clinical instructor of dermatology at Cornell University’s Weill Medical College
