Cystic acne: what is it and what can you do about it?

Cystic acne is probably one of the most difficult forms of acne to treat. The sores are more painful and the chance of scarring from the spots is much greater than with a mild to average form of acne.

Cystic acne is caused by hormones. The skin’s sebaceous glands, for a reason as yet unknown, become extremely sensitive to an increased level of male hormones and they respond by producing excessive amounts of sebum.

The sebaceous glands become saturated, swell, harden and cannot discharge the excessive sebum to the skin surface, which makes them burst under the skin. This causes an acute inflammation with redness and pain. It often results in scarring.    

The cause appears to be genetic. Because hormones play a significant role, the condition usually occurs during puberty, pregnancy, the menstrual cycle, perimenopause and menopause and with polycystic ovary syndrome disorder (that causes cysts in the ovaries).

How do you recognise it?

You can recognise cystic acne by the visible red swellings deep in the skin. These swellings often have a white head. They are painful to the touch, sometimes painful even without being touched. You can often feel the infection before the swelling is visible.

Treatment plan

Cystic acne cannot be completely cured, but there are ways to minimise the effects.

  • Follow a simple, consistent skincare routine. 
  • Use a mild, effective, water-soluble cleanser twice a day. 
  • Avoid bars of soap. The ingredients used to give a soap a solid form can block the pores.
  • Use a BHA (salicylic acid) exfoliant daily. This reduces redness and swelling, reduces the formation of bacteria in the pores and improves the skin’s ability to discharge the sebum. 
  • Additionally, use a product with benzoyl peroxide (available at a pharmacy) daily to kill the bacteria in the pores. Make sure you don’t use products containing irritating ingredients, such as menthol and alcohol, which only increase the chances of redness and inflammation.   
  • Do not use a day or night cream that has a thick texture on areas with cystic acne, since the creamy texture in particular can block the pores. A good alternative is a light gel or lotion. 

If you do not see any improvement after using this treatment plan daily for four weeks, then we recommend you consult a dermatologist.

Sources: Journal of Affective Disorders May 2010, pages 306-308; Contraception, April 2009, pages 282-289; Journal of Drugs in Dermatology, September 2009, pages 837-844; Dermatologic Clinics, January 2009, pages 33–42; Journal of Cosmetic Dermatology, September 2008, pages 180–188; Journal of Drugs in Dermatology, July 2008, pages 627–632; Seminars in Cutaneous Medicine and Surgery, December 2007, pages 210-220; Lasers in Surgery and Medicine, February 2007, pages 180–188; Advances in Dermatology, Volume 23, pages 155–163; and www.medicine.net.

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