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Keeping It Clear: Tips and Tricks for Combatting Cystic Acne

The dreaded acne breakout. It shows up at the most inopportune times—right before your Zoom presentation to the team or before a first date. Anyone who has ever experienced an inconvenient pimple knows that it’s annoying but eventually goes away pretty fast. However, there is a big difference between a random breakout and cystic acne. Let’s dig into why cystic acne is so different than a regular breakout.

What is Cystic Acne?

Cystic acne often looks like boils on the skin, while common pimples are more likely to appear on the surface of the skin. Cystic acne develops because a combination of bacteria, dead skin cells, and oil gets trapped deep within your hair follicles. They can appear on the surface of the skin as large pus-filled cysts and large red bumps if they rupture. Cystic acne can also be incredibly painful. While cystic acne is mostly present on the face, it can also appear on the chest and back as well. Because of how severe cystic acne is, treatment with OTC (over the counter) topicals will do very little because they are not strong enough. If you believe you have cystic acne, is important to receive treatment as quickly as possible with a dermatologist. Cystic acne, if left untreated, can lead to severe scarring.

How to Treat Cystic Acne

So how do we treat this type of acne as compared to a random pimple? Prescription topical and oral therapies are necessary to start combating the causes of cystic acne. Dermatologists will often combine two therapies depending on the severity. Oral antibiotics may be used as a first line of treatment for cystic acne. Oral antibiotics work by attempting to decrease the bacteria that is contributing to the deep cysts and large pus-filled cysts. The only problem with oral antibiotics is it will not get rid of dead skin cells and excess oil, which are the other culprits. They are used short term, so you do not develop bacterial resistance.

The oral medication spironolactone is also prescribed for women with cystic acne on their lower face or jawline- the area of hormonal breakouts. It works by managing hormone levels that could be a contributing factor to cystic acne. It is a very commonly prescribed medication, but it may cause birth defects, so you should not take this if you are planning to become pregnant.

Accutane for Cystic Acne

If there is no response to oral antibiotics or spironolactone (for women), the most powerful (and considered the most effective) medication for cystic acne is isotretinoin, or Accutane. It is a powerful derivative of Vitamin A in oral form. Over 80% of patients see improvement within six months of beginning isotretinoin therapy. However, there are several side effects that can occur, such as nosebleeds, headaches, joint pain, and new or worsening mood disorders. Although rare, if you begin to experience any new or worsening depression you must notify your dermatologist immediately. The most severe side effect of isotretinoin is severe birth defects in pregnant women. A mandatory prescribing and compliance system called iPledge is necessary for the use of isotretinoin. You will be required to be registered into the system and meet the requirements of program to receive the medication. Your dermatologist must be enrolled into this program to be able to prescribe it to you.

Retinoid for Cystic Acne

Topical retinoids (different from retinols) are also a derivative of Vitamin A but used on top of the skin. While topical retinoids are nowhere as strong as isotretinoin, they do work to unclog the hair follicles to help break up the cysts and prevent future breakouts. They can be used daily but may make your skin peel and flake and make you more sensitive to the sun. A non-comedogenic physical sunscreen must be used to protect your skin. Peeling and flaking are temporary and will go away as your skin gets used to this product.

Acne Scarring

Early treatment of cystic acne is important to avoid acne scarring. All acne scarring occurs when a breakout damages the tissue beneath and around it. The dark marks that are left behind, after the pimple that you picked, is not an acne scar, just discoloration of the surrounding skin. Those spots typically fade within a few weeks or months. Cystic acne scarring is severe, and if left untreated becomes increasingly difficult to treat. Depressed scars are the most common, also known as atrophic scars. Depressed scars go deep into the skin and occur when the tissue around the cyst is not healing properly. They can be shallow or deep. They can also look like holes or chickenpox scars. It is important that you do not pick or pop any of the cystic lesions to avoid these scars from forming.

Chemical Peels for Cystic Acne

In-office treatments can also be used as a super charged booster to your treatment regimen. While results from such treatments will never be 100%, adding them into your treatment plan can help to clear your skin more rapidly. Chemical peels are one of the most common treatment boosters. Chemical peels are comprised of gentle acids that help exfoliate the top layers of the skin to help unclog pores and begin to improve deeper scars. Chemical peels are made in different strengths and penetrate to different levels of the skin, so it is important to ensure that you are having them performed by a trained professional to avoid further scarring or other complications. They are often performed in a series of 3-5 monthly treatments.

Lasers for Cystic Acne

Lasers and light-based therapies can also help to improve breakouts and scarring. Light-based treatments, such as Isolaz and Photodynamic Therapy (PDT) work on killing the bacteria that causes the cysts to develop as well as calming inflammation of the larger deep cysts. Lasers are used to resurface the skin which helps to improve the appearance of the deep scars. However, laser resurfacing can only be done once an active cystic breakout is cleared. As with both treatments, a series of treatments (often 5) are recommended, and improvement happens over time and varies from patient to patient.

Fillers for Acne Scars

Fillers can also be used to fill in very deep scars. PRP, or platelet rich plasma, is one of the most common fillers for deep scars. It is an infusion of your body’s own growth factor rich collagen which helps to repair the wound that is causing the scar. A series of treatments is recommended, and maintenance treatments are required to maintain the results. The other popular filler for deep acne scarring is Bellafil®, which is comprised of ingredients that stimulate your body to produce its own collagen. Improvement can last 5 or more years.

Can you prevent cystic acne?

The answer to that is yes and no. Let’s start with the no. Cystic acne may have a hormonal component to it. Lab tests will need to determine if that is the case. Cystic acne can also be genetic. If a parent had cystic acne, the likelihood of you developing it is higher. Bottom line: there are some things you cannot control in the development of cystic acne.

Now let’s get into the yes. Having a good foundational skincare regimen and lifestyle routine will help to reduce some of the contributing factors that cause cystic acne.

At-Home Care for Cystic Acne

First off, the products that you use daily are most important. Washing your face is essentially one of the most important parts. If you are developing cystic acne, chances are you have oily skin. It is important to wash your face morning and night. Aim for a gentle foaming cleanser that removes dirt and excess oil but doesn’t dry you out. If you want to take it up a notch, you can add an acid-based cleanser that contains alpha-hydroxy-acids (AHAs) or beta-hydroxy-acids (BHAs). These will help to exfoliate your skin and unclog pores. These cleansers should be used in the morning to clear out any breakout causing bacteria and dead skin cells that may have been building up overnight. Less is more when it comes to using acid-based products. You can irritate your skin if you use too much! Avoid harsh exfoliants like mechanical brushes, harsh sponges, and facial scrubs. Over exfoliating your skin is not only super irritating, but it can dry out your skin or make you break out more. It is also important to wash your face and body immediately after working out to remove oil and bacteria buildup.

While this sounds completely counterintuitive, you still need to use a moisturizer. Treatments for cystic acne can dry out your skin and make it flaky. Stay away from oils and products that contain glycerin. These ingredients can definitely clog up pores. Use a calming cream formula for sensitive skin or a hyaluronic acid-based moisturizer. This will hold moisture into the skin without creating a breeding ground for breakouts.

Makeup for Cystic Acne

If you wear makeup, select products that are labeled “oil-free” and “noncomedogenic.” Try and avoid layers of heavy makeup which can clog pores. If you are looking for full coverage products, look for mineral pigments and hypoallergenic formulas. Those will be gentle on skin. Instead of painting on layers, use concealer for more targeted spots. Avoid shimmery powders, which can draw attention to cystic acne by attracting light to your face. If you want to set your makeup, use a clean brush and swipe on powder. Don’t push it into your skin with the puff that comes in the compact. Make sure that you are washing your brushes weekly and using a cleansing spray in between to keep bacteria from growing and transferring to your face.

Two Important Tips for Fighting Acne

Here are the two most important tips to fight Acne

Never go to bed with makeup on!

Going to bed with makeup on is literally like a spring break party for bacteria on your face! Think about it- sweat, dirt, oil, products, smog, etc. nestled nicely underneath a layer of makeup for the next 8 hours. Make sure that you take off any makeup with a gentle micellar water and your gentle foaming cleanser. Unless you have prescription topicals that you must use at night, it’s just two simple steps and then bed!

Use Sunscreen

Even though you aren’t lying on the beach, you still need to use sunscreen every day. Both oral and topical medications can make your skin sensitive to the sun and increase your risk of sunburn. Look for oil-free sunscreens with physical blockers with an SPF 30-50 for the best protection. If you choose to look for a moisturizer with sunscreen, ensure that you are selecting one with physical protection.

Stress and Acne

Stress can have an effect the behavior of the skin. It is one of the major causes of breakouts. Studies have shown that when our bodies are stressed, hormones are released and can bind to receptors in the skin’s sebaceous glands, which drives up the skin’s oil production. While stress alone isn’t the cause of cystic acne, it can certainly contribute when combined with other factors. It is important to find mindful moments of meditation or relaxation throughout the day. Yoga and other forms of exercise also help to reduce stress levels.

If you think you are starting to experience more persistent and severe breakouts that are getting worse, it is time to schedule an appointment with a dermatologist. With a proper treatment plan and following these tips, you can help keep it clear.

Schweiger Dermatology Group features world renowned experts in the field of medical and cosmetic dermatology. With over 70 offices in New York, New Jersey, Long Island, and Pennsylvania, we offer same day appointments both in office and via video visit. The health and safety of our patients is staff is our top priorty. Our offices are employing enhanced safety measures should you prefer to be seen in office. While we are doing our best to protect one another, it is important that we take the time to take care of ourselves. Call 844-DERM-DOC or visit to schedule an appointment.

About Schweiger Dermatology Group

Schweiger Dermatology Group was founded to help make excellent dermatology care accessible throughout the Northeast. In 2010, Dr. Eric Schweiger started the practice with a single location in Midtown Manhattan. When he saw the need for high-quality dermatology care that did not require weeks or months of waiting to see a qualified provider, his vision of a multi-location practice was born.

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