Cystic Acne : Definition, Causes, Treatment and Prevention

One of the vastly seen skin disease in adolescents is acne. It affects about 80-90% adolescents attaining pubertal age. Some of this acne also continues into adulthood leaving some kind of psychological and social impact. Acne, also called as acne vulgaris is a chronic skin condition that results from dead skin cells and sebum from the sebaceous glands. Acne presents itself in the form of pimples, blackheads, whiteheads, and scarring. Acne are common in body parts which consists of higher density of sebaceous glands – especially on the face, back and chest.

Overview

Cystic acne is the most grave type of acne. They are more painful and emotionally taxing. In this, pores of the skin are clogged due to buildup of skin debris, sebum and dirt, resulting in infection and inflammation. Cystic acne are more common in people with extremely oily skin. It occurs because of accumulation of bacteria, sebum and skin debris in the pores of the skin. Generally, cystic acne fade away with age. But they tend to leave scars and bumps which may remain forever and may not respond to treatments. It is recommended to visit a dermatologist if one is suspecting to have something like cystic acne to contain its damage right at the beginning and prevent scarring

Causes

The causes of cystic acne are many. Genetic make-up of a person is one of the factors that determines the susceptibility to developing acne. Other factors include :

• Acne are commonly seen in adolescents as sebum production from the sebaceous gland is at its peak during puberty due to a drastic shift in hormone levels and metabolism. During puberty, there is a surge in some hormone levels like androgen, which causes the sebaceous gland to enlarge and produce more sebum
• Acne are also usually seen is women attaining menses and women with hormonal imbalances like polycystic ovarian syndrome (PCOS); increased levels of male sex hormone – androgen
• Increased humidity and polluted air can cause acnes
• Acne result due to side effects of drugs like corticosteroids, phenytoin and isoniazid
• Diet also influences the occurrence of these acnes. Consumption of large amounts of dairy products like milk, cheese, butter, cottage cheese can lead to development of acne as these products increase mucous production in the body which acts as a trigger for clogging the pores. Also, a diet that is high in fat and refined sugars is a cause for acnes. Research has shown that diet containing milk and milk products stimulate the release of insulin and insulin like growth factor -1 (IGF-1), which further increase the production of androgen hormones, sebum and thereby, acne.
• Cosmetic products like a greasy moisturizer, other make-up and skin care products can cause the pores to clog and increase the occurrence of acnes
• Stress can also trigger acne breakouts. This could be due to increase in the levels of hormones which lead to excess sebum production and thus, acne

Identifying cystic acne 

Apart from being the most serious type of acne, they also tend to be the biggest in size and deepest in the skin layers, as compared to other acne types, which protrude only on the top of skin’s surface. Cystic acne have a boil-like appearance on the skin’s surface. Other features of cystic acne include : pus-filled cysts, redness, large white bump, painful to touch. Cystic acne are prominently noticeable on a person’s face and are commonly seen on chest, back and arms.

Treating cystic acne 

Due to the severity of the nature of cystic acne, many over-the-counter options may not be sufficient to treat them. They require a more intensive medical treatment under a expert to show desired results.

They include :

• Antibiotics : Antibiotics are used in treating cystic acne as the reason for development of this type of acne is due to bacterial infection. Antibiotics reduce inflammation and kill the acne causing bacteria. They have some side effects like abdominal pain, diarrhea and nausea
• Benzoyl peroxide : This is commonly used treatment for acne. It works by destroying the bacteria P. acnes, and also helps in treating comedones, which can result in acne breakouts. Benzoyl peroxide is a component of gels, creams and lotions to be used on skin as a topical application
• Isotretinoin : A derivative of Vitamin A, this is one of most widely used drug for treating stubborn refractory acne which do not respond to antibiotics in recent times. It is considered most effective in treating cystic acne with promising results in few weeks after starting the medication. However, there are some serious downside of taking isotretinoin like excessive dryness, raised lipid levels, joint pain and chapped lips. It can cause serious irreversible damage to the baby like congenital deformities if taken during pregnancy. It has to be strictly taken and monitored under a professional in the field
• Retinoids : Topical ointments and creams containing this Vitamin A derivative help in unplugging hair follicles to remove and prevent acne. They are not equally effective as isotretinoin. They maybe used in combination with other topical antibiotics such as clindamycin for better results. Using retinoid based creams or gels can temporarily make the skin turn red and peel in some cases
• Steroid therapy : This treatment is only carried out by a dermatologist. It involves injecting corticosteroid directly in the cyst to reduce inflammation and possible scarring. It can have some acute localized after effects on injecting the drug
• Birth control pills : Oral contraceptives are another option for treatment of cystic acne in some women with hormonal imbalances especially during menstrual cycle. Oral contraceptives contain Estrogen, a hormone which helps in regulating hormonal levels and reduce acne breakouts. However, they have to be prohibited for people with blood clots, smokers and women trying to conceive
• Aldactone : This drug, also known as Spironolactone, is conventionally used as a diuretic in the treatment of edema and hypertension. However, it is also used for cystic acne treatment. It does so by balancing the elevated androgen levels in the body, which cause inflammatory acne to develop. It has to be selectively given only by a dermatologist as it has some serious side effects. Spironolactone can cause birth defects if taken during pregnancy and it is not recommended to be taken by people with existing kidney disease. Apart from this, it can cause breast tenderness, fatigue and menstrual irregularities, hence requires caution. It is usually effective in women with cystic acne on jaw or lower part of the face.

Compared to all types of acne, cystic acne are the most scar forming. Picking and touching the cysts can make matters worse by spreading the bacteria to other parts. If the scarring caused by cystic acne is very severe, it might need intervention like synthetic peeling, dermabrasion or laser resurfacing, which are routinely done as a part any type of acne scarring

Home remedies for cystic acne 

Although cystic acne requires medical intervention in most cases, some home remedies do not harm. They can be tried on less severe forms of cystic acnes. They are :

• Ice application : applying ice to the affected area soothes it by decreasing swelling and pain. It can be done couple of times in a day
• Vinegar : Since vinegar has natural antibacterial properties, diluted vinegar with water can be applied on the affected areas. Caution is required as vinegar can cause some amount of burning and skin irritation
• Aspirin mask : Some experts suggest making a mask out of aspirin tablet by crushing it and mixing it with water. It is said to reduce inflammation and the pain associated with it. It can cause irritation on the skin when directly applied
• Turmeric paste : Famous for its anti-inflammatory and antiseptic properties, turmeric can be used to make a home remedy for treating cystic acne by mixing it with water, making a paste and applying on the face for few minutes
• Tea tree oil : Tea tree oil has antimicrobial and anti-inflammatory functions which can be a topical natural remedy for treating acne cysts and reducing acne breakouts
• Probiotics : Probiotics are the healthy bacteria that improve the gut health and immunity. They can reduce inflammation and improve skin health

General skincare recommendations 

Though there are treatments available for cystic acne, it is always better to be able to prevent it in the first place from happening. Some of skincare tips to maintain a healthy skin and prevent acne include :

• Cleaning and washing the face twice in a day if one has a very oily skin. It is advisable to use a cleanser that cleanses all the dirt and sebum from the skin and not drying the skin at the same time. A gentle facial cleanser could work well in place of scrubs
• Refrain from touching and picking acne. This can make matters worse and lead to permanent scarring
• Use makeup and skincare products that are non-comedogenic or unlikely to clog pores. Using products that make the skin feel light and weightless after use are good for acne prone skin
• Wash away the makeup before sleeping. Sleeping with makeup can clog pores and result in acne breakouts
• Applying sunscreen daily as a part of skin care routine. This helps to prevent the skin from acne caused due to sun exposure and sun damage
• Lifestyle changes like reducing stress levels by resorting to exercise, mediation and hobbies help in maintaining hormonal balance in the body. Dietary factors also play a role. Consuming a plant based diet, with more raw fruits and vegetables, minimizing on dairy, sugar and processed foods keeps the skin healthy and prevents from acne breakouts

Conclusion

Cystic acne are difficult to treat on our own and requires one to visit a dermatologist for treating them. They are emotionally challenging and can affect a person’s self-esteem. It is essential to practice basic skincare to prevent any kinds of acne breakouts, more so cystic acne.

References

1. https://www.sciencedirect.com/science/article/pii/S2352647517300862
2. https://www.cmaj.ca/content/183/7/E430
3. https://www.mdpi.com/1420-3049/21/8/1063