7 Ways to Get Rid of Cystic Acne and Scars
There’s acne, and then there’s acne. Almost everyone has had the occasional pimple or blackhead. Through adolescence, you probably had the WORST DAY EVER because of a full-on, both-cheek-covering outbreak. But simple pimples do not compare to the pain, severity, and potentially permanent damage caused by cystic acne, a type that delves into the skin, creating cysts—lesions that are particularly deep, painful and prone to spreading.
“Cystic acne is like little balloons beneath the skin,” says Suzanne Friedler, MD, a dermatologist and clinical Instructor at Mount Sinai Medical Center. “The skin is red and painful and pus-y.” The compounded oil, dead skin cells, and bacteria that pile up under the skin through a pore-clogging patchwork for cysts create an inflamed appearance and the scaring from this stress on the skin can be permanent. Most often it effects the face but breakouts can spread to the chest and back.
Cystic acne aches and itches. Scratching it perpetuates a cycle, spreading the infection. “The oils in the skin are like food for the bacteria,” Friedler says. Acne is often offset by high testosterone levels; the hormone regulates and stimulates oil glands. Therefore, cystic acne is most prevalent in men from their late teens to early 20s, who are enduring a hormonal flux.
Because of the potential for scarring, Friedler says the most important consideration in cystic acne treatments is timeliness: Treat it as soon as it’s diagnosed; you are outracing a cyclical worsening of the ailment and permanent skin damage. Here are your options:
Cystic Acne Treatment: Antibiotics
If you see a dermatologist for cystic acne—and experts agree that over-the-counter remedies are not sufficient for cystic pimples—their first option will likely be an oral antibiotic, says Adarsh Vijay Mudgil, MD, a New York City-based dermatologist. Antibiotics attack the underlining bacteria that may be causing and perpetuating the acne.
The relief can be immediate. “It works as an anti-inflammatory,” says Mudgil. Tetracycline-type antibiotics—like minocycline or doxycycline—are the most common choices. Some dermatologists also use topical antibiotics.
Cystic Acne Treatment: Accutane
Antibiotics are often effective at reducing inflammation and eliminating bacteria, but if that alone doesn’t clear up the skin, a dermatologist’s next tool will likely be isotretinoin. It’s an oral medication originally sold under the brand name Accutane and still widely called that and now available as a generic.
Isotretinoin is a retinoid, a medication that acts as a synthetic version of vitamin A. It has a long, concerning list of side effects, including dry skin, itching, rash, irritation to the eyes, and anxiety and depression. Because of the potential for birth defects, it is absolutely barred for pregnant women.
Its effect on mental health has been particularly scrutinized due to a high-profile case; then-U.S. Rep. Bart Stupak's son. B.J. Stupak. Stupak and his wife blamed the drug for their son’s suicide, at age 17 in 2000, and unsuccessfully tried to sue the manufacturer, Roche Holding.
However, Friedler said it is generally safe to use, as long as high-risk patients are screened and monitored. “Accutane gets a bad rap,” Friedler says. She said patients rarely experience severe changes in mood. “I would have patients with dry skin, dry lips, high cholesterol,” she said.
“We do monitor blood work when starting treatment but it is overall well tolerated,” says Erum Ilyas, MD, of Montgomery Dermatology, a clinic with several locations near Philadelphia. “We have to make sure that female patients are not planning pregnancies during treatment and for six months after completion. And we do screen for depression risks prior to starting on therapy. There are mixed studies on this potential side effect.” Generally, isotretinoin treatment lasts five to six months.
Cystic Acne Treatment: Topicals
Topical treatment—of either the prescription or over-the-counter variety—probably will not resolve the deep-seated problem of cystic acne alone, but they can be helpful if prescribed with an oral medication.
The “[g]old standard therapy for inflammatory acne treatment is combined topical therapy with oral medications,” said Melanie Palm, MD, a San Diego dermatologist and clinical professor at Scripps Encinitas Memorial Hospital. Benzoyl peroxide and topical antibiotics (such as clindamycin) often go with anti-biotics or retinoids.
Cystic Acne Treatment: Good Skin Hygiene
The population who suffer the most from cystic acn3—high school- and college-age males—are not exactly known for their cleanliness and skincare routines.
“They work out a lot and have sweaty clothes against their skin,” Friedler says. She recommends that men of prime acne age be mindful to change their workout clothes and use an antibacterial body wash.
Cystic Acne Treatment: Manage Medications
Palm said that certain medications can alter one’s testosterone system, leading to acne flair ups. These include anabolic steroids, (inhaled steroids that treat asthma treatment) and hormone replacement (testosterone and progesterone).
Cystic Acne Treatment: Phototherapy
For those who don’t respond to—or are unable to withstand the side effects of— isotretinoin, there are a few new treatments. “Unconventional and new approaches coming down the line for acne are exciting,” Palm says.
These include blue light therapy to fight off bacteria and photodynamic therapy, a kind of medication that makes certain cells vulnerable to an intensive light (more often used for cancer treatment). Insurance might not cover these treatments, she adds.
Although light therapies may reduce acne, they aren't effective at getting rid of pimples completely, says the American Academy of Dermatology (AAD). Generally, you'll need multiple treatments and may even need follow up sessions.
Infrared, blue, red, and blue + red light devices won't eliminate cystic acne, according to the AAD. But photodynamic therapy can treat severe cystic acne for years after initial treatment.
Cystic Acne Treatment: Surgery
After you have already treated your cystic acne, you may be left with scarring, if the swelling or lesions were severe enough. Few acne scars are severe enough to warrant surgery, says Larry Linkov of City Facial Plastics in Manhattan. “It’s not terribly common,” he says. “Only one time, I’ve been asked to do acne.”
There are a variety of minimally invasive surgeries, says Linkov. He has used microneedling, a dermaroller procedure that uses small needles to prick the skin, which has smooth out small scars and abrasions. “It’s like sandpapering the area,” Linkov says. Occasionally, cosmetic surgeons use dermal fillers in this progress.
Facial chemical peels and laser resurfacing are also effective in eliminating the blemishes left by cystic acne. “Usually [acne leaves] a localized scar that doesn’t go very deep,” he says. “We’re not having to make any massive incisions.”
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