If you are suffering from a very painful pimple with a diameter of 5 mm or more, you probably have nodulocystic acne, also known as cystic acne. This type of acne forms deep within the skin and is one of the most severe forms of acne vulgaris. A relatively uncommon problem, cystic acne can be a one-pimple incident or widespread over your face, neck, chest, back or shoulders.
Nodulocystic acne can form from a variety of causes. It might develop from a popular or nodular lesion, or possibly from a non-acne cyst that develops in the outer layer of the skin. It can also be the result of personal choices, such as using harsh soap on your face or not using clean hands to apply cosmetics or cleansers to the face. Additionally, a diet deficient in fruits and vegetables, particularly those with vitamin A, can result in cystic acne. The antioxidants in vitamin A curb the creation of chemicals that develop into cystic acne.
It is tempting to attempt to extract the pus in cystic acne; however, squeezing a pimple can cause an infection deeper within the skin coupled with painful inflammation that will last a longer period of time than if you had let the acne be. Even picking at the cyst could result in scarring and permanent skin damage.
Because nodulocystic acne is considered severe, it requires aggressive treatment. This might include isotretinoin and antibiotics, or your dermatologist might try to "melt" the cyst with intralesional corticosteriods. This takes three to five days to work and reduces swelling. If these options do not work, the cyst might need to be drained and surgically excised by a dermatologist, who will make a small incision into the skin to remove the cyst.
Nodulocystic acne, while severe, could actually get worse by developing into acne conglobata. This occurs when cysts that are close together combine and produce soft areas under the skin with tunnels, cell destruction and inflammation. This is a chronic form of acne vulgaris, and you might experience deep abscesses, scarring and severe damage to the skin.
Preventing cystic acne is very similar to general skin care--wash your face twice a day with gentle cleansers and use noncomedogenic skin care products. If you have developed a cyst, keep the affected area clean and avoid using makeup. Keep your hands away from the cyst, being sure not to squeeze or pop it.