Acne that forms under the skin as cysts and nodules isn't one of the more common types of lesions, according to the American Academy of Dermatology. These lumps and bumps are not only disfiguring; they're also tender and painful. The AAD advocates seeking a dermatologist's help to resolve nodulocystic acne, the most severe type of acne.
Acne Types
Excess oil, dead skin cells and bacteria cause acne. But the Mayo Clinic points out that acne lesions can present themselves in many forms. There are blackheads and whiteheads (comedones) and more conspicuous pimple types, papules and pustules, which are red and inflamed. Acne cysts and nodules form underneath the skin, deeper within the shaft of the hair follicle. While nodules are ungainly, solid lumps, cysts, are filled with pus. If these lesions rupture, scarring can result.
Medical Treatment
The American Academy of Dermatology cites the use of prescription antibiotics and oral contraceptives in treating severe acne. In-office procedures may include surgically draining larger lesions that have the potential to rupture and scar. Alternately, intralesional injections of corticosteroids may be delivered into the cyst or nodule to dissolve it within three to five days. However, deep acne that develops under the skin may require treatment with an oral medication called isotretinoin.
Isotretinoin for Severe Acne
Isotretinoin is one of the most effective medical treatments for severe acne, as it eliminates all factors that cause it: bacteria, dead skin cells and excess sebum. Patients take isotreinoin daily for between 16 and 20 weeks. In many cases, one round of treatment is enough to resolve severe acne, although a second may be necessary if a patient doesn't respond to the first course of isotretinoin. However, although this may often be the best way to get rid of stubborn cysts and nodules, the AAD states that this medication must be administered with extreme caution.
Potential Dangers
Isotretinoin comes with a host of uncomfortable side effects, some of the more common being dry skin, eyes and nasal passages; thinning hair; gastric upset; and aching bones and joints. But the medication can cause more profound side effects, such as bloody diarrhea, blurred or impaired vision and even depression and suicidal thoughts. Isotretinoin causes birth defects in developing fetuses. Female patients must take routine pregnancy tests before, during and after treatment. Additionally, they must use two forms of birth control and sign up with the U.S. Food & Drug Administration's iPLEDGE program, says the Mayo Clinic. Isotretinoin isn't the best course of treatment for patients with certain medical conditions.
What Won't Work
Like other types of acne, cystic and nodular lesions beneath the skin won't go away by using miracle or overnight cures. It may take years to find the right treatment for this type of acne, says the AAD. The Mayo Clinic and AAD advise patients with severe acne to seek help from a dermatologist to avoid pain, facial disfigurement and potential scarring. Although there are numerous treatments for residual acne scarring, such as dermabrasion, laser resurfacing and injectable fillers, these are considered cosmetic in nature and are unlikely to be covered by an insurance plan.
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