Acne is a common skin condition that affects approximately 40 to 50 million people in the U.S., according to the American Academy of Dermatology. While it’s not unusual to experience a few pimples from time to time, some people develop cystic acne, a more serious form of acne that causes painful, red cysts. Over-the-counter acne creams are ineffective in treating cystic acne, but dermatologists offer several treatments that can relieve symptoms and reduce cysts.
Acne occurs when the pores--the tiny openings in your skin--become clogged with oil, bacteria and dead skin cells. While people of any age can develop acne, it is most common in teenagers. Oil production increases during the adolescent years due to the effects of hormones called androgens, according to the American Academy of Dermatology. So much extra oil is produced that not all of it can reach the skin’s surface and a blockage occurs.
The type of blemish that forms depends on the depth of the oil plug. A whitehead or blackhead forms when the blockage is near the skin’s surface. When the blockage is deeper and filled with pus, a pimple develops. Very deep blockages cause the formation of a red, painful, pus-filled bump on the skin called a cyst, according to the American Academy of Dermatology. Acne cysts most often occur on the face, arms, back, shoulders, upper thighs and buttocks,
Doctors don’t know exactly what causes cystic acne, but they do know that several factors contribute to a worsening of the condition, according to DermaNetwork. The effects of female hormones can cause cystic acne to increase in women. Pregnancy, hormonal birth control use and fluctuating hormone levels due to the menstrual cycle can contribute to the problem, according to DermaNetwork. Using topical steroids, cream, lotion or cosmetics during outbreaks can irritate the skin. Children’s Mercy Hospital and Clinic recommends avoiding wearing tight clothing if you have acne on your back, chest or shoulders because tight clothing can trap skin oils.
Severely inflamed cysts can be treated with an injection of an interlesional corticosteroid. The injection decreases inflammation and shrinks the cyst over a period of a few days. Your doctor may also prescribe an oral antibiotic to decrease bacteria. Oral contraceptives may be effective in reducing cystic acne in women. Isotretinoin, an oral medication, is prescribed to treat severe cystic acne that has not responded to other treatments. Isotretinoin use can cause a remission of cystic acne symptoms for months or years and only one course of treatment may be needed, according to the American Academy of Dermatology. Isotretinoin is a very powerful drug that can cause birth defects in unborn babies. Women who use the drug must use a reliable means of birth control and avoid breastfeeding, as the drug can be passed on to the baby through breast milk. If cysts are particularly large, your doctor may recommend drainage and surgical removal.
Severe cystic acne can result in scarring on the skin. Doctors reduce the appearance of scars by using laser treatments, microdermabrasion, dermabrasion and chemical peels to remove damaged layers of skin. Treatment for deep scars involves filling the affected area with skin fillers. If scarring is not severe, over-the-counter scar creams may be helpful in minimizing the scars. Acne scar treatment is most successful after acne is under control and you are no longer experiencing breakouts.
While it may be tempting to pop open an acne cyst, doing so can cause more pain and problems. Popping the cyst can push the oil plug deeper, worsening the cyst, and can cause infection and scarring.