Even though almost every teen--85 percent of the total--gets some acne, most manage to clear their skin by the time they're in their early 20s, according to the American Academy of Dermatology. But in some people, especially women, acne can appear later and include large, severe cysts. Hormones generally spark this type of cystic acne, which can cause acne scars if not treated properly.
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At some point in their lives, up to 1/4 of all males and 1/2 of all women get hormonal adult acne, which can involve cysts. Hormonal shifts, which commonly occur in women who are pregnant, approaching menopause or during their normal monthly cycles, can spur the skin's sebaceous glands to make too much sebum. When your skin is too oily, your pores clog more easily, and bacteria can flourish.
An acne cyst occurs when skin oil and debris block one of your pores deep within your skin. Infection sets in below the blockage, and the pore fills with pus, causing a large, visible and painful bump on the skin's surface. Some cysts can be more than 1 inch in diameter, and cysts can occur anywhere on the face, scalp, neck, chest, back and shoulders, according to the AAD.
According to the AAD, if you have hormonal cystic acne, you shouldn't even try over-the-counter treatments. Instead, you should seek professional help immediately to protect your face from scars. In fact, your dermatologist may want to surgically drain large cysts or possibly inject them with a corticosteroid solution that helps them heal quickly, perhaps avoiding a scar. You may also receive a prescription for oral antibiotics to fight your acne's bacterial infection.
If you're a woman, your dermatologist may place you on a hormonal medication to smooth out your hormone swings, which should help stop your cystic hormonal acne. Oral contraceptives represent one hormonal option for women who don't plan to become pregnant. They often can reduce acne significantly within about six months, although acne can get worse initially as your hormones readjust. Other hormonal options include the medication spironolactone, which counters the influence of your own hormones, and hormone replacement therapy with estrogen and progesterone. All of these medications carry some risks, and you should talk to your doctor about what they involve.
If your acne fails to yield to oral antibiotics and hormonal treatments, your next step may be the acne medication isotretinoin. Dermatologists generally reserve isotretinoin for their most severe acne patients, since the drug can cause some serious side effects, including severe birth defects and depression. But isotretinoin, which is sold as Accutane, unquestionably represents the most powerful prescription weapon available to fight acne.