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Cystic Acne: What Is It and How Do You Treat It?

When you’re a teenager, it’s not unusual to have a pimple or two. But if you have large, red, and painful breakouts deep in your skin, it could mean you’ve developed something called cystic acne.

These breakouts can be treated. Don’t try to wait them out. Cystic acne can linger for years. It can affect large areas of your skin and leave permanent scars. A dermatologist can help you with a treatment plan.

What Is It?

You get a pimple when a pore in your skin gets clogged, usually with dead skin cells. Sometimes bacteria get trapped inside the pore, too, causing the area to become red and swollen.

Cystic acne happens when this infection goes deep into your skin, creating a red, tender bump that's full of pus. It may hurt or itch. If a cyst bursts, the infection can spread, causing more breakouts.

Who Gets It? And Where?

You’re most likely to develop cystic acne in your teens or early 20s. But it can strike someone as young as 8 or as old as 50. Your face, chest, back, upper arms, or shoulders can be affected.

Severe cystic acne is more common in men, but women get it, too. Women often have cysts on the lower half of the face.

What Causes It?

No one is sure of the exact cause, but hormones called androgens play a part. When you’re a teenager, androgens increase. This leads to changes in your skin that can result in clogged pores and acne. In women, hormone changes can be brought on by menstrual cycles, pregnancy, menopause, or a condition called polycystic ovary syndrome.

If one of your parents had severe cystic acne, you have a greater chance of getting it.

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How Is It Treated?

Over-the-counter medicines that work on milder acne often have little effect on cystic acne. A dermatologist will likely recommend one or more of the following:

  • Oral antibiotics help control bacteria and lower inflammation. Sometimes your acne may not respond to antibiotics, though. Or you may find they don’t work as well after a few years.
  • Birth-control pills help some women by regulating their hormones.
  • Prescription-strength creams, lotions, or gels with retinoid, a form of vitamin A, can help unplug your pores and help antibiotics do their job.
  • Isotretinoin (formally known as Accutane but now available as the brands Claravis, Sotret, Myorisan, Amnesteem, and Absorica) attacks all causes of acne. The recommended dosage for most of these medications is to take a pill once or twice daily for about 5 months. For most people, this clears the skin completely and permanently. If it recurs, you can repeat the treatment. Women should avoid becoming pregnant while taking this drug.
  • Spironolactone is a medication that helps you get rid of unneeded water, but also is effective for cystic acne in women.

More Advice

Don’t touch cysts or pick at these blemishes. You may push the infection deeper and make it spread.

Try to relax. Stress can cause your body to release more hormones, which can make acne worse.

Follow a healthy lifestyle. Get plenty of sleep and exercise. Some research suggests that a low-glycemic diet, which limits sugar, can help symptoms.

WebMD Medical Reference Reviewed by Debra Jaliman, MD on July 19, 2016

Sources

SOURCES:

American Academy of Dermatology: “Acne.”

Laura Ferris, MD, PhD, University of Pittsburgh Physicians Department of Dermatology.

Sharon Raimer, MD, chair, department of dermatology, The University of Texas Medical Branch at Galveston.

Diane Berson, MD, FAAD, associate professor, department of dermatology, Weill Medical College of  Cornell University; assistant attending dermatologist, New York Presbyterian Hospital.

National Institute of Arthritis and Musculoskeletal and Skin Diseases: “Questions and Answers about Acne.”

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