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Getting Rid of Cystic Acne

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Cystic acne is a severe form of acne vulgaris. It requires urgent and aggressive treatment in order to prevent further damage to the skin and permanent scarring. Find out what treatment options are available for this form of acne.

What is Cystic Acne?

Cystic acne is also called acne vulgaris; however, cystic acne is actually a severe form of acne vulgaris.

Acne vulgaris is a common skin disease that affects almost everybody at least once in a lifetime. It usually starts at the beginning of puberty and although it resolves to treatment when adolescents become young adults, it may persist into adulthood for some people.

Cystic acne is given its name because of the acne cysts that appear on the skin when severe acne is not well controlled. Along with cysts, nodules are the other inflammatory acne lesions that appear during this stage of the disease. Because of this, cystic acne is sometimes also called nodulocystic acne.

Features of Cystic Acne

There are two types of acne lesions: inflammatory and non-inflammatory acne lesions.

Along with these lesions, hyperpigmentation and scarring will also affect the skin during cystic acne breakouts. The features of cystic acne are discussed below.


Whiteheads are also called closed comedones. They appear as tiny bumps on the skin with white tops. Whiteheads are formed from pores blocked by plugs of sebum, dead skin cells and bacteria. These comedones do not last very long and they are the first wave of lesions to appear during acne breakouts.


Blackheads are also called open comedones. They appear as tiny bumps on the skin but with black tops. Blackheads are formed in the same way as whiteheads but unlike whiteheads, the pores are only partially blocked. Therefore, the sebum trapped inside is oxidized in air. This oxidized sebum and melanin, the skin pigment, are responsible for the dark color of blackheads.


Papules are inflammatory acne lesions. They appear as inflamed, red, tender bumps on the skin. Papules have no heads and they should not be squeezed or aggravated in no way.


Pustules are also inflammatory acne lesions. They appear as red circles with white or yellow centers. Pustules are filled with pus and they are also commonly known as zits.


Nodules are deep inflammatory lesions. They are much larger than papules. Nodules appear as large, hard and painful bumps under the surface of the skin. They can lay dormant and unresolved for a while only to flare up repeatedly. When aggravated, nodules can cause severe trauma to the skin as well as extensive scarring.


Cysts are also deep inflammatory lesions. They are larger than pustules and as large as papules. They appear on the skin like boils. Cysts must not be aggravated as they can cause deeper infection in the skin.


Seborrhea is also called seborrheic dermatitis. It is responsible for the red pigmentation of the skin during acne breakouts. Seborrhea also makes the skin scaly, flaky and itchy.

Acne Scars

Acne scars arise when the body tries to heal itself from the damage caused by acne. Acne scars can either appear as indentations in the skin to mark the area where acne inflammation caused tissue loss or appear as thickened, keloid-like bumps to mark the places where the body overcompensation for the tissue loss by producing too much collagen.

Causes of Cystic Acne

Cystic acne is caused by a number of co-dependent factors such as genetics, diet, stress, hormones and bacterial infection.

Cystic acne does have a genetic component. Multiple members of the same family from different generations usually have acne breakouts concurrently. The severity of this acne is even inheritable and in some families, severe forms of acne may be the norm.

Even though cystic acne may be an inheritable condition for some people, it is usually triggered by other factors such as diet, stress, drugs, diseases and hormonal production.

Examples of foods that can trigger acne breakouts are milk, dairy products and those sugary drinks and snacks with high glycemic index. The root cause of food-caused acne is actually hormones. For milk and milk products, androgens and other growth hormones used for raising the animal supplying the milk are introduced into the body.

On the other hand, foods with high glycemic index raise the levels of insulin-like growth factor 1 (IGF-1).

Stress, especially emotional or psychological stress, is also a common cause of cystic acne. In such cases, stress affects the nature of the skin and promotes the production of proinflammatory lipids on the skin.

The hormones are known to cause cystic acne are the ones listed above: androgens and IGF-1. Androgens such as testosterone and dihydrotestosterone are the chief hormonal root of acne breakout.

They bind to androgen receptors in the skin and then encourage the proliferation of sebocytes. This quickly leads to the enlargement of the sebaceous glands and the increased secretion of sebum.

When excess sebum is being pushed to the skin surface, part of it gets stuck in the pores where they mix with bacteria and dead skin cells to clog the pores. This action is directly responsible for the early appearance of acne comedones and the later appearance of inflammatory acne lesions such as cysts.

Excess sebum increases the population and nature of acne-causing bacteria.

A prime example of acne-causing bacteria is Propionibacterium acnes. It is naturally found on the skin as a harmless commensal but when hormones trigger the excessive secretion of sebum, P. acnes turn virulent.

This bacterium is trapped in the anaerobic and microaerobic environment of the sebaceous follicles along with dead skin cells and sebum. While this is the right environment for P. acnes, sebum is also its ideal growth environment.

Therefore, the bacterium thrives and cause damage to the layers of the skin.

In response to this damage and bacterial infection, the immune system sends proinflammatory immune factors to the sites of infection. These immune factors, however, cause the local inflammations that are seen as swelling and bumps in acne breakouts.

When the damage is near the surface of the skin, superficial inflammatory acne lesions such as papules and pustules are produced. However, when the bacteria infection is deep in the dermis, deep inflammatory acne lesions such as nodules and cysts result.

Natural Remedies for Getting Rid of Cystic Acne

A little improvement in skin care regimen can improve (and even prevent) the symptoms of cystic acne.

First, make sure to wash the area of your skin affected by the acne at least two times daily. Do not scrub the skin or you will irritate it and aggravate the lesions.

Instead, use mild, moisturizing soaps and cleansers. Never use oily or greasy skin care product on your skin during acne breakouts.

In addition, try not to touch your face since touch is the primary way by which bacteria get to your skin. Also, refrain from picking, popping, rubbing, scratching or squeezing the acne lesions on your skin.

You can treat cystic acne with some natural remedies you have at home. The remedy you choose must have one or more of these medicinal properties: antibacterial, anti-inflammatory, antioxidant, anti-irritant and astringent properties.

Common home remedies to use at home are hydrogen peroxide, baking soda, vinegar, egg whites, cucumber, and tomato. Other natural remedies include lemon juice, aloe vera, fenugreek, garlic, turmeric, cinnamon, and honey.

Some of these remedies can be applied to the skin as a cleanser (hydrogen peroxide, vinegar) or as part of an acne mask (honey, baking powder). They can also be used as a drink (lemon juice and vinegar).

Natural antioxidant teas such as green tea, rooibos tea, and spearmint tea are also excellent acne remedies. Other herbs used for getting rid of cystic acne include gum guggul, licorice root, burdock root, dong quai, vitex and tea tree oil.

Apart from herbal extracts, some vitamins and minerals are also natural remedies used to treat cystic acne. Nutritional supplements such as omega-3 fatty acids which have anti-inflammatory properties are also anti-acne remedies.

Vitamins A, C, E, B1, and B5 are especially effective. The B vitamins are needed for improving skin health while the other 3 vitamins are antioxidants and sometimes antibacterial and/or anti-inflammatory agents. A whole class of acne medications called retinoids is derived from vitamin A.

Of minerals, the most useful ones in acne treatment are zinc and selenium.

Selenium is a potent antioxidant while zinc is a powerful antibacterial agent.

There are oral and topical acne products formulated with different combinations of these natural acne remedies. These are mostly as efficient as conventional acne medication and come with far lesser side effects.

A prime example of such natural acne product is Actimine, an acne supplement formulated with natural remedies such as vitamins A and E; zinc and selenium; as well as methylsulfonylmethane and gum guggul.

OTC Acne Products for Getting Rid of Cystic Acne

Over-the-counter topical acne products are also used to treat cystic acne. These products contain one or more of these active ingredients: benzoyl peroxide, salicylic acid, azelaic acid, sulfur, and resorcinol.

They are available as acne creams, gels, lotions, cleansers, serums and facial wash under different brand names.

These agents have 3 mechanisms of action. 

How OTC Acne Products Work
  • Kill off acne-causing bacteria
  • Keep the skin dry by absorbing the excess sebum secreted
  • Increase the turnover of the skin by exfoliating the top layer of the skin

Medications for Getting Rid of Cystic Acne

Conventional acne drugs are also available for treating cystic acne. However, most of them need prescriptions and they may produce some serious side effects.


Antibiotics are used to treat cystic acne because they can drastically reduce the population of the skin by acne-causing bacteria such as P. acnes. Both oral and topical antibiotics are prescribed for this use.

Topical antibiotics include clindamycin, erythromycin, and dapsone. They are applied to the skin and seem to have the most direct effect on surface bacteria. Therefore, they produce far fewer side effects than oral antibiotics but they are not usually as effective.

Oral antibiotics used in the treatment of cystic acne include the tetracycline antibiotics (including tetracycline, doxycycline, minocycline etc.) and erythromycin.

Tetracycline antibiotics increase the photosensitivity of the skin and may cause hyperpigmentation.

However, antibiotics generally become less effective with time. This is due to the development and emergence of antibiotic resistance. To prevent treatment failure, antibiotics are now prescribed along with other acne medications such as benzoyl peroxide or retinoids.


Corticosteroids are anti-inflammatory drugs. They are used solely to control the swelling associated with acne lesions such as cysts.

Oral corticosteroids like prednisone can be taken to control acne inflammation. However, in severe cases, cortisone injections are injected directly into acne lesions.

Anti-androgens and Birth Control Pills

Anti-androgens and birth control pills work by blocking androgens from interacting with sebaceous glands. Therefore, they prevent the secretion of excess sebum.

These agents break the chain of events that eventually leads to skin inflammation.

Anti-androgens used for treating cystic acne include spironolactone, flutamide, and Finasteride. These can be safely used in males.

For women, birth control pills containing estrogen/progestin combinations are especially useful. These synthetic female hormones block the production and activity of androgens.


Retinoids are synthetic analogs of vitamin A. They have varied actions but are especially useful for treating cystic acne when all other medications fail.

There are 2 types of retinoids: topical and oral retinoids.

Topical retinoids are formulated as acne creams. They include tretinoin, adapalene, and tazarotene. They are safer than oral retinoids and are effective for controlling acne inflammation.

The most common example of oral retinoids is isotretinoin or Accutane. It is a very effective acne medication but only used as a last resort because of its extensive and permanent side effects such as birth defects.

Isotretinoin works by preventing the enlargement of the sebaceous glands. However, studies have shown that it also has some other anti-acne properties that are not well understood.

Other Therapies

Drugs are not the only way to treat cystic acne. Laser therapies are recommended when drugs cannot fully control cystic acne. Laser and other light treatment destroy the inflammatory tissues in the skin so that healthy, normal tissues can grow.

Surgery is another option for treating stubborn inflammatory acne lesions such as cysts. This involves draining the cysts. Surgery is usually recommended when the inflammatory lesions are joining together and spreading to other parts of the body.

To get rid of all the damage done by cystic acne, chemical peeling may be recommended to rejuvenate the skin. Alternatively, microdermabrasion can be used to remove the acne scars left by cystic acne.





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