Cystic acne: symptoms, causes, treatment and prevention
Cystic acne is a severe form of acne. Find out more about the symptoms, causes and treatments of cystic acne.
Cystic acne: how can it be prevented and treated?
Cystic acne is the most severe form of acne. Our detailed guide explains the causes, symptoms and treatments of cystic acne.
What is cystic acne?
Cystic acne is a severe form of acne characterised by the presence of large, red, painful, pus-filled nodules. It can cause severe scarring and complications linked to abscesses. It is an inflammatory disease of the pilosebaceous follicle that develops in flare-ups over several years.
What are the symptoms of cystic acne?
Cystic acne most often appears on the face, but is also common on the neck, shoulders, back and upper chest. It generally appears during adolescence, but can also appear in adulthood.
Cystic acne is characterised by the presence of cysts and deep, painful, pus-filled lesions. The cysts are caused by the inflammation of boils and can develop into abscesses. Nodules can also form in the epidermis, forming a mass up to 5 mm in diameter, which can leave permanent scars. These scars, which vary in depth, can be atrophic and easy to heal, or keloid and very difficult to remove.
Cystic acne lesions can be :
- Retained: open comedones, closed comedones, sebaceous cysts, microcysts, etc.
- Inflammatory: papules, pustules, nodules
In addition to the visible symptoms mentioned above, cystic acne can also have psychological and psychosocial repercussions, particularly in adolescents.
The origin of cystic acne is still poorly understood, but genetic predisposition may play an important role in its development. Several clinical observations have identified certain causes that favour the appearance of cystic acne.
A hormonal imbalance may be one of the causes of cystic acne in adult women. This imbalance affects sebum production, leading to overproduction and accumulation of sebum, in which bacteria responsible forinflammation of the hair follicles develop. The pores then become clogged and the sebum and dead skin cells can no longer drain away.
If the cause of cystic acne is hormonal, the advice of an endocrinologist may be sought to carry out a hormonal assessment.
Hereditary history must be taken into account in the development of cystic acne. Depending on the skin type, gender and genetics of the parents, cystic acne may be less likely to develop. For example, men who suffer from photosensitivity and whose parents have developed symptoms of cystic acne will be more greatly affected than other types of profile.
Cystic acne can also be the result of untreated or poorly treated inflammatory acne that has degenerated. If the first symptoms of acne appear, it is essential to consult a dermatologist and take appropriate treatment.
Where can you get cystic acne?
Cystic acne most often appears on the face, particularly on the cheeks, jawline and chin, but it can also develop on the neck, shoulders and chest.
How is cystic acne diagnosed?
To diagnose cystic acne, you need to consult a dermatologist.
First, a skin examination will be carried out to determine the skin disorder. Observation of the symptoms associated with cystic acne, such as the presence of boils, cysts, nodules or abscesses, enables the disease to be diagnosed. An analysis of the family and genetic history may help to validate the diagnosis. If necessary, a skin biopsy or hormone tests may be carried out in addition to the clinical examination.
When should you seek help for cystic acne?
The appearance of acne cysts on the face is a sign that you need to consult a skin specialist.
In the case of mild acne, if your symptoms persist and become more complicated, it's important to make an appointment with a dermatologist to find more effective treatment solutions.
The following symptoms indicate the need to see a doctor quickly:
- Proliferation and infection of pimples
- Worsening of lesions
- Appearance of cysts and/or scars
Treatments to get rid of cystic acne
Treatment for cystic acne depends on the severity of the condition. A treatment plan should always include the least restrictive option for the patient with the fewest side effects.
Topical antibiotics are applied directly to the skin on the areas to be treated and work by killing the bacteria. Tretinoin is particularly effective, but irritates the skin and makes it more sensitive to sunlight. It is therefore essential to apply this treatment with care and to gradually increase the doses.
For people with inflamed boils or pustules, tretinoin can be combined with benzoyl peroxide.
The antibiotics generally used to treat cystic acne are doxycycline, minocycline, tetracycline and erythromycin. It takes around 12 weeks to achieve maximum benefits.
These treatments target both the back and the face.
In the treatment of acne, topical retinoids help toextract blackheads and soothe inflammation. They also stimulate skin cell renewal and act directly on microcysts. Topical retinoids are particularly effective in combating the bacteria that accumulate in pimples.
Like retinoids, keratolytic agents have the ability to treat clogged pores. Keratolytic cream easily eliminates blackheads, papules and pustules.
For women for whom oral antibiotics are not effective or cause side effects such as vaginal fungal infections, oral contraceptives containing oestrogen and progestin can be taken.
In cases of very severe acne,isotretinoin is the only drug that can potentially cure the acne. However, the side-effects can be serious and harm foetal development.
Roaccutane and Curacné are considered to be the most effective treatments for cystic acne. Only available on prescription, these treatments have a number of contraindications:
- A pregnancy test must be carried out before starting treatment, and an oral contraceptive must be taken for the duration of the acne treatment due to the very high risk of foetal malformation.
- Regular psychiatric follow-up for psychologically fragile patients due to the risk of depression
- Photosensitivity requiringsystematic use of a sunscreen for all exposure to the sun
- Treatment contraindicated with other acne medications
Treatment generally lasts 16 to 20 weeks.
People with large inflammatory nodules or abscesses can be treated with corticosteroid injections.
Laser treatments are used to treat superficial or deep scars.
Natural solutions can also complement the treatments mentioned below.
Adopt a regular skin cleansing routine using suitable natural products to limit the symptoms of cystic acne.
Aloe Vera is a highly effective natural anti-inflammatory that can help relieve cystic acne. Pair it with black cumin oil or argan oil, which also have interesting properties for calming the symptoms of inflammation.
Clay also has the ability to absorb seborrhoea and reduce shine on the face.
On the other hand, essential oils should be avoided in cases of cystic acne, as they are comedogenic and clog pores already blocked by excess sebum.