Everything You Need to Know About TreatingCystic Acne.
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It’s one of the most eye-poppingly commonwoes of young adulthood: Eight in ten people between the ages of 11 and 30 get acne, accordingto the National Institutes of Health.
But it only takes a quick survey of the averageschool gym class to note that not everyone is affected by the same type.
When you imaginered, swollen, painful pimples, you’re thinking about cystic acne—the kind that also leavesscars.
While the causes behind cystic acne are still not entirely understood, and researchersare always looking for new and improved ways to treat it, there is still a lot you cando to effectively tame it and keep it from leaving a lasting mark.
What is cystic acne?Cystic acne is an inflammatory type of acne that causes bumps deep under the skin thatare usually tender, red, and painful.
“Often they come up in big crops and wax and waneover time,” says Laura Ferris, a dermatologist and an associate professor of dermatologyat the University of Pittsburgh.
Cystic acne most commonly appears on the face, Ferrissays, but it’s also found on the back, chest, upper arms, and shoulders.
It’s differentfrom other, more superficial types of types of acne, like blackheads and whiteheads, becauseit’s deeper down in your skin.
“Because of the depth and the amount ofinflammation, cystic acne is the one that causes scarring,” says Bruce Robinson, aNew York City-based dermatologist and clinical instructor of dermatology at Lenox Hill Hospital.
What causes cystic acne?Oil glands that keep your skin moist are attached to your pores, which is where hair grows anddead skin cells are eliminated.
All types of acne pop up when your pores get pluggedwith oil and dead skin.
With cystic acne, bacteria trapped deep in your pores causeinflammation—i.
, redness, swelling, and pain.
There are lots of different factors that increasethe risk of cystic acne.
“For some people it’s genetic, for others it’s hormonal,and some people are just acne-prone,” says Nada Elbuluk, an associate professor of dermatologyat the University of Southern California Keck School of Medicine.
Because cystic acne is linked to testosterone,men tend to be slightly more susceptible.
For women, acne can get worse around menstrualcycles.
Does diet trigger cystic acne?A lot of studies have tried to look at diet and acne, Ferris says, but the jury is stillout.
One study linked acne to skim milk, while others have tied it to eating too many sugaryfoods.
Robinson says some people do find they get more cystic acne when they eat glutenor dairy, although they’re not necessarily gluten- or dairy-intolerant.
Ultimately, expertssay diet has nothing to do with acne for the vast majority of people.
In the meantime, it’s always a safe betto cut back on sugary foods and eat a well-rounded diet—without going overboard.
“There’sno evidence that elimination diets work for acne,” Ferris says.
When do most people get cystic acne and howlong does it last? Cystic acne is strongly linked to hormones;an estimated 85 percent of the time it hits around hormone-heavy puberty and tends tostick around until your 20s.
“But I certainly see women and men in their 40s who have cysticacne, even for the first time,” Ferris says.
In fact, a growing number of women in their30s, 40s and 50s are getting acne, according to the AAD.
In women, hormonal changes that happen duringpregnancy can trigger cystic acne later in life.
PCOS, a hormonal imbalance where thebody makes more testosterone-like hormones behind cystic acne, is another common cause.
Because fat cells can convert female hormones into weak male hormones, Robinson notes.
Even menopause rarely causes cystic acne due to hormonal fluctuations.
“It’s a bigtrigger for some women.
That’s usually when you’ll see another peak,” says Robinson.
Hormonal-linked acne usually appears around the jawline and the mouth, he adds.
If you get cystic acne for the first timein your 30s or 40s, your doctor will usually work with a gynecologist or endocrinologistto test for hormonal imbalances and work together to treat it.
“There are even more rare syndromesthat can be associated with acne, so if someone suddenly got bad acne later in life we lookfor another underlying cause,” Ferris says.
How to treat cystic acne.
Although it’s worth testing OTC treatments like benzoyl peroxide or salicylic acid athome, if you have severe acne you’re better off seeing a dermatologist to minimize breakoutsand scarring, Robinson says.
The treatment your doctor will pick depends on the causebehind your breakouts, the severity, whether there’s scarring and if you’ve been onother treatments that failed in past.
While creams and washes are sometimes enoughfor surface acne like whiteheads, blackheads, and pustules, you’ll usually need to popa pill to treat cystic acne, Elbuluk says.
Your doctor may start you off with oral antibioticsfor three to six months, although if flare-ups happen around your menstrual cycle, Robinsonsays he sometimes prescribes it for regular brief periods around your period.
Antibiotics work by killing the bacteria andcalming the inflammation that contribute to acne, Elbuluk says.
Problem is, they alsocome with loads of not-so-nice side effects: Antibiotics can cause abdominal pain, diarrhea,and nausea, and some make your skin more prone to sunburn, Ferris says.
Relying on them forlong periods of time can affect the balance of good bacteria in your gut and skin.
Andthey can contribute to antibiotic resistance, where they become less effective against moreserious bacterial infections.
That’s a problem, Ferris says, since some of the drugs doctorsprescribe for acne are also used to treat Lyme disease and MRSA.
Here’s the other issue: As soon as you gooff of antibiotics, acne tends to roar right back.
“Acne isn’t a short-term problem,”Ferris says.
That’s why doctors will usually try an antibiotic cream or other surface treatmentlike Retin A, a vitamin A cream that increases the rate your body sheds dead skin cells toprevent clogging, Elbuluk says.
“I’ll often mix and match, depending on the patient’ssensitivity and the types of acne they have.
” If you’re a woman and your acne is likelyhormone-related, your dermatologist may refer you to an OB/GYN for a birth control prescriptionto help regulate your hormones, a few of which are FDA-approved to treat acne.
Your OB ordermatologist might also suggest spironolactone, another type of hormonal treatment for womenonly that reduces testosterone levels to reduce oil production and cut back on acne, Ferrissays.
Doctors agree, however, that by far the bestcystic acne treatment is isotretinoin (i.
Accutane), an oral form of vitamin A thattargets all the sources of cystic acne by killing acne-causing bacteria, uncloggingpores and cutting back on excess oil and inflammation.
It’s the only medicine that permanentlystops cystic acne instead of just treating it while you’re using it, Robinson says.
“It permanently shrinks oil glands so your skin will never be as oily as it used to be.
It also changes the way your skin cells mature, so your pores don’t get blocked.
It caneven help improve scarring, he says.
You’ll need to go on just one round that lasts fourto six months, which clears up acne for 85 percent of people, Elbuluk says.
While isotretinoin is safe—the most commonside effect is dryness of skin and peeling of lips—it can cause serious birth defects,so your doctor will only prescribe it if you’re on birth control and using a second form ofprotection to avoid getting pregnant.
The good news is, if you are hoping for a mini-meany time in the future, it’s perfectly safe to get pregnant as soon as one month aftercoming off Accutane, Ferris says.
If all else fails—or if you’re just reallyagainst using antibiotics or Accutane—your dermatologist may try photodynamic therapy,the most effective laser treatment for severe acne, Elbuluk says.
After applying a specialprescription medication to your skin and letting it sit for up to three hours, he or she willshine a special light that activates and kills acne-causing bacteria.
While there is no way to prevent cystic acne,getting treated ASAP is important to prevent scarring.
“That’s one of the reasons whyif someone does have fairly severe acne, most of us will push to move on to Accutane ortopical creams like Retin A,” Ferris says.
Caring for acne-prone skin.
Day in and out, doctors recommend using a gentle cleanser (like Cetaphyl or Purpose)and lukewarm water morning and night.
If you have oilier skin, your doc might suggest amore drying soap (like Ivory or Dial), Robinson says.
Use a moisturizer with sunscreen everymorning, and skip harsh scrubs, astringents and toners, which cause more dryness, redness,and inflammation.
The future of cystic acne treatments.
You’ve probably heard a lot about your microbiome, the mix of bacteria in your body that impactsyour metabolism, immune system, and gut health.
Turns out, variations in your personal mixof bacteria may even impact the likelihood of getting cystic acne.
Research last year found that people who sufferfrom acne have more of one of two versions of a type of bacteria, propionibacterium acnes(P.
acnes), on their skin that’s more likely to cause breakouts.
Although the researchis preliminary, it could eventually lead to treatments like bacteriophages and probioticsthat only target that particular strain of bacteria that causes acne or boost good-for-your-skinstrains.
“This study showed that the P acnes in patientswith acne is different than the P acnes in patients without acne,” Ferris says.
“Therapythat could target the pathogenic strain of P acnes could be a new approach to treatingacne.
” Robinson adds, “As medicine advances, weseek to better target causative agents like P.
acnes and not perturb the normal floraof the skin and gut.
” Getting rid of cystic acne scars.
If you do end up with cystic acne scars, lots of treatments can help reduce or eliminatethem, including chemical peels, laser resurfacing, and micro needling, Elbuluk says.
Most peopleneed around four laser treatments or four to six peels to clear up cystic acne scars,depending on how severe they are.
Robinson says these treatments cause way less injuryto the skin than older options like microdermabrasion and can work wonders to heal cystic acne scarswithin weeks of treatment up to decades later.
For more severe cystic acne scars that aredeeply tethered down, another more invasive procedure known as subcision involves usinga needle to physically loosen them and allow the skin to better pop out, Robinson says.
A doctor may even surgically remove scar tissue and sew the skin back together, he adds.
Justkeep in mind all of these treatments can come with a pretty price tag, since they’re usuallynot covered by insurance, Ferris says.
Before applying these recommendations, consultyour doctor.
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