Last Updated on July 31st, 2019
Cystic acne is one the most severe and difficult forms of acne to treat. Causing masses of infection to accumulate underneath the skin, cystic acne cannot be treated simply by opening up pores in the skin—because the pores no longer exist. No over the counter products, natural treatments, or home remedies can cure this severe, painful problem. With the right combination of strong medication and simple skin care, however, cystic acne can be reversed and skin damage repaired.
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Cystic acne is basically a pimple you cannot possibly pop. The bacterium that causes acne, Propionibacterium acnes, grows faster when it is not exposed to the air1. A skin pore gets clogged with the skin oil sebum that hardens over a colony of this acne bacteria. The bacteria themselves produce peroxides that help break down the sebum they consume as food. These peroxides are irritating, but they are not the main source of the problem in cystic acne.
The major damage of cystic acne is done by the immune system itself. The body sends white blood cells that release inflammatory chemicals known as interleukin-8, interleukin-12, and tumor necrosis factor. The bacteria send out chemicals that make the skin unusually sensitive to these chemicals, and the walls of the pore dissolve. Since acne bacteria don’t need air, and grow faster when they are not exposed to air, they invade surrounding tissues around the pores. They send out more chemicals to make more skin cells sensitive to inflammation, and the immune system sends out even more inflammatory agents.
As long as the pore is open to the surface, the infection can be treated with topical antibiotics and benzoyl peroxide. In babies who have rapidly growing skin and in certain people whose skin grows faster in response to inflammation (more about those groups in a moment), however, new skin encases the infection. This forms a cyst that can persist for months or years, causing itching, irritation, and embarrassment.
Anyone can get cystic acne, but the condition is most common in:
Babies can be born with blackheads. These blemishes are distressing to the new parents, but they usually go away in a few weeks. When the baby has been exposed to some chemical that alters the immune system, however, the blackhead can trap bacteria inside the skin and cause a cyst to form.
Hispanic teens and adults of both sexes are much more likely to get cystic acne than people of northern European descent. Actually, one does not have to have a Hispanic surname or Hispanic ancestors to have an elevated risk of acne. Dermatologists term the type of skin that gets “Hispanic” acne Fitzpatrick Skin Types IV and V. This is skin that is beige to dark brown2 that takes a tan but very seldom burns.
By “African” skin, dermatologists really mean Fitzpatrick Skin Type VI. This is black skin that never burns. Most people who have black skin only get cystic acne on the face. When cystic acne occurs elsewhere on the body, it is a telltale sign of another condition that is common among people of African heritage3, sarcoidosis. Blacks and Whites get acne about the same rate, although Blacks typically develop acne in response to changes in sex hormones, while Whites typically develop acne in response to stress hormones.
White people can get cystic acne, too. Unlike people of African heritage, people of European heritage usually develop cystic acne on the back and chest, not on the face. In Whites, cystic acne on the face is a sign of immune deficiency disease.
Women of all races can develop persistent acne with polycystic ovarian syndrome, or PCOS. In PCOS, acne is due to overproduction of testosterone by the ovaries, but it is not exclusively due to the overproduction of testosterone by the ovaries. Growth hormone also affects the condition of the skin4. Ironically, the women who are working hardest to control their PCOS by natural means are the women who are most likely to develop cystic acne. This is due to the fact that fasting diets are used to bring down blood sugar levels to bring down testosterone levels, and growth hormone levels increase during fasting.
Nothing you put on your skin heals cystic acne. Microdermabrasion won’t work, because the skin over the cysts is still healthy. Laser therapies won’t work because they don’t penetrate deep enough. Natural therapies just don’t work, either. This form of acne has to be treated from the inside out with heavy duty acne medication, or treated with surgery. Most people prefer medication to lancing or surgery.
The drug most commonly prescribed for cystic acne5 is isotretinoin, also known as Accutane. This drug is taken by mouth, not spread over the skin. It gradually shrinks the tissues encasing the cyst, and it stimulates the growth of the skin over the cyst so it eventually opens to the surface without lancing. But that’s when your daily acne skin care routine has to begin in earnest.
Stimulating the growth of the skin opens cysts, but it also closes pores. If you do not follow an effective daily skin care routine, preferably with the help of a treatment kit such as Exposed Skin Care so you take care of every aspect of mild to moderate acne care, your underlying condition can cause your skin to form new cysts about as fast as the old cysts heal. It is essential to do the same cleansing, moisturizing, and exfoliating routine anyone does for non-cystic acne, probably for the rest of your life. But if you keep up your skin care, cysts will be gone for good. Then you can turn your attention to acne scar removal.
There are conditions that look like cystic acne that are not really cystic acne, especially acne keloidalis nuchae, which occurs most frequently in Black and Hispanic teenage males. Never take someone else’s acne treatment. Work with your dermatologist to find your own acne solutions to get the best results.
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