Cystic Acne, Ask Dr. Wilkinson

Question: What causes cystic acne? What’s the best way to treat it using OTC treatments?

Answer: Let’s start by clarifying what a cyst is, since that’s the basis for the term ‘cystic acne’.

A cyst is basically a sack that typically contains a fluid or other material. So, when the term ‘cystic acne’ is used, it’s referring to acne that involves the formation of cysts.

Here’s how that happens. All acne forms in the pore (or follicle), a cavity in the skin that also contains a hair shaft and an attached sebaceous gland that produces oils bound for the skin’s surface.

Because of a blockage of the pore, oil becomes trapped behind the plug. As the sebaceous gland continues to produce more oil, it backs up within the follicle. This collection of oil gradually causes the follicle to swell, essentially creating a sack of oil within the skin – or a cyst.

There are bacteria that are normally found within the follicle and live there in relatively small numbers. They feed on the oil in the follicle, but since it is normally just a fine film around the hair shaft, gradually seeping toward the surface, their food supply is limited.

Now, with the backed up pool of oil within the cyst, the bacteria find they’re living in a banquet hall! As a result they multiply dramatically. So, now the cyst is filled with oil and bacteria.

But, the bacteria have a nasty habit. They produce molecules that are very irritating and cause an inflammatory reaction. And with lots of them in the cyst, things start to get out of control.

White blood cells come to the area to attack the bacteria and find their way into the cyst where the battle rages – and the swelling of the cyst continues. Increased blood flow to the area causes it to turn red and the surrounding tissue swells and hurts.

If this all continues without being brought under control, the cyst can swell so far that it finally ruptures. Now all the toxic stuff that was held within the cyst is released out into the tissue – causing dramatic inflammation and damage. The ultimate result is that scar tissue forms in the process of repairing the damage.
That’s what cystic acne is.

Now, what can you do about it?

Cystic acne is still basically acne. So, treatment for cystic acne is much the same as for acne in general. If it is out of control, it’s a good idea to see a dermatologist in order to minimize the risk of scarring. Once scarring occurs, it’s generally with you for life – so it’s best to prevent it in the first place.

In addition to prescription medication, your dermatologist can also treat the cysts individually by opening them and draining the stuff in them or by injecting medication right into the cyst.

If you aren’t quite ready to see a dermatologist and feel that you have time to try to control the problem with over-the-counter (OTC) medications, there are a few things you should keep in mind.

You should consider including benzoyl peroxide as a part of your treatment plan. It penetrates deeply into the pore and is quite good at killing the bacteria there.
In general, the higher the concentration of benzoyl peroxide used, the more effective it will be in decreasing the bacterial presence. However, people differ as to how well their skin tolerates the medication, so there is no one strength that will be ideal for everyone.

AcneRecovery’s Treatment Lotion uses benzoyl peroxide and enables the user to adjust the strength from a low of 2.0% to as high as 7.0%, if needed. This enables users to find the right balance for their acne needs and tolerance of benzoyl peroxide.

Other suggestions:

• Zip Popping - Don’t do it! Remember the cyst full of stuff? If you put all that pressure on the zit, you may cause it to rupture – exactly the thing you didn’t want to happen! If they’re bad, see the dermatologist.

• Open The Pore - If you can also get the plug to dissolve and open the channel to the surface, you’ll be better off. Salicylic acid medications are helpful for this. Like AcneRecovery’s Face Wash and Repair Lotion.

• Oil Control - Using oil wipes or clay mask treatments to help reduce the oiliness of the skin can help.

• Gentle Cleansing - Don’t be overly aggressive in cleansing the skin, but many find the gentle scrubbing beads found in some cleansers (like AcneRecovery Face Wash) to be helpful.