Understanding Cystic Acne

Understanding Cystic Acne and Nodulocystic Acne
By Angela Palmer, About.com
Updated: December 30, 2008
About.com Health's Disease and Condition content is reviewed by the Medical Review Board
Cystic acne, or nodulocystic acne, is the most severe form of acne vulgaris. Deep, inflamed breakouts develop on the face and/or other areas of the body. The blemishes themselves can become large; some may measure up to several centimeters across.
Although many people use the term "cystic" to describe any type of severely inflamed acne, only those who develop cysts truly have cystic acne. Cysts are the most serious kind of acne blemish. They feel like soft, fluid-filled lumps under the skin's surface. Cysts can be painful.
Nodulocystic acne sufferers develop nodules as well as cysts. Nodules are hard, painful lumps under the skin's surface. Much larger than papules, nodules form deep within the skin and take a long time to heal. Some skin care experts believe acne cysts are not really cysts at all, but rather severely inflamed nodular breakouts.
For those who have nodules, but do not have cystic lesions, the term nodular acne is more accurate. No matter what label you use, a dermatologist must treat acne of this severity.
Who Gets Cystic Acne?
Cystic acne can affect anyone, but it is more common in teenage boys and young men. Acne seems to run in families. If your parents had cystic acne, you are more likely to experience severe acne yourself.

Causes of Cystic Acne
Cystic acne is caused by the same factors as other forms of acne, which are:
• overactive oil glands
• excess dead skin cells within the hair follicle (pore), and
• a large number of acne-causing bacteria, Propionibacteria acnes
Inflamed acne blemishes develop when the follicle wall ruptures, leaking infected material into the dermis. If this break occurs near the skin's surface, the blemish is usually minor and heals quickly. Deeper breaks in the follicle wall cause more serious lesions. Nodules develop when the contaminated material infects adjoining follicles.
Like nodules, cysts begin as a deep break in the pore wall. A membrane then forms around the infection within the dermis. Some people are more prone to developing these types of serious breakouts than others.
Cystic acne is not caused by a lack of cleansing, drinking soda, or eating sweets. The sufferer has done nothing to cause his skin problems.
Effects of Cystic Acne
Nodulocystic breakouts damage and destroy healthy skin tissue. Because of this, the likelihood of developing scars is extremely high. Picking at the skin and trying to pop cysts or nodules should be avoided at all costs. Doing so can greatly damage the skin, lead to scarring, and worsen acne. Aggressively treating this form of acne can help limit the severity of scarring.
It's also common for those with severe acne to have feelings of embarrassment, shame, and anger regarding their skin. Some sufferers avoid mirrors, or shy away from social situations. Acne can hurt the self-esteem, and may lead to depression. If you feel acne is greatly affecting the quality of your life, please talk to your doctor. Luckily, with treatment, most people find their self-confidence improves.
Treatment
A doctor must treat cystic and nodulocystic acne. Powerful systemic medications are usually required. Acne of this severity can be hard to control. Don't be discouraged if the first treatment attempt fails. It may take several tries to find the treatment or combination of treatments that work for you. Some common treatments for nodulocystic acne include:
• Oral antibiotics
• Accutane (isotretinoin)
• Oral contraceptives - for women
• Surgical excision and drainage - A doctor makes a small incision in the skin and extracts the infected material.
• Intralesional corticosteroid injections - Medication is injected directly into the lesion to reduce inflammation and shrink the blemish.