For every useful page of information about cystic acne brought up by an internet search, dozens more pages give thinly veiled sales pitches for commercial skin products, or claim miraculous cures among lists of home remedies, shamelessly appealing to people who have become exasperated by their skin problem.
The truth is that while there is no wonder cure for this often emotionally distressing problem, severe acne can be managed effectively with the help of doctors, and medical treatment can result in the prevention of some of the worst effects of cystic acne.
Contents of this article:
Fast facts on cystic acne
Here are some key points about cystic acne. More detail and supporting information is in the body of this article.
- Cystic acne is the most severe form of acne.
- While acne is very common, cystic acne is relatively uncommon.
- Cystic acne is not caused by chocolate, nuts or greasy foods, nor by poor hygiene or masturbation.
- The main factor behind cystic acne is the hormonal change in puberty, but the problem is also experienced by older age groups.
- Cystic acne can be painful, as well as emotionally distressing because of its effects on facial appearance.
- Cystic acne is easy to diagnose and does not require any special tests.
- A specific oral medication, taken over a number of months, is typically successful against cystic acne but it can produce severe side-effects and has to be prescribed by registered specialists.
- Practical self-care tips are helpful in ensuring acne, including cystic acne, is not made worse.
What is cystic acne?
Cystic acne is a skin condition in which the pores in the skin become blocked, leading to infection and inflammation in some cases. The skin conditions mainly affects the face, but also often affects the upper trunk and upper arms.1
Acne is a familiar sight among teenagers - effects on skin by puberty hormones are to blame.
The medical term for the pores of the skin is pilosebaceous units, which includes the hair follicles and their accompanying sebaceous glands that secrete the oily substance known as sebum.1
Normal sebum secretions help protect the hair follicles and skin, but overproduction of sebum (and overgrowth of skin cells) can cause the pores to become plugged with sebum and epidermal cells shed from the skin. This can create optimal conditions for the overgrowth of an anaerobic bacterium normally found on the skin, Propionibacterium acnes.1,2
These plugs are also known as comedones, and can be white- or black-headed. The comedones can be uninfected - non-inflammatory acne - or they can become infected and inflamed, leading to papules, pustules, nodules, or cysts. Cystic acne is the worst of these lesions (often called "pimples," "spots" or "zits"):1,2
- Papules occur when the P. acnes bacteria lead to irritation of the hair follicles
- Pustules occur when the P. acnes bacteria lead to inflammation of the hair follicles, causing swollen red bumps
- Cysts occur when the inflammation leads to rupture of the hair follicles (which can also be caused by squeezing the spots, or by harsh scrubbing), releasing matter that triggers wider inflammation, and deeper, hard, painful cysts.
Acne most often affects adolescents and young adults, with an estimated 80% of people between 11 and 30 years of age are affected at some point.3
Cystic acne is the most severe form, and affects far fewer people - the US Centers for Disease Control and Prevention (CDC) estimate that approximately 2 in every 1,000 people are affected by cystic acne, compared with nearly 70 in 1,000 for acne in general.4
In 2009, the CDC found that acne was the top reason patients gave for visiting a dermatologist, and a top five skin diagnosis.5
What causes cystic acne?
As discussed above, acne is characterized by a blockage of the skin pores because of the overproduction of sebum, or skin cells, combined with inflammation triggered by the bacterium P. acnes. Cysts are the most inflamed, ruptured form of these comedones.
The biggest factor causing acne is the hormonal change in adolescent teenage years. During puberty, levels of circulating androgen hormones increase dramatically leading to increased sebum production and greater proliferation of skin cells.1,2
Acne is not confined to teenagers, however, and other factors are involved, including an inherited tendency for acne, alongside:1,2
- Hormonal changes - related to puberty, the menstrual cycle, pregnancy, birth control, the use of hormone therapy, and stress
- Occlusive, greasy cosmetics, cleansers, lotions, and clothing
- High levels of humidity and sweating
- Some drugs and chemicals (for example, corticosteroids, lithium, phenytoin, isoniazid), which may worsen or cause eruptions that are similar to acne.
There are numerous myths about the causes of acne, with blame wrongly assigned to factors that have been roundly dismissed by scientific research.
Acne, including cystic acne, is not caused by:
- Chocolate, nuts, or greasy foods
- Most other dietary choices - research has found an association between intake of milk products and acne, as well as a high glycemic index diet and acne
- Poor hygiene or inadequate face washing
- Masturbation or sex.
Recent developments about causes of acne
Strain of acne-causing bacteria found to actually preserve skin. This small study published in January 2013 found that different strains of a bacterium associated with acne have different roles to play - and that some are associated with healthy skin.
Signs and symptoms of cystic acne
Acne produces symptoms familiar to all of us - 70-80% of people are affected at some time,3,4 and we have all seen faces affected by acne.
Cystic acne is even more visible because it is the severe form that produces cysts and nodules in addition to numerous inflammatory papules and pustules.3 Acne can also cause visible scarring.
All forms of acne can affect self-esteem and mood, but the risk of psychological distress is higher for cystic acne as it typically has a greater impact on the appearance of the face and disproportionately affects young adults who may be more socially sensitive.
Most forms of acne do not produce physical symptoms felt by the person themselves, but the skin's appearance can cause emotional distress. In cystic acne, however, the distress may be higher, and the cysts may be painful.1
The importance of treatment is underlined by the risk of scarring from long-term cystic acne. This can produce long-term and permanent damage in the form of:1
- 'Ice pick' scars (small, deep pits)
- Larger pits
- Shallow depressions
- Hypertrophic scarring (red, raised scars).
On the next page we look at diagnosis of cystic acne, methods of prevention and self care and the treatment options for cystic acne.