I work with teenagers in my day job, and I see an astounding array of facial blemishes on a regular basis, from huge throbbing white pustules to awkward colonies of blackheads. It is hard not to look at them. Cystic acne or nodular acne is beyond the scope of ordinary acne. It's larger, more painful, and overtly tragic in its stigmatizing abilities. It is acne that is so bad, it often leaves acne scars that will last a lifetime. I really feel bad for those who suffer from this problem because, for the most part, there is no miracle cure to get rid of acne, and sometimes the side-effects from treatments are worse than the condition.
Just because there is no miracle cure, it doesn't mean that there is no hope. There are things you can do to help minimize the effects of acne and maybe prevent it from progressing to the point of becoming cystic acne. However, there is some evidence that the tendency to develop cystic or nodular acne might be genetic—which means that it becomes a lot harder to prevent. There is certainly no harm in trying though, and I've gathered here together the most highly recommended options. Just remember that the first step should always be to talk to a dermatologist.
Cystic Acne Treatments
Keeping yourself clean is the first step. I know, I know, acne isn't necessarily related to cleanliness. Even the neatest, cleanest prude can develop a giant pimple on her forehead. But, it has to be said: very often, the people I see with really bad acne have obviously greasy skin. This means that their body produces a lot of sebum. It's those overactive sebaceous glands that tend to get clogged and infected and turn into acne. Work on finding a washing regimen that gets rid of that grease, but isn't so harsh that it irritates the skin; sometimes an over-zealous scrubbing will only serve to make acne worse.
Wear clean clothes, as sweaty, dirty fabric can exacerbate the situation. I'm sure you'll agree that the most obvious and psychologically damaging area for cystic acne to take hold is your face. Our faces, the thing people see first, are full of those problematic sebaceous glands. Cystic acne is equally as common on our backs, chests, buttocks, and groins, because those areas are also full of sebaceous glands. These areas have another problem in that they are usually covered by clothing. It is important that you change out of sweaty, dirty clothes as soon as you can. Also, try to wear breathable, loose-fitting clothes, as hot areas and areas which are irritated via rubbing can also cause acne flare-ups.
Try not to irritate acne-prone areas. This goes against our instincts. Most people, when they see a pimple coming on want nothing more than to pop that thing, thus spilling its contents to the wind. Evidently a red area of irritation is more socially acceptable than one with a white pulsing center. With cystic acne, it is likely that the infection is so deep that squeezing the area will only cause more problems. If it is a nodule, you could potentially bruise the skin and burst capillaries, which will make it look worse and cause scarring. This is not to mention the potential for bacterial contamination. If you are going to do it, do it clean—sanitize the area with rubbing alcohol first—or, at the very least, wash your hands.
If you want to avoid a breakout, avoid oily skin products. Just as people with naturally oily skin increase their risk of acne by not keeping it under control, people who use skin-moisturizers, lotions, and other greasy products can have similar problems. In many cases, acne is caused by pores or hair follicles which become overwhelmed with oils, dead skin, and sweat. If you add moisturizing oils to the mix, as much as they might relieve pain from sensitive skin, you are only contributing to the problem. Bacteria can overgrow in the clogged pores, causing an infection, and then you're stuck with another round of acne.
Use products like benzoyl peroxide or salicylic acid. These products, whether in lotion or bar soap form, work by causing the skin to exfoliate more than it would ordinarily. This gets rid of dead skin, encourages new skin growth, clears out pores, and reduces bacterial populations. These products are for treatment of mild to moderate acne and probably won't be able to clear severe acne. However, if you can treat acne early on, it is less likely to progress to the more severe stages. It should be clear, from the description, that these products are going to cause some irritation. You are, after all, peeling skin away. In most cases, that irritation should subside after a couple of weeks.
When to Seek a Dermatologist
You've been through all of this. You've washed with every soap, every lotion. You've tried popping zits and leaving them alone—all to no avail. If you haven't been to a dermatologist, then you haven't tried everything. Medical professionals have a large arsenal of products at their disposal, and they have the experience and expertise to help you solve your problem.
- Prescription strength skin lotions containing retinoic acid, salicylic acid, or benzoyl peroxide help to get rid of dead skin cells and promote new cell growth.
- Antibiotics in topical or ingestible form are a good option for dealing with bacterial infections caused by acne. Some common ones are minocycline, tetracycline, and doxycycline.
- Accutane, a vitamin A derivative, is a prescription drug that is used only for very severe acne, as it has some nasty side effects.
- Hormonal treatments, in the form of oral contraceptives, are an option available to women who are suffering from severe acne.
- Cortisone injections will reduce swelling and promote healing in an area of deep, severe acne unaffected by topical treatments.
