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Acne is by far the most common reason for patient appointments at Tennessee TeleDerm. In fact, acne is the most common reason for dermatology visits in the world. That means millions of people with acne seek help every day. Furthermore, common Google search terms include ‘how to get rid of cystic acne’, ‘what is causing my cystic acne?’, ‘how to treat acne scarring’, and ‘can a dermatologist provide acne treatments?’ So if you have acne, remember you are not alone.

The good news? Acne is easy to treat. While it may take 2 to 3 months for a patient to see consistent improvement, acne is neither difficult nor expensive to treat. Patients simply need the right medications for their skin, which is often only available by prescription.

In this post, we provide an overview of cystic acne and explain its causes, ways to treat it, and things you can do right now to make it better. Read on to learn more.

What is acne?

Acne is the term used to describe a variety inflammatory lesions on the skin. Types of acne lesions include papules, pustules, comedones, and cysts or nodules. Additionally, acne-affected skin has other complicating factors such as excess oil and sebum, bacteria, irritation, and clogged pores.

Patient with Cystic Acne

What is cystic acne?

Cystic acne is a type of acne that develops in the deeper layers of the skin. It produces painful, red, and deep, slow-to-heal cysts. Cystic acne is also most common on the lower face, back, and shoulders. Furthermore, it can lead to scarring and skin discoloration because of the depth of the lesions and associated inflammation in the skin.

What is causing my cystic acne?

Normal and expected hormone shifts are the primary cause of cystic acne. However, it’s important to recognize that these hormonal shifts are predictable and normal. In fact, patients with cystic acne do not have hormone imbalances or disorders. To explain, predictable hormone shifts occur during adolescence, young adulthood, pregnancy and postpartum, with menstrual cycles, and during middle age. Having acne during these times of hormone fluctuation is normal and treatable.

Additionally, it’s important to note that diet and stress do not cause cystic acne. Though blaming acne flares on an unhealthy diet or the stress of final exams can be easy, multiple studies show these things do not cause acne breakouts. Acne may slightly improve with an overall healthier lifestyle (less sugar, no smoking, etc.). However, the improvement, if any, will be minimal since the hormone shifts will continue.

What happens during a cystic acne flare? 

Acne is a skin condition that can be caused by hormonal changes, such as increased testosterone and estrogen during adolescence, or rapid increases and decreases in hormones during the menstrual cycle. It can also be caused by activity level, such as exercise. Many patients with acne have breakouts for years because of hormonal changes. The severity of acne is based on genetics and activity level/exercise.

Other body changes that may result from these hormone shifts include growth spurts, hair growth, migraines, mood shifts, uterine cramps, breast tenderness, hair loss in middle age, and energy changes.

How does dermatology treat cystic acne?

Cystic acne forms deeper in the skin than all other acne lesions. For this reason, oral medications are most effective. The oral medications reach the inflammation deeper in the skin via the bloodstream. Topical creams and lotions are less effective as solo treatment because the medication is not able to be absorbed deep enough in the skin for significant improvement. The skin is designed to be a protective barrier, so it makes sense that topical acne medications are only going to treat the most superficial, top layers of the skin.

Oral medications have been used for decades to treat acne. They are safe, effective, and inexpensive.

Oral medications used to treat cystic acne include:

  • Doxycycline
  • Minocycline
  • Spironolactone
  • Isotretinoin (Accutane)
  • Oral contraceptive pills (birth control pills)

Each of these oral medications have a unique and beneficial effect on cystic acne. Doxycycline and Minocycline block inflammation in the skin and are used to treat many skin conditions other than acne. Spironolactone block androgen associated with adult female cystic acne. Isotretinoin increases skin cell turnover and reduces oil production, which decreases inflammation. Oral contraceptive pills stabilize a woman’s monthly cycle by minimizing the large hormone shifts that prepare the body for pregnancy each month and trigger acne flares.

Cystic Acne Care at Home

Though topical medications aren’t as effective for treating cystic acne, they are still an important part of the treatment plan. Topical medications are used reduce surface inflammation, resurface clogged pores, and fade discoloration resulting from repeated breakouts.  Topical medications are typically applied in the morning and at night and left in place to minimize current breakouts and mitigate the severity of future breakouts.

Topical medications used to treat cystic acne include:

  • Clindamycin (reduces inflammation)
  • Benzoyl peroxide (reduces inflammation)
  • Azaleic acid (reduces inflammation and mild resurfacing)
  • Spironolactone (blocks androgen which decreases oil/sebum)
  • Minocycline (reduces inflammation related to acne bacteria)
  • Dapsone (reduces neutrophilic inflammation-very specific to acne)
  • Sulfacetamide (reduces inflammation)
  • Resurfacing acids (glycolic, salicylic, lactic, retinoic acid)
  • Fading agents (hydroquinone, vitamin c)

Laser treatments could help to reduce acne lesions. However, results are temporary and the treatments must be repeated intermittently. That said, lasers are very effective in treating skin imperfections resulting from acne such as discoloration, broken capillaries, and acne scarring/pitting.

What should I do now to treat my cystic acne?

The short answer is: make an appointment with a dermatology professional or dermatologist. Simply put, treating cystic acne requires prescription medication only available from a healthcare provider, preferably a dermatology nurse practitioner or dermatologist. During the appointment, the patient and provider will discuss which prescription medications are most appropriate for your cystic acne.

Here is a basic skin care routine all acne patients should be doing :

  • Wash face twice a day with a liquid cleanser meant for the skin type of your face. Look for words like oily or combination skin printed on the cleanser (no bar soaps, no face wipes, no moisturizing washes).
  • Avoid harsh scrubs/exfoliants and toners. Acne lesions are inflammatory and scrubbing or using harsh chemicals only worsens the inflammation.
  • Check your skin care products to confirm they are oil-free (moisturizers, SPF, makeup).
  • Moisturize your skin every morning (and at night if dry). Irritated and inflamed skin needs hydration and protection. However, the products must be oil free as to not clog the pores even more. CeraVe and LaRoche both make gentle oil free moisturizers that are easy to find and affordable.

Why should I choose Tennessee TeleDerm for my cystic acne?

At Tennessee TeleDerm, we treat cystic acne every day at our telehealth appointments and are ready to help you! In fact, our patients routinely achieve acne-clearing with safe medications at minimal cost. Our virtual appointments provide patients with more flexibility in how they are seen. Our patients don’t have to wait, fight traffic, or miss school and work. Also, we offer availability sooner than an in-office appointment. This is because in-office providers also perform time-consuming skin procedures such as biopsies and surgeries. Lastly, you do not have to use insurance to be seen at Tennessee TeleDerm. In addition to insurance, we offer affordable self-pay options to everyone.

Schedule an appointment online, 24/7 here.

Have questions or comments, or want to book an appointment?

Tennessee Telederm is proud to announce we are expanding to offer urgent care services. Learn More.

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