Adult cystic acne can be a nightmare. It is one thing to experience acne during puberty along with all the other hormonal changes. Teenage acne is now so common that it is almost expected for most people. But to have acne continue into adulthood or even start when you are an adult is unexpected and depressing – especially when it is cystic acne, the most painful and the most difficult type to treat.
Cystic acne is a kind of common acne or acne vulgaris which appears as nodules or cysts under the skin. The cysts are deeper below the surface than the whiteheads of other types of acne. This is because they often form in sweat ducts rather than hair follicles, although in some cases cysts can form in a follicle.
Adult cystic acne nodules are often found on the buttocks, groin and armpit areas as well as the face. They are inflammatory and can be painful as well as embarrassing. When they appear on the face, they can be disfiguringly large and difficult to treat. They also tend to form bigger and longer lasting scars than other types of acne.
So what can you do about adult cystic acne? First, let’s make it clear that you cannot pop the pimples of cystic acne and you should not even try. The inflamed matter is not close enough to the surface and you will only push it even deeper, making the problem worse.
If your acne is mild to moderate, the first thing to try is benzoyl peroxide cream which you can buy from a drugstore or on prescription. Benzoyl peroxide is also an active ingredient in many of the most successful acne creams and washes. It dries the skin and increases sensitivity to the sun, so you will also need to use an acne-friendly moisturizer such as jojoba oil and a sunscreen.
If you have severe adult cystic acne or if you find that benzoyl peroxide is not effective enough, you will need to visit your doctor or dermatologist for advice. Some years ago, it was popular to prescribe antibiotics for cystic acne, but unfortunately the bacteria that are involved in acne have now become resistant to most antibiotics. Therefore, doctors rarely prescribe these now.
You may be prescribed topical retinoids. These are gels and creams whose active ingredient is related to vitamin A. They regulate the cells in the hair follicle and prevent blockage. Retinoids include tretinoin which is marketed under the brand name Retin-A.
When you first use retinoid products on the skin you will probably find that the acne and redness gets worse before it clears up. Do not give up too soon, because the products can be very effective in the long term.
If you have a severe case of adult cystic acne and topical gels are not successful in dealing with it, your doctor may prescribe oral isotretinoin. This has several brand names including Accutane. Oral isotretinoin can be very successful, clearing or significantly improving acne in around 80% of patients. In most cases the acne is cleared permanently and does not return when the treatment is stopped, but in about one-quarter of patients, a second or third course of treatment is required after some months.
However, oral isotretinoin has some serious side effects, so it is only prescribed in severe cases. The most significant effect is that it will create birth defects if taken by pregnant women. For this reason, if sexually active women want to take it, they are usually required to use two different forms of birth control to be sure that they will not get pregnant. Other side effects include dry skin, nosebleeds and possible liver damage (although this has been disputed).
So there are plenty of treatments available for adult cystic acne. There is no need to live with it if it is causing you embarrassment or depression. If drugstore remedies are not effective, go see your doctor to discuss possible prescription treatments for your adult cystic acne.