Dr Ai Nhi Bui
A GP gives us the lowdown on cystic acne and how you can treat it at home
Cystic acne is the most severe type of acne. It can be painful and cause scarring, which is why you need to be careful with how you treat it. With so many skincare products out on the market, it’s important to choose the right regimen for your particular skin type. Everyone’s skin is different, and acne products are not a one-size-fits-all solution.
As a GP, I treat plenty of adult patients who are ready to start their acne journeys by offering personalised acne treatment plans, from cleansers and moisturisers to prescription acne medications.
What is cystic acne and what causes it?
Pimples range in severity, starting with mild blackheads and whiteheads. These are blocked pores that are noninflammatory. Once they become inflamed, they can be red, tender and pus-filled. These types of inflammatory pimples are called papules (red and tender) and pustules (red, tender and pus-filled). The next stage of severity comes in the form of nodules. Nodules are large, hard lumps that form deeper under the skin.
The most severe form of acne is cystic acne. When your pores become clogged with a combination of bacteria, oil and dead skin cells, cysts develop deeper below the surface of your skin than nodules, papules, pustules, blackheads and whiteheads. People who are prone to oily skin are more likely to develop cystic acne. It can appear anywhere on your skin, including your face, neck, chest, back, arms and shoulders.
How to treat cystic acne
Having acne is a normal part of puberty and your teenage years, but when you’re still dealing with spots in adulthood it can be really frustrating. The good news is there are prescription acne treatments that can help clear your skin.
Because cysts are quite severe, oftentimes you’ll need something stronger than over-the-counter washes and creams in order to properly treat it and prevent scarring.
Prescription-strength retinoids are one of the most popular cystic acne treatments. They work by increasing the rate of skin cell turnover, giving your skin cells less time to become clogged with acne-causing things (like bacteria, excess sebum or oil and dead skin cells) and thus revealing fresher, younger-looking skin. However, retinoids are often associated with skin purging (sometimes referred to as the tretinoin purge) - the 4 to 6 week period when your skin is going through a full cycle of regrowth that surfaces all of the debris that was in between the skin layers.
Oral antibiotics can be prescribed if your cystic acne covers a large area of your skin. Because one cause of cystic acne is bacteria clogging your pores, oral antibiotics can help decrease the amount of bacteria that is present.
Antibiotics should be prescribed for the least amount of time possible in order to prevent bacterial resistance.
They are often prescribed alongside a topical retinoid like tretinoin for greater effectiveness.
For women, oral contraceptive pills can be prescribed to help manage hormonal acne. If your acne cysts are typically appearing during your menstrual cycle, talk to your doctor about using the birth control pill to help treat your breakouts. The hormones in the pill can help balance out the hormones that are causing the pimples in the first place.
The first step in addressing cystic acne (or acne of any kind) is to talk to your doctor either face-to-face or online via a digital health service that can prescribe acne treatments online. GPs can identify a treatment plan tailored to your skin and your unique needs. Rosemary Health is a digital service connecting Australians to quality healthcare online and can assist with acne treatment. It’s possible that things will get worse before they get better (due to the skin purge), but keep at it - report side effects and progress to your doctor and you’ll be on your way to clearer skin.
Whatever you do, do not pop cystic acne. I know that it can be tempting to do so, but popping cystic acne will be painful and delay the healing process. It will also likely cause scarring and possibly discolouration.
Dr Ai Nhi Bui is a registered GP and medical director at Rosemary Health.
With over 15 years of experience, Dr Bui has an interest in women’s health issues ranging from skincare and sexual health to chronic conditions.