Cystic acne is a so-called “severe” form of acne, which often occurs due to hormonal imbalance. If not taken care of, the lesions can persist and generate scars that are difficult to reverse. The intervention of a dermatologist, or even an endocrinologist, is often necessary.
Acne is an inflammatory disease of the follicle pilosebaceous that plays mostly in spurts, over several years, to cure. It usually makes its appearance at the time of adolescence, but can also persist, or appear in adulthood. This is particularly the case with cystic acne, a very resistant form of acne, considered “severe” because it is likely to permanently mark the skin of patients.
What is cystic acne?
Cystic acne is a “severe” form of acne that is often linked to hormonal imbalance. It can also be the result of untreated inflammatory acne that has degenerated.
As the name suggests, it is characterized by the formation of cysts (deep lesions under the skin), which are often painful to the touch.
How to recognize cystic acne?
This type of acne most often settles on the lower face (cheeks, jawbones, chin), but can also spread to the neck, shoulders or chest.
In general, cystic acne combines all the basic lesions of acne:
- Retentional lesions: open comedones, closed comedones, cysts (comedones surrounded by a fibrous shell preventing drainage of the sebaceous gland), microcysts.
- And inflammatory lesions: papules (red, firm, sometimes painful eruptions, generally less than 5 mm which can either develop on an existing comedo or appear spontaneously), pustules (linked to superinfection and generally less than 5 mm. purulent fluid that may drain or rupture.), nodules (deeper lesions with a diameter greater than 5 mm, or even 7 mm, which often progress to abscess and give way to scars).
It can give way to more or less deep scars:
- Atrophic scars (shallow, they look like small craters and are relatively easy to heal);
- Hypertrophic scars, also called “ice pick”, deeper, narrower and giving a “pockmarked” appearance to the face;
- And keloid scars (swollen and reddish), more difficult to treat because they spread irregularly around the original wound.
But acne can also cause psychological damage and have psychosocial repercussions. A phenomenon is all the more important among adolescents in the middle of construction. To avoid irreversible damage, it is therefore important to treat acne lesions as soon as they form.
Cystic acne: Are some people more at risk?
It is difficult to determine a “typical profile” of patients with cystic acne. In principle, anyone can suffer from it: we know that it affects adolescents as well as adults. According to Dr Schollhammer, however, this severe form of acne is more common in men (as is fulminating acne).
A family history of severe acne and skin type (color, photosensitivity) should also be taken into consideration. A person whose parents suffered from cystic acne is more prone to developing this disease.
What Are the Causes of Cystic Acne?
The origin of cystic acne is still poorly determined, but genes are known to play a crucial role in the development of severe acne. Some aggravating factors have also been identified on the basis of clinical observations:
“In the case of cystic acne, we can a priori rule out stress and diet, which have no impact on the development of severe acne,” says Dr Schollhammer. However, a combination of several risk factors (tobacco, pollution, taking birth control pills, menstruation, taking inappropriate medications, stress, sun exposure, excessive alcohol consumption, etc.) can participate in the development of severe acne breakouts.
Hormonal imbalance ( polycystic ovary syndrome, hyperandrogenemia, hypothyroidism ) can also be the cause of cystic acne in adult women. An appointment with an endocrinologist, a dermatologist or a gynecologist will make it possible to rule out this hypothesis, or, if necessary, to find a solution adapted to each patient.
When and who should you consult in case of cystic acne?
General practitioners can prescribe a classic anti-acne treatment (a local treatment associated with a course of antibiotics, or zinc ), but if the acne persists, or becomes complicated, a visit to the dermatologist (doctor specializing in the skin ) is required.
A monthly follow-up is necessary for women and bimonthly for men. If the dermatologist suspects a hormonal cause in a patient, he can refer her to an endocrinologist for a hormonal assessment.
How to treat cystic acne?
A severe form of acne, this type of acne manifests itself under the skin, deep down. Traditional and local acne treatments (based on zinc, azelaic acid or benzoyl peroxide) are therefore not always effective.
Several levels of treatment can be considered:
- Appropriate care: it is recommended to clean the facial skin with a micellar lotion, a special “acne-prone” cleansing gel or a soap-free cleanser. Exfoliation of the skin of the face is to be avoided. On the other hand, makeup products and moisturizers must be non-comedogenic, or specifically suitable for combination to oily skin. To find out more about the preferred products, do not hesitate to ask your dermatologist or pharmacist;
- Local treatment: based on benzoyl peroxide or local retinoids, local treatments are in the form of creams, gels or lotions. The frequency of application of the treatment depends on the severity and extent of the lesions. If the skin is too dry, treatment can be combined with a non-comedogenic moisturizer. The effects of treatment usually appear after several weeks (about two months). It should be continued until the acne has completely disappeared;
- A combined treatment, with local treatment and oral treatment: general treatments (oral) can be zinc, an antibiotic or hormonal treatment (contraceptive pill in women);
- Isotretinoin treatment: this oral treatment is considered in severe acne (first-line for grade 5 acne), or when other treatments and medications have not given the expected results (second-line for grade 4 acne). The treatment is implemented over several months (between 4 and 6 months approximately), and the dosage is adapted according to the age of the patient, the degree of severity of the acne, the extent of the lesions, etc. This treatment can cause serious side effects. It is never prescribed for pregnant women and must be taken as part of very regular medical monitoring (biological examinations and psychological evaluations).
Sometimes your doctor may use corticosteroid injections to treat nodules and abscesses caused by cystic acne. He can also incise them, to then drain them.
Are “natural” treatments effective?
A priori, the “natural” stamped treatments which aim to fight against active acne cannot harm our skin, “as long as we do not use fatty products”, insists the dermatologist. And to add: “clay, for example, absorbs seborrhea and reduces shine, but will not treat the origin of cystic acne “.
In addition, the effectiveness of masks or essential oils (sometimes photosensitizing) to reduce acne, or acne scars seems to be inconclusive and may also expose you to the risk of contact eczema.
How to reduce scars associated with cystic acne?
” The best treatment for acne scars is time,” recalls Dr Schollhammer. Usually, at the end of treatment, the scars maybe a little red, then they un-redden and can fill for 18 months. “.
Otherwise, once the acne is gone (usually after a year), we can resort to deep peels (to be performed by an experienced dermatologist preferably), but especially today, or fractional lasers (which stimulate the dermis to accelerate its filling work).
However, it should be understood that lasers do not completely erase scars: “Lasers are not magic erasers. They can reduce scars, but we can never completely erase them. We can make them less visible, less unsightly, but they are part of the patient’s story. Acne is not a shameful disease, even if it refers to the period of adolescence which is sometimes difficult to live “.
Can we prevent cystic acne?
The best prevention remains the treatment of acne, to be implemented as soon as the first symptoms of gravity appear. ” The cessation of smoking, which promotes seborrhea (excessive secretion of sebum by the sebaceous glands) is useful,” advises dermatologist. As well as good food hygiene and regular physical activity. Since we know little about the causes of severe acne, these preventive tips are not law and do not offer any guarantees.
Daily, cleanse your skin once or twice a day with a gentle product. Remember to moisturize it regularly using non-comedogenic cosmetics and avoid fatty cosmetics at all costs. You can also exfoliate your skin once a week with a salicylic acid-based exfoliator.
To hide your scars or inflamed pimples, bet on makeup: there are many oil-free and “non-comedogenic” products created specifically for acne-prone skin, which prevent clogging of the skin’s pores.