Cystic acne is a pain — quite literally. Compared with all of the types of spots out there — whiteheads, blackheads, pustules — cysts are the most uncomfortable and severe. They are deep, under the skin spots that not only cause throbbing and aching, but can also take longer to heal, leaving long-lasting red marks behind.
Just like we treat varying skin concerns, different types of spots require different treatment. And although some gadgets or unexpected hero products can help calm your other skin woes, cystic pimples are a whole other best (not new beast) that needs to be treated very carefully. Unfortunately, cystic acne is unlikely to be taken care of using every-day drugstore products or simply drinking enough water. The root of cystic acne and inflammation is too deep in the skin for a regular skincare regime to have significant effect.
As a cystic acne-sufferer herself, Dr Anjali Mahto, consultant dermatologist at the Cadogan Clinic, stresses the importance of getting cystic acne under control with the help of a specialist because, "delaying the right treatment can lead to unnecessary skin scarring as well as a prolonged negative effect on our mental well-being."
With that in mind, we wanted to find out more about why exactly your average skin care products won't work and what you can do to treat it. So we called on Dr Mahto and cosmetic doctor, Dr Jonquille Chantrey to give us all of the facts. Read on to see what they had to say, and remember: whatever you do, do not put toothpaste on your spots, OK?
What Is a Cystic Acne?
So, let's get straight to it. What exactly is a cyst? According to Dr. Chantrey, there are around 42 types of cysts. They range "from sebaceous cysts on the skin and benign cysts in the breast, to acne which presents itself as cystic in nature." Cystic spots, she explains, come from "the increase of hormones, which in turn increases the production of oil and sebum on the surface of the skin. When the pores get clogged with dead skin cells, sebum, and bacteria, the area becomes red and swollen." With cystic acne, the inflammation goes deep into the skin, forming "deep, red, painful bumps underneath the skin surface," says Dr. Mahto. "Rather than lasting a few days, they can take a long time (sometimes weeks) to heal." This type of acne can occur on the face, chest, or back and is at high risk of producing scarring (small indents or pits in the skin).
Why Do We Get Cystic Acne?
Why are more people prone to getting cystic pimples than others? Unfortunately, "there is no definitive reason," says Dr. Chantrey. Cystic acne can occur at any age but is more common in teenage years, Dr Chantrey explains, due to a surge in hormones. "Sometimes it isn't down to what we are eating, or sleepless nights, or heavy make-up, or anything else we are doing wrong, it's just the luck of the DNA draw in terms of our unique combination of hormones and genetics," says Dr Mahto.
In addition to this, cystic acne can be triggered by a condition called Polycystic Ovary Syndrome (PCOS). This is due to excess of male hormones, also known as hyperandrogenism, which can trigger excess sebum and dead skin cells to get trapped in the hair follicles and cause breakouts, explains GP and skin specialist Dr Ross Perry.
What Are the Differences Between a Cystic Acne and a Other Spots?
Regular whiteheads and cystic spots can, in some cases, be quite similar in appearance (they are red, raised, and not to mention pretty painful), but regular whiteheads will be easier to clear. "They usually clear up on their own or with the use of a mild topical cleanser or cream that contains an exfoliant such as salicylic, glycolic, mandelic, or lactic acid," explains Dr. Chantrey. "These products help to reduce the oil production, clear, and tighten the pores, and as such reduce the inflammation."
However, when it comes to cystic spots the remedy isn't so straightforward. Cystic acne occurs due to inflammation in the deeper skin layers such as the dermis. "One of the skin's main functions is to act as a barrier — it is there to stop things getting in and out," explains Dr Mahto, which makes it hard for products to penetrate deeply enough through to the deeper layers of the skin. "The very top layer of the epidermis, the stratum corneum, is made up of about 15-20 layers of dead skin cells", Mahto says. "One of the biggest challenges in producing a cosmetic formulation is to create a product which will successfully cross this barrier into viable or living epidermis, and one that will be high enough concentration when it crosses the barrier to the acne."
Because of this, unlike regular breakouts, over the counter topical products will unlikely clear up cystic acne. "The inflammation is simply sitting too deep in the skin for any topical over-the-counter skincare products to work", says Dr Mahto. "This is also the reason that superficial chemical peels also don't work for cystic acne as they are unable to act at a deep enough level to treat the cysts."
How Should We Treat Cystic Acne?
This doesn't mean cystic acne can't be treated. First things first, Dr. Chantrey reminds us that, under absolutely no circumstances should a cyst be squeezed: "This will not reduce the inflammation, but it could cause the bacteria to spread, which will exacerbate the condition and could lead to further inflammation and scarring."
"There is a common misconception that optimising your skincare routine can lead to both short and long-term clearance of cystic acne," says Dr Mahto. Since cystic acne is unlikely to respond to over-the-counter skin-care alone, Dr Mahto stresses the importance of seeking medical advice. "Struggling alone, spending hundreds of pounds on facials or skincare, is unlikely to provide the answer." But that doesn't mean there isn't a solution out there. "If you are suffering with your skin there are always solutions," Dr. Mahto wrote in an Instagram caption explaining her experience. "They do not come with the guarantee that after a round of treatment your acne will not return, but there is always something that can be done and no one needs to suffer or just put up with it."
If you suspect you may have cystic acne, seeing a dermatologist is strongly advised. During the appointment, the dermatologist can assess the extent and severity of your acne, the scaring (or scaring risk) you may have, as well as any effects your skin may be having on your mental health — which is an incredibly important factor when seeking help. Options for treatment of cystic acne include a variety of oral medications (including isotretinoin, otherwise known as Roaccutane), which is prescribed on a case-by-case basis.
According to Dr. Chantrey, one of the most successful in-clinic treatments is a medical procedure called Theraclear, which uses a special vacuum machine to deep cleanse the pores and broadband light to reduce sebum production and clear the bacteria.
As mentioned previously, treatment for cystic acne may not be a one time fix, either. Dr Mahto explained to POPSUGAR that after six months of trying to stay on top of her own intermittent and largely premenstrual acne with skincare and chemical peels, a recent bout of spots led to some new, indented scarring. She reveals that, "this was the impetus I needed to accept that I needed medication again and skincare was no longer going to cut it."
— Additional reporting by Tori Crowther