Blog > Acne > Cystic Acne – What it is, Causes & Treatment

Cystic Acne – What it is, Causes & Treatment

Looking for an effective cystic acne treatment in Singapore? Let’s dive into the causes of cystic acne and the different types of treatments available.   

Cystic acne is an inflammatory condition that creates acne lesions deep under the skin. These lesions then manifest on the surface of the skin as large bumps, which are often tender and/or painful. 

This form of acne is noticeably different from the more common and recognizable acne conditions, like blackheads and whiteheads, because it occurs much deeper in the skin. As a result, the cysts never bulge into a “poppable” head. If left untreated, it can lead to significant discomfort and potential permanent acne scars 

In this article, we will explore what cystic acne is, its causes, and various treatment options available to manage this condition effectively.  

cystic acne nodular acne vs pustule regular acne

What is Cystic Acne? 

Cystic acne, the most severe form of acne vulgaris, is characterized by deep, inflamed lesions that develop into large, pus-filled cysts. This usually occurs when bacteria enter the pores, causing swelling, inflammation and the formation of pus. It can be notably painful especially when there is no opening to release the pent-up bacteria and oil.  

It is best to treat cystic acne early, because if a cyst bursts, the infection can spread to the other parts of the face, causing more breakouts. Due to the depth and severity of the inflammation, this form of acne can also leave long-lasting scars - like ice pick scars. Unlike milder forms of acne, this form of acne is also more resistant to over-the-counter treatments like benzoyl peroxide and often requires professional intervention. 

What causes Cystic Acne?  

Several factors can contribute to cystic acne, including hormones, diet and stress. One of the primary culprits of acne is the hormones called androgens, particularly in teens, and they are every teen's worst nightmare.  

During puberty, androgen levels increase, which leads to changes in the skin that can result in clogged pores and acne. Women are especially affected by acne vulgaris because hormonal changes, such as menstruation, results in the overactivity of sebaceous glands.  

According to the Acne Management Guidelines by the Dermatological Society of Singapore, cystic acne is seen more often in adults, and it affects up to 69% of the female population in their adulthood [1]. 

Other factors that contribute to cystic acne include; 

  • Pregnancy 

  • Hormonal Imbalances  

  • Polycystic ovary syndrome (POS) 

  • Genetics  

  • Excessive Sebum Production  

  • Bacterial Infection  

  • Lifestyle Factors  

cystic acne nodular acne

When to see a doctor for Cystic Acne Treatments?  

As mentioned, cystic acne is a severe form of acne that if left without the appropriate treatments will risk permanent scarring. While there are over-the-counter topical acne creams available for milder forms of acne, they are generally not effective enough to successfully target the deep-seated bacteria. It involves deep-seated inflammation and infection within the skin, which requires more potent medications and targeted treatments.   

Over-the counter treatments typically contain lower concentrations of active ingredients and are not designed to address the underlying causes effectively. Due to its severity, it often require prescription-strength medications that are not available over-the-counter 

Therefore, it is important to speak to a doctor for cystic acne treatment to receive the most appropriate care and improve the chances and successful management of the condition while minimizing the risk of complications and scarring.  

Cystic Acne Treatments in Singapore 

 1. Prescription Medication 

Cystic acne almost always require medical-grade treatments that are not available over-the-counter. In order to eliminate the deep-seated bacteria, stronger treatments like oral medication for acne such as antibiotics, birth control pills, isotretinoin, spironolactone or topical retinoids are often needed. 

These oral medications are only available with prescription and the dosage has to be monitored by doctors to ensure their effectiveness and minimize potential side effects.  

2. Corticosteroid Injections/ Cortisone Injections  

Cortisone acne injections can be an effective treatment method for cystic acne due to their anti-inflammatory properties. When injected directly into the lesion, cortisone rapidly reduces inflammation, redness and swelling, providing an almost instant relief to the affected area.  

However, this cortisone acne injection treatment is a short-term solution, as it temporarily shrinks large acne cysts. It does not address the underlying causes.

Cortisone shots are synthetic versions of certain steroid hormones, they suppress the immune response to reduce the production of inflammatory substances, such as cytokines, which play a crucial role in healing and repair. By doing this, it weakens the body's immune system, making the skin more susceptible to infection. Other side effects may also lead to skin pitting, resulting in permanent scarring.  

cortisone steroid injection for cystic acne

3. In-clinic treatments 

While prescription medications play a crucial role in managing cystic acne, in-clinic treatments such as lasers and microneedling, acne medical facials and chemical peels can value add the overall acne treatment more comprehensively.  

These treatments help to effectively combat acne in general, reducing scarring and preventing future breakouts. These treatment procedures utilize advanced medical-grade technologies that effectively reach the different depths of the skin to not only help control overactive sebum production, repair damaged skin cells but also stimulate collagen production and reduce the overall appearance of pores and scars.  

4. Lifestyle Changes 

Treating acne also includes lifestyle modifications. A balanced diet, regular exercise, and adequate sleep can improve overall skin health. Reducing stress can also help manage hormone fluctuations that may contribute to acne breakouts. 

Prevention is Better Than Cure 

The best way to manage cystic acne is to prevent it from developing in the first place. Follow a consistent skincare routine, remove makeup before bed, cleanse your skin regularly, and never pick or squeeze acne, as this can lead to more inflammation and potential scarring. 

Cystic acne can be a stubborn and painful condition, but with the right medical treatments, clear skin is definitely possible. If you're struggling with this condition, it's crucial to speak to a doctor to find the best personalized treatment strategy for you.