Cystic acne

Cystic acne: what is it

Cystic acne, also called nodule-cystic or conglobata, is the most severe form of acne, an inflammation of the skin that affects the hair follicles and sebaceous glands and which commonly has the following characteristics:

• appearance of closed comedones (called whiteheads) and open comedones (also called blackheads) caused by the accumulation of sebum (material released by the sebaceous glands that helps to form the hydrolipidic microfilm that protects the skin) and dead cells that obstruct the outlet of the hair follicle on the skin surface
• presence of papules, lesions of the epidermis that manifest themselves as small solid reliefs
• appearance of pustules, that is, superficial pimples containing pus.

Both papules and pustules develop due to the excessive proliferation of bacteria in the follicles.

Cystic acne, in particular, is a rare form of disease, which can affect both sexes, with a preference for the male gender. It usually occurs during puberty, or later between 20 and 30 years of age.

It is characterized by the presence on the face of:

• subcutaneous nodules, resulting from the collection of secretions in depth
• cysts containing pus.

The size of nodules and cysts, which can be conglobated with each other and, in some cases, also affect the trunk and the upper part of the body, vary largely from subject to subject: they can range from 2-3 millimeters to several centimeters. These formations also tend to swell, can cause pain and lead to the appearance of permanent lesions and scars.

Unfortunately, cystic acne has a long course and often the symptoms persist for years, with a negative effect not only on the health of the skin, but also on the quality of life of those who suffer from it. The first side effect is certainly the psychological discomfort resulting from the appearance of one’s skin, which appears irregular and strongly compromised due to the ongoing inflammatory activity.

Causes of cystic acne

The direct causes of cystic acne are not yet known and it is therefore difficult to talk about prevention.

It is believed that it may be linked to a neuroendocrine stimulus that causes a hyper-activation of the sebaceous glands and, consequently, an excess of sebum production that generates the occlusion of the hair follicle. This facilitates the bacterial proliferation of germs normally found in the skin and inflammation of the follicle and gland, causing redness, pain, swelling and accumulation of pus.

Speaking in general terms, however, there are several recognized factors that can favor the development of acne, of which cystic acne is, remember, the most serious form:

• familiarity
• hormonal imbalance, which causes an excessive increase in testosterone in men’s blood and estrogen in women, typically during adolescence
• gynecological disorders, such as polycystic ovary syndrome
• stress, which increases the production of insulin, which in turn acts on hormones
• use of drugs such as corticosteroids, antidepressants, antiepileptics, steroids, folic acid, vitamin B12 etc.
• Contaminants
• Inadequate skin treatment, such as using greasy cosmetics and aggressive facial cleansing products or excessive rubbing.

Ingesting fatty foods, such as chocolate, cold cuts and cheeses, does not seem to be among the possible causes of acne. An unbalanced and too caloric diet, however, can worsen a disease already in place.

How to cure cystic acne

For the treatment of cystic acne it is necessary to proceed with a specific dermatological therapy. Although they are in fact appropriate measures for the care of the skin affected by inflammation, the use of topical products and DIY methods is not decisive.

The first step is to consult a dermatologist for a correct diagnosis. During the check-up, through the physical examination, the specialist will be able to detect the actual presence of nodules and cysts and establish the best way to proceed with the treatment. At this stage it is important to act promptly to prevent the formation of lasting lesions and scars.

The treatments indicated in case of cystic acne aim to reduce the production of sebum and prevent the obstruction of the follicles, allowing the regression of nodules and cysts in a period of time ranging from four to six months. In this way, there can be a progressive improvement of the symptoms and, finally, the recovery of the patient.

It is important to always consult your doctor before starting any treatment in order to evaluate any side effects and the possibility or not of taking certain substances during pregnancy.

In addition to pharmacological remedies, other remedies can be used to reduce the incidence of symptoms, such as micropeeling and photodynamic therapy. Healing, in these cases, however, takes place over a longer period of time.

Micropeeling is a chemical peeling that involves the application, before sleeping, of a serum at very low concentrations directly on the areas affected by cystic acne. Following the use of a cleanser on the skin, a few drops of transparent product are applied to a cotton pad, which must then be rubbed on the treatment area. Although at the beginning of treatment (first 4-8 weeks of application) you may notice an apparent worsening of your condition, in the long term the skin is “repaired”. To see the disappearance of comedones and small cysts, therapy must in fact be carried out for a few months under the observation of the doctor. Given the antiseptic action of the lotion, it is also not necessary to accompany micropeeling with the use of antibiotics.

Photodynamic therapy is based on the irradiation of the skin and the application of a photosensitizing cream by specialized doctors. The cream acts on the skin in depth, reaching the damaged cells, which are then destroyed thanks to the stimulus of a red LED light. The side effects of this treatment are limited; The most common are burning during sitting and prolonged post-treatment skin inflammation.

In combination with these treatments, the use of supplements can help sensitive skin to repel the aggression of external agents and regain its balance.

As already highlighted, in fact, if acne is treated promptly and effectively, the skin is able to regenerate and the disease leaves no trace of its passage. However, in the event that the therapy does not take place in time, the inflammation degenerates, is prolonged or aggravated by infections, there may be a risk of scarring, which give the skin an uneven appearance.

Acne scars are basically of two types:

• pigmented, i.e. represented by small spots that appear following the disappearance of pimples
• well-shaped, which are configured as small holes in the skin and appear following an accumulation of pus.

Although this is a purely aesthetic problem, to restore the surface of the skin to its original appearance there are several methods currently in use:

• fractional laser or Co2 laser (phototherapy)
• chemical peeling or chemical exfoliation
• filling of depressions through collagen fillers
• dermabrasion to eliminate the most superficial layer of the skin
• skin or fat grafts taken from the patient himself.

In addition, the removal of scars or the lifting of depressions can also take place through surgery.

Remedies for cystic acne

In addition to dermatological therapy, necessary to obtain an effective and lasting result, the specialist can provide some advice to promote the treatment of cystic acne, as well as to prevent greater damage. In particular, the following behaviors are recommended to the patient:

• Perform skin cleansing twice a day with the use of water and gentle, non-foaming products, in order to eliminate dead cells and excess sebum without causing irritation
• Avoid, where possible, rubbing the skin with the fabrics of the clothes. Low cut and cotton sweaters are indicated
• Do not use cream makeup, which tend to grease the skin, preferring powdered mineral ones
• Always remove make-up before bedtime to allow the skin to “breathe”
• In summer, avoid direct sun exposure of the area affected by cystic acne. To this end, it is good to use photoreflective mineral products, always preferring them to the use of sunscreens.