Cystic-acne sufferers know that a cyst is not the same beast as a standard pimple. While whitehead pimples sit on the surface of the skin (which, though unsightly, means they’re easier to treat and conceal), cysts can linger under the surface of the skin like oil-filled balloons, growing bigger and more inflamed over time. The scarring can be severe, too, making skin appear pockmarked and fissured, which is why dermatologists approach it with a powerful combination of topical treatments and antibiotics, moving on to scorched-earth methods like Accutane or a hormonal drug like Spironolactone if those fail.
Inflammatory Acne: Inflammatory acne is red bumps and pustules, not whiteheads, blackheads and comedones. It doesn't necessarily start as them, either. It arises on its own. Whiteheads, blackheads or comedones that become inflamed can be painful and unsightly. Persistent inflammatory acne may require treatment by a physician or dermatologist, in addition to over-the-counter acne remedies.
Isotretinoin is an oral retinoid that is very effective for severe nodular acne, and moderate acne that is stubborn to other treatments. One to two months use is typically adequate to see improvement. Acne often resolves completely or is much milder after a 4–6 month course of oral isotretinoin. After a single course, about 80% of people report an improvement, with more than 50% reporting complete remission. About 20% of patients require a second course. Concerns have emerged that isotretinoin use is linked with an increased risk of adverse effects, like depression, suicidality, anemia, although there is no clear evidence to support some of these claims. Isotretinoin is superior to antibiotics or placebo in reducing acne lesions. The frequency of adverse events was about twice as high with isotretinoin, although these were mostly dryness-related events. No increased risk of suicide or depression was conclusively found. Isotretinoin use in women of childbearing age is regulated due to its known harmful effects in pregnancy. For such a woman to be considered a candidate for isotretinoin, she must have a confirmed negative pregnancy test and use an effective form of birth control. In 2008, the United States started the iPLEDGE program to prevent isotretinoin use during pregnancy. iPledge requires the woman under consideration for isotretinoin therapy to have two negative pregnancy tests and mandates the use of two types of birth control for at least one month before therapy begins and one month after therapy is complete. The effectiveness of the iPledge program has been questioned due to continued instances of contraception nonadherence.
For an overnight solution or something that covers a larger surface area (rather than a smaller spot-treatment), Zeichner also recommends Neutrogena’s rapid-clear leave-on mask. The idea is that you spread benzoyl peroxide all over your face, but it’s not a wash-off mask, so you’re getting a prolonged exposure to the antibacterial peroxide. He says it’s helpful for treating the pimples you have and preventing new ones from popping up.
Do a Google search for "how to get rid of acne fast" and you'll see plenty of websites telling you to eat better for clear skin. But are there really foods that cause acne, or is that an old wives' tale? Dermatologist Hilary Baldwin, MD, of the Acne Treatment and Research Centre in Morristown, New Jersey, says the answer isn't really simple at all. "The simple answer is, we don't know. So far studies have suggested that high-glycemic index diets (those with lots of white foods like potatoes, pasta, bread, rice and sweets), as well as diets high in skim-milk dairy products and whey protein supplements might be associated with worsening of existing acne but are less likely to cause acne," Baldwin says.
What's Going On: If it's big, red, and painful, you're probably experiencing cystic acne, one of the more severe types. "Cystic pimples are caused by genetics and hormonal stimulation of oil glands," says Zeichner. Not only are they large, but they're also notoriously tough to treat. They often recur in the same place, because even if you manage to get rid of one, it can keep filling up with oil again and again, like an immortal pimple.
This article was medically reviewed by Hilary Baldwin, MD. Baldwin, medical director of the Acne Treatment Research Center, is a board-certified dermatologist with nearly 25 years of experience. Her area of expertise and interest are acne, rosacea and keloid scars. Baldwin received her BA and MA in biology from Boston University. She became a research assistant at Harvard University before attending Boston University School of Medicine. She then completed a medical internship at Yale New Haven Hospital before becoming a resident and chief resident in dermatology at New York University Medical Center.
Acne vulgaris is a chronic skin disease of the pilosebaceous unit and develops due to blockages in the skin's hair follicles. These blockages are thought to occur as a result of the following four abnormal processes: a higher than normal amount of oily sebum production (influenced by androgens), excessive deposition of the protein keratin leading to comedo formation, colonization of the follicle by Cutibacterium acnes (C. acnes) bacteria, and the local release of pro-inflammatory chemicals in the skin.
Retinoids and retinoid-like drugs. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.