Cystic or nodulo-cystic acne is a severe type of acne marked by painful, red, irritated breakouts on the face and body often leading to pitted scars if left untreated.
The pimples and pustules of cystic acne are raised, red and filled with pus. Sometimes the lesions extend deep and merge together to form nodules, hard painful lumps underneath the skin. Nodules are difficult to treat with conventional medical treatments, very slow to heal and frequently lead to deep scarring.
The causes of cystic acne are not completely understood but genetic predisposition seems to play a part in predicting incidence.
A few factors make cystic acne worse in genetically predisposed individuals. These include hormonal changes or imbalances, certain dietary ingredients, humidity, sweating etc. Cystic acne is more common in teenagers, boys more than girls .
A multi desiplinary approach to treating cystic acne works best for long term management of lesions and prevention of scarring.
I combine Lifestyle modification (dietary consideration, vitamin supplements, stress management, adequate skin care) with 6 to 10 weeks of prescription oral antibiotics to control inflammation. I also incorporate office treatments like regular cyst extractions, Medical microdermabrasion and Medicated Chemical peels to improve surface texture and reduce cyst formation.
In our practice, for patients who do not respond adequately to the above measures, 2 to 4 sessions of Photodynamic Therapy (PDT) performed four weeks apart provide satisfactory results. Most of our cystic acne patients who underwent Photodynamic Therapy had over 90% reduction of cysts, nodules and inflammation. Combining this type of treatment with microdermabrasion leads to improvement in skin texture and reduction of scars.
For Photodynamic Therapy we combine ALA (Amino Levulinic acid ) application with Intense Pulse Light. There is relatively little downtime following this treatment, some patients may experience mild to moderate redness, flaking and peeling of the treated area for 2-5 days following the treatment. This treatment is very well tolerated provided the patients follow the post treatment instructions carefully. It is essential to avoid sunlight exposure for at least 48 hours after the treatment.
Some women are given medications like Spironolactone or oral contraceptives to regulate hormonal imbalance. I personally do not prescribe oral contraceptives or Spironolactone for acne due to the undesirable side effects from these medications.
Accutane has been used for many years to successfully treat cystic acne. I do not prescribe Accutane due to the large number of potentially dangerous side effects from Accutane. Studies indicate comparable treatment success rate from accutane and PDT. Cost of PDT is comparable to Accutane as well with none of the side effects so commonly reported with Accutane.
For pitted acne scars, CO2 fractional laser resurfacing works very well in reducing surface irregularity and filling in the deep defects. For severe scarring, most people need more than one session of resurfacing.
Mild acne scarring can be improved with a series of medical microdermabrasion and chemical peels.
For further information on Photodynamic Therapy for cystic acne visit our website or call our office at 888-210-9693 for an appointment.
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