Hi everyone, we had such great feedback from the last post regarding skincare. My husband wanted to bring his insight on what can help acne breakouts. It’s a reoccurring problem that so many people face.
Cystic acne is extremely common. Cysts are firm, deep bumps that are often tender. Unfortunately, the cysts often resolve with scars, so therapy is typically aggressive to prevent new bumps. Cystic acne is common with teenagers. However, often females with no history of acne will develop cysts in the early to late 20s.
In females, cystic acne related to hormones tends to flare prior to menstrual cycles. Common sites include the chin, cheeks, and jawline. The bumps often resolve with dark spots and/or scars. In females, cystic acne is sometimes a sign of polycystic ovarian syndrome (PCOS). Hormone irregularities lead to something called hyperandrogenism (i.e higher hormones like testosterone). This can result in abnormal hair growth, including hair on the back and chin. This can also cause abnormal menstrual cycles (changes in blood flow or length of the cycle). Of note, most females with cystic acne do not have PCOS.
Treatments for hormonal acne commonly include birth control, Spironolactone, Metformin, and topical Dapsone (“Aczone”). Hormonal birth control methods (oral contraceptive pills, some IUDs, injections, etc) help normalize hormone levels. However, not all birth control help acne. Some forms (i.e shots) can actually worsen acne.
Spironolactone is a pill that was originally developed for high blood pressure. However, it also blocks hormone receptors that play a role in acne. Aczone is also called topical Dapsone. It has been shown to be effective in cystic acne related to menstrual cycles. Aczone, a topical gel, is a great opton for patients who prefer to avoid taking pills.
Some cystic acne has no association with hormones. These patients still require oral antibiotics because the bumps are deeper in the skin (topicals cannot penetrate very far). Patients that fail to respond to oral antibiotics may require Isotretinoin. Accutane is the common brand name used to refer to Isotretinoin. This medication is very effective, but requires close monitoring for side effects.
Some patients may only get a few cystic bumps per month. These patients tend to best be treated with injections of glucocorticosteroids into the bumps. The needle is very tiny, so the pain of the injections is minimal. The injections decrease the inflammation (redness, irritation), and thus decrease the risk of scar.
Rarely, oral steroids or intramuscular steroids can be given if a cystic breakout occurs around the time of a big event such as a wedding or prom. Steroids can have many side effects so are only given on a limited basis.
Please post any questions to the blog. If you would like to be seen in clinic, please contact Tiffany and we can set up an appointment.
My next topic will be “Diet and Acne.” If you have any other suggested topics, please post on the blog page.