Cystic Acne Treatments At A Glance
- Best Results1-3 sessions
- Treatment Recovery0 - 2 days
- Procedure Time10 - 20 minutes
- Skin SpecialistMedical dermatologist, nurse
- Duration of ResultsRemission in most
- Back to WorkImmediately
- Cost$- $$
Cystic Acne Treatments
Acne cysts can occur in many locations including the face, neck, chest & back. Acne cysts can range from small cysts, called microcystic acne, thru to large inflammatory cysts. Early & effective management will reduce acne scars.
FactsFacts on laser for acne cysts
- Acne cyst range in size, amount & type
- Micro-cystic acne measure between 1 to 2.5 mm in diameter
- Small cysts are best treated & extracted by laser
- Large cysts maybe associated with scarring & respond best to anti-inflammatory injections & tablets
- Acne cysts can also be treated with vitamin A topicals or tablets
- AviClear laser due in 2023 offers a quick, effective & side effect free treatment for cystic acne
Why do acne cysts occur?
Acne cysts are common, and occur in over 50% of acne cases. Cysts form as part of the ‘skin surface’ occurring under the skin. Cyst are usually lined with a cyst wall, consisting of skin cells and lie in the deeper parts of the skin.
How do I know if I have cystic acne?
Acne cysts are commonly seen in patients with moderate to severe acne, but can also occur in milder forms of acne. Acne cysts are lumps on the skin that range from 0.5 mm (microcysts) thru to 2-3 cm inflammatory cysts. Patients with larger cystic lesions are more prone towards acne scars.
Microcysts can be difficult to diagnose, as they occur in the deeper layers of the skin. Microcystic acne usually occurs on the chin and cheek areas, and usually presents are multiple deep lumps measuring 1 to 2.5 mm in diameter. They are more prominent if the skin’s surface is stretched. Given the depth of the cysts, they do not resolve with creams, microdermabrasion or chemical peels. The good news is that they are easily removed with laser treatment.
What treatments are available to treat acne cysts?
Acne cyst treatments will depend on the type & size of cysts. Cysts can be classified as inflammatory (red, angry and of sudden onset), or microcysts (tiny and persistent acne cysts on the cheeks and chin area).
Intralesional anti-inflammatory injections – This technique is used to treat large inflamed acne cysts. Injections are painless, and most cysts will subside within a day or two. Ideal for large, red, cysts on the face, neck and back areas.
Laser treatment with Erbium Spot- this is our specialist technique for treating smaller deeper cysts. Micro cystic acne or comedomal acne is notoriously difficult to treat. These microcysts may number in the hundreds, and are frequently located on the cheeks, chin, and forehead areas. They lie deep in the skin, and are more visible if you stretch the skin, or cause pressure from underneath. (For example, push your tongue in your cheek)
An erbium laser is a highly accurate method of cyst removal. Erbium laser drills a very tiny hole in the skin’s surface and targets the cyst wall.
Excision of cyst– this treatment is undertaken by a Plastic Surgeon. As part of the team we enrol the assistance of a plastic surgeon to remove deep, persistent, and hard cysts located in complex areas such as the cheek and chin area.
Anti-inflammatory medications– this can reduce the number of acne cysts. Your Specialist Dermatologist will discuss this technique if you have multiple cysts. Most anti-inflammatory medications will need to be taken over a period of weeks to months.
Accutane is another treatment option for cystic acne.
Lasers & cysts
How can laser treat acne cysts?
A new acne specific laser is due in 2023. AviClear uses the power of laser light to target the oil gland- the cause of cystic acne. 3 sessions can reduce acne by over 85%.
What is Kleresca?
Kleresca is an old fashioned treatment for cystic acne that has been re-branded & marketed for commercial purposes.
This treatment is known as photodynamic therapy. It uses a chemical that is absorbed by the cyst. This chemical is then activated by blue light. I don’t like this treatment because it can cause staining of the skin- especially in darker skin types.
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How long will it take for my skin to heal after laser treatment?
Healing time will depend on several factors including the depth of the cysts, the number of acne cysts treated, and individual factors.
Small micro cysts take 2-4 days to heal following laser.Tiny scabs may form for the first 2 days. We will go thru the post laser skin care regime during the laser procedure. In some cases (if lots of acne microcysts are treated) we may give you a short course of antibiotics after treatment.
Larger cysts may take 3-7 days to heal following steroid injections.
Will acne cysts return after laser treatment?
Most cysts will NOT return after laser. This is because laser permanently destroys the cyst wall. Some patient may have hundred or even thousands of acne micro-cysts and several treatments maybe needed for optimal results.
Accutane can be considered in severe cases of cystic acne.
Preventing acne cyst formation is very important. AHA, BHA peels, Vitamin A creams and tablets can help.
Can Roaccutane/ Oratane / Accutane treat acne cysts?
Yes…buy- it can also flare up cystic acne. Think of Roaccutane or Oratane as a method to shrink down the oil glands. Oil (sebum) cannot just disappear, it must either be pushed out, or absorbed back. If you have closed cysts, Roaccutane can temporarily worsen, or flare up acne, before improving it.
Our dermatologists will provide a tailored regime to minimise the chance for flare -ups. This may involve taking anti-inflammatory medications, or a series of erbium laser drilling, or even a simple (but painless) injection. Treatment will depend on the type of cyst you have.
Will skin care be enough to treat cystic acne?
Probably not, but you can give it a go. Here’s a simple acne skincare routine;
AM: Wash, azelaic acid.
PM: Salicylic acid 2 % wash, retinol. Option for adapalene gel.
It takes 6-8 weeks for skin care to work, with maximal results at week 12 to 16.
What is AviClear & why do dermatologist advocate it?
The most predictable way to treat cystic acne is with Accutane. This drug has many side effects. Dermatologists are always trying to find new ways to treat cystic acne without side effects.
AviClear is due in Australia in 2013. It provides a drug free method for treating all forms of acne including cystic acne. AviClear uses laser light to selectively destroy the oil gland- the cause of cystic acne.
Can acne cysts be associated with acne scars?
Cystic acne has a higher incidence of acne scars, especially if the cysts are large. Smaller cysts (microcystic acne) is not usually scarring, however if you pick deep cysts, scarring may ensure.
Large acne cysts are best treated with injections, anti-inflammatory antibiotics and possibly Roaccutane.
Smaller cysts can be extracted with erbium laser.
How long will it take to see results?
As a guide, cystic acne treatments takes time to work.
Skin care: up to 4-5 months for optimal results.
Accutane: 2-8 months for best results.
Laser drill of cysts: 1-3 weeks.
AviClear laser: 1-2 months.
What are other tips to manage cystic acne?
Lifestyle choices are super important as they can accelerate clearance of cystic acne. In some cases even cure acne.
Diet: eat no sugar, no skim milk, avoid whey protein, avoid processed foods.
Vitamins & supplements include zinc sulfate.
Make up: mineral or oil free solution. Let your skin breathe for at least 2 make up free days per week.
Water intake: RDI
Do I need a referral to see a dermatologist?
A referral from your GP would be ideal, as a referral will enable you to claim part of the consultation fees. Additionally some procedures such as injections, surgery & laser for acne scarring can be partially claimed on Medicare.
Davin’s Perspective on treating acne cysts
The treatment of acne cysts will depend on the type of cyst. Large inflammatory (red & angry) cysts are treated with a course of steroid injections and antibiotics which can reduce inflammation. Smaller, more resistant cysts located on the cheek, and chin areas are best extracted. These small cysts (microcomedones) lie in the deeper layers of the skin, and are usually resistant to chemical peels, microdermabrasion, and creams.
We use a technique called erbium drilling (sounds painful, but it isn’t) to extract these cysts. A 1mm erbium spot laser is used to drill a very tiny hole in the skin’s surface. The laser provides an avenue to extract the cyst wall and it’s contents, and once treated, cysts are gone! Laser treatment of cysts is painless because we use a local numbing cream, and side effects are very, very rare. Deeper isolated cysts that are hard and lumpy are best excised. I usually work in with a plastic surgeon to remove these types of cysts.
Of final note, preventing cysts from recurring is very important, vitamin A, either in a cream or tablet can be very effective.
Disclaimer: I do not treat acne nor do I treat acne cysts. My work is focused in the management of severe & recalcitrant acne scars. For treatments of cysts, please consult my medical colleagues or the clinical team @cliniccutis
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