The DM:
Dear derm,
I’m on the NHS waiting list to get cystic acne treatment. How can I help myself in the meantime?
Kate L
The Derm:
Dr Anjali Mahto, Consultant Dermatologist & Founder of Self London.
The Diagnosis:
Dear Kate,
This is a tricky one. Cystic acne can be challenging to treat, so it often requires intervention from a consultant dermatologist. Unlike milder forms of acne, cystic acne does not respond as well to over-the-counter treatments and often requires prescription medications due to its intensity and resistance. It’s more prone to causing long-term scarring and pigmentation issues, so early and effective treatment is crucial. The sooner we see you in clinic, the better. In the meantime, there are some products and ingredients I’d recommend to soothe and manage the condition (mentioned below).
Here’s what you need to know…
Recognise the signs
Cystic acne is a severe form of acne characterised by deep, painful, inflamed cysts beneath the skin’s surface. Unlike typical acne, which involves clogged pores and surface-level pimples, cystic acne forms when pores become clogged with oil, dead skin cells and bacteria, leading to large, swollen lesions. These cysts can be red, tender, and filled with pus, often taking weeks or even months to heal. Cystic acne commonly affects the face, but it can also appear on the chest, back and shoulders.
Cystic acne differs from other types of acne in its severity, depth, and likelihood of causing scarring. While typical acne forms as blackheads (open comedones) or whiteheads (closed comedones) on the skin’s surface, cystic acne develops deep within the skin. The lesions are larger, more inflamed, and more painful than regular pimples, as they form cysts filled with pus and can feel like firm nodules under the skin.
Consider the cause
This type of acne is often driven by hormonal changes, which is why it’s common in teenagers but it can also affect adults. Genetics can play a role, making some individuals more susceptible.
Speak to your GP or dermatologist about how best to treat it
Treatments may include prescription medications such as oral antibiotics or isotretinoin (commonly known as roaccutane) for severe cases. A newer, less invasive laser treatment called AviClear is also now approved for treatment to moderate severe acne. AviClear works in much the same way that isotretinoin does in that it targets the sebaceous glands to reduce their activity. However it does this without the use of any medication. This makes it particularly beneficial for those who don’t want to (or can’t) take medication. It’s also been revolutionary for a lot of my patients who are undergoing fertility treatments as AviClear is safe to use during this time.
Implement a derm-approved at-home skincare routine
In some cases over-the-counter treatments won’t have the impact needed to address cystic acne, which is why it often requires prescription medications. However, there are some ingredients that can help. Look for products containing salicylic acid such as the CeraVe SA Smoothing Cleanser, use a moisturiser such as the Purifide Microbiome Equaliser and incorporate Benozoyl Peroxide into your routine. Apply this after cleaning and before sunscreen and moisturiser.
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