It is one of the biggest nightmares of puberty. (No! not heart-breaks. You get them even during your life in the toddler hood, childhood).  It is the most repulsive and avoidable condition. It is Cystic Acne.

To begin with, cystic acne can cause a lot of pain and misery to the patient. The chances of acquiring cystic acne are quite high during puberty and teenage years owing to the elevation of sex hormones which can affect the oil glands in the skin. As a result, a substantial amount of natural oil is released from skin, enough for America to be interested. The oil, along with the dead cells, provide bacteria the perfect feast to feed upon. The risk of bacterial infection increases tenfold, eventually resulting in acne.

During the initial stage, the symptoms of acne are mild but can become severe as treatment is delayed. This delay should be avoided as much as possible because it can promote inflammatory symptoms. The most commonly observed physical changes of the skin caused by acne are comedones. A condition that has made DYI artists famous over Youtube. The skin pores become blocked due to oil and dead skin cells resulting in either open (blackhead) or closed comedones (whitehead), papules which are small pimples or pinhead-shaped swollen units that can form rash, scars, and pus-filled cysts.

What is A Cyst?

As I said before, acne cyst is one of the most serious kinds of acne as it can penetrate through the layers of your skin. Even if it appears to be a small lesion, one must be cautious as it can set off a bacterial infection depending on how deep it can go within your skin.

A cyst is a sac-like space or cavity that contains fluid, air or any other molecules. Pus is usually the liquid formed in cysts, but it can be blood, oil, sweat or any other substance as well.

In most cases, cysts are non-cancerous and benign and can occur on virtually any part of the body. Since they are quite often harmless, they are often ignored, but in the case of acne, they represent a more serious problem than an ordinary bruise, scar or lesion.

They are physically similar to blisters which occur on the topmost skin layers and are caused due to frictional injuries. Moreover, they can become difficult to treat, and do not heal themselves, and therefore, need to be taken care of immediately, otherwise, they will result in redness or form deep scars.

A careless mistake such as popping a pimple, which admittedly we all have done at least once in our life, can cause the infection to spread resulting in more severe symptoms such as redness, rash and cause the bacteria to spread to other parts of the body, and result in inflammatory lesions all over the skin.

What Is Cystic Acne?

What is it? Cystic acne is a scarring type of acne with deep inflammation in the skin. It’s the most severe form of acne and something that you want to start treating early on. “There is a whole social impact and an emotional impact.

Types of Cystic Acne

Acne cysts evolve and go on to form either a cyst or a nodule, after starting from a papule. Symptoms of cystic acne will appear in various forms, such as;

Papule:

As you may already know, acne is found in mild, moderate, and severe forms. Papules and pustules are typically classified as moderate types of acne. Papules are small pimples or skin swelling that often results in blemishes, rash, and redness when papule effect in a small area on the skin in a cluster. Acne starts off as a tiny pimple called a papule, size of a pinhead, unlike cysts it does not contain pus or any other fluid, or molecules. It is just a small lesion that can appear in other shapes, sizes and even colors as well. They are not at all smooth and when touched can feel quite rough the skin can feel as papules that appear together can feel like a larger skin abrasion, causing a reddish appearance. Since they do not contain any pus, they are quite safe.

Cysts

Cysts are typically pus-filled sacs or pockets and quite often appear as a bump on the skin. They differ from nodule in the sense that they are not as rough as nodules and are filled with liquid-like substances. They are smooth to the touch and feel.

Cysts usually take some time to grow and can vary in shape and size, depending on how old the cyst is.

Acne cysts are usually responsible for inflammatory symptoms but are often painless. Cysts can form deep inside the layer as well, apart from the skin’ outermost surface, and can be filled with dead skin cells, bacteria and even oil secretions, known as sebum. Because of these infections, genetic diseases, duct blockage and even chronic inflammation can cause cyst.

Acne cysts are typically pus-filled sacs or pockets which quite often appear as a bump on the skin. They differ from nodules in the sense that they are not as rough and are filled with liquid-like substances. They are smooth to touch and can join together to create large scars. Acne cysts usually take some time to grow and can vary in shape and size, depending on how old the cyst is.

Acne cysts are usually responsible for inflammatory symptoms but they are often painless. Cysts can form deep inside the layer as well, apart from the skin’ outermost surface, and can be filled with dead skin cells, bacteria and even oil secretions, known as sebum. Because of this reason, cysts can be caused by infections, genetic diseases, duct blockage and even chronic inflammation.

When acne cysts form deep in the layer, the oil collected does not drain away easily, because it has a lot of ground to cover to reach the surface, due to which dermis infections take place. This can further cause scars and boils. One should not try to deal with cysts on their own, as it can further aggravate the condition by spreading the infection and causing further inflammation, and should be left to the dermatologist. So, please stop relying on Youtube as a consultant. If the acne cysts are popped, they cause the pus to release and spread to deeper skin layers, causing inflammation as a result.

Since the acne scars formed due to acne cysts are usually deeper than other lesions, they can be quite painful and difficult to treat, since more layers are involved and collagen gets damaged at deeper depths, which makes recovery more problematic. Some acne cysts can also involve surgery to treat, especially when standard medications and drugs fail to work.

Collagen is the main structural protein of connective tissue part of the skin, and if collagen gets severely damaged it doesn’t get replaced, and usually acne scar treatment requires silicone injections or exogenous collagen supplements. The space left by collagen damage is filled by scar tissue. Therefore, the more collagen gets damaged the bigger the resulting acne scar will be.

Acne cysts do change their shape and size with time and can disappear on their own. The exact cause of cysts in unknown but it has been thought that hormones play a major part in cyst formation. Therefore, cysts usually form during puberty.

Nodule

Nodules are generally a more serious cause of concern than simple pustules. If a basic pustule or papule is inflamed, it may result in nodule formation and can cause severe pain due to the fact that they most often get lodged beneath the skin. Nodules can develop deep in the skin and can penetrate to other organs in the body as well, such as the lymph nodes or thyroid gland. The most common areas for nodules to develop are groin, shoulders, lungs, armpits, and facial region. Nodules are formed when the skin gets unnecessarily aggravated.

Nodules are generally a more serious cause of concern than other acne lesions such as whiteheads, blackheads or pustules. Nodules can develop deep in the skin, and can penetrate to other organs in the body as well, such as the lymph nodes or thyroid gland, and can be felt deep in the skin, and do not present superficially. The most common areas for nodules to develop are groin, shoulders, lungs, armpits, and facial region. Nodules are formed when the skin gets unnecessarily aggravated. If a basic pustule or papule gets inflamed, it may result in nodule formation and can cause severe pain due to the fact that they most often get lodged beneath the skin.

Due to the areas nodules affect, they differ from a papule, but their similar appearance may cause confusion. While a papule most commonly affects the uppermost skin layers, a nodule affects the deeper skin layers. A papule is lodged epidermis layer, which is the skin’s outermost layer while a nodule affects the layer beneath epidermis known as dermis or the layer below it known as hypodermis or deeper layers. Because of how deep the reach is of a nodule it leaves a bigger impression on the skin in the form of scars of bruises.

Usually, nodules are benign but they can be cancerous as well. Nodules often disappear on their own but if symptoms such as increased heartbeat, difficulty breathing, weakness, fatigue, neck pain, or sweating and high fever present it is better to seek medical care at once. Due to the nature of some nodules, they may not be treated with simple ointments, cream or antibiotic medication and may require surgery. If a doctor wants to check the nature of it i.e whether it is cancerous or not, he may conduct a biopsy of the nodule, and may even suggest chemotherapy or radiation therapy. Dermatologists will most often advise patients not to press the nodules, because as they burst the infection may spread deeper and may result in a larger inflammatory response.

Nodules usually take longer to disappear compared to other skin lesions, ranging from weeks to even months in some cases, ultimately evolving to form cysts. Sometimes nodules and cysts can appear together when not all nodules are converted to cysts, giving rise to a condition known as nodulocystic acne. If not properly managed the condition can progress to a more severe form of acne known as acne conglobate. It causes a highly extreme form of inflammation which can occur with comedones, nodules, cysts and abscesses, pimples and whiteheads. Due to the massive variety of lesions it causes it causes massive inflammation. It is quite resistant and most treatments require anabolic steroids and quite often results in scars. It is not exactly known how or why this type of acne occurs, but evidence suggests it has to do with testosterone, therefore, most likely to occur in men.

Cysts and nodules are the basic cause of cystic acne but Pustules worsening results into cystic acne. However, nodules and cyst turn into conglobate and this process is confusing. We have addressed these knotty questions that come into your mind about cystic acne.

How Nodules Turn Into Cysts And Conglobate?

Nodules usually take longer to disappear compared to other skin lesions. It may take them from a week to months to exude itself in the patient, ultimately evolving to form cysts. Sometimes nodules and cysts can appear together in the case when not all nodules converted to cysts, giving rise to a condition known as nodulocystic acne. If not properly managed, the condition can progress to a more severe form of acne known as acne conglobata. It causes a highly extreme form of inflammation which can occur with condones, nodules, cysts and abscesses, pimples and whiteheads. Due to the massive variety of lesions it causes it causes massive inflammation. It is quite resistant and most treatments require anabolic steroids and quite often results in scars. It is not exactly known how or why this type of acne occurs, but evidence suggests it has to do with testosterone, therefore, most likely occur in men.

What Is The Difference Between Nodules And Papules?

Due to the areas nodules affect, they differ from a papule, but similar to a papule in appearance. While a papule most commonly affects the uppermost skin layers, a nodule affects the deeper skin layers. A papule is a lodged epidermis layer, which is the skin’s outermost layer while a nodule affects the layer beneath epidermis known as dermis or the layer below it known as hypodermis or deeper layers.

Because of how deep the reach is of a nodule it leaves a bigger impression on the skin in the form of scars of bruises. Usually, nodules are benign but can be cancerous as well. Nodules more often than not, disappear on their own but if symptoms such as increased heartbeat, difficulty breathing, weakness, fatigue, neck pain, or sweating and high fever prevail, it is better to seek medical care at once.

The nature of some nodules, they may not be treated with simple ointments, cream or antibiotic medication and may require surgery. If a doctor wants to check the nature of it i.e whether it is cancerous or not, he may conduct a biopsy of the nodule, and may even suggest chemotherapy or radiation therapy. Dermatologists will most often advise patients not to press the nodules, because as they burst the infection may spread deeper and may result in a larger inflammatory response.

What Causes Cystic Acne?

Causes that are responsible for cystic acne include:

  • Hormonal Cystic Acne

Hormonal changes are the culprit numbero uno behind cystic acne. They affect the adolescents and teenagers the most. Adult acne erupted as the reason of hormonal changes that causes hormonal cystic acne.

According to the American Academy of Dermatology, approximately 85 percent of people between the ages of 12 and 24 experience at least minor acne. The reason is that during puberty many changes are taking place in the body, most of which are driven by sex hormones. These sex hormones, which are the cause of hormonal cystic acne, also known as androgens cause changes such as:

  • Deepening of the voice.
  • Growth spurt.
  • Development of sexual characteristics.

Moreover, androgens activate and enlarge oil glands present on the skin and result in to an increased oil secretion. This excess oil secretion combined with dead skin cells and bacterial presence leads to acne.

Hormone-suppressing drugs are given as a treatment option so the excess oil secretion can be controlled. Unfortunately, though some hormonal changes persist or recur after an individual outgrows his puberty stage, and such men and women both can face hormonal cystic acne again.

  • Pregnancy Causes Cystic Acne

Cystic acne is just one of the messes a woman is served during pregnancy due to hormonal changes.

Hormonal surges are at their peak around the 6th week of pregnancy, during which progesterone, the female sex hormone involved in pregnancy, menstruation, and embryonic development which causes sebum producing pores to open, thus elevating oil secretions. Moreover, progesterone makes the body prone to retain water, thus increasing chances of suspended toxins in bodily fluids to cause an infection.

Moreover, the increased sebum secretion can deposit in hair follicles causing the pores to block, which can cause further deterioration of skin cells. The blocked pores combined with dead skin cells and bacteria lead to a pimple and pustule formation. Further aggravation can lead to cyst and nodule formation.

Pregnant women who suffered from acne during puberty and adolescent years can face a reoccurrence of acne.

  • Genes

Our genes also have a significant part in our risk of developing cystic acne.

A family history of cystic acne substantially increases the risk of developing the condition. The heritability is almost 80% in first-degree relatives. A positive family history is linked to earlier and more severe acne. Many studies have pointed that genetics play a vital role. Scientific evidence has shown that following genes are few of the many genes that can cause cystic acne.

  • Interleukin-1 alpha
  • Tumor Necrosis Factor-alpha
  • CYP1A1

Unfortunately, for individuals who have a family history of acne, have little chance of avoiding acne, but can discuss their situation with their dermatologist.

6. Lesion Infections And Acne

Lesions becoming infected seem like an obvious factor in acne formation, since the bacterial invasion, along with excess sebum secretion remains one of the most prominent causes of acne.

Bacterial Colonization Of Skin Layers

Even if a person suffers from a mild condition such as dry skin, bacteria can permeate the cracks in the skin, and lesions can become infected over time. Due to which many dermatologists advise against touching pustules or pimples, as it can cause bacteria to spread to other parts of the skin. One of the bacteria that contributes significantly to lesion infections is the Propioni bacterium acnes.

Acne Promoting Features Of P. Acnes

Genetic tests on the Propioni bacterium acnes have shown several proteins and enzymes that have skin damaging effects and activate immune system response.  The docile bacterium is naturally present on the adult human skin, feeding off fatty acids found in sebum secretions. It is found in few adolescents as well. When nodules and cysts are touched, there is a chance the bacteria might spread, aggravating inflammation and spreading the infection.

Due to such high risk of developing acne during pregnancy, women have to be extra cautious and make sure to keep skin moisturized, use a moisturizing soap, but be careful not to accidentally pop pimples or zits as it can cause infection to spread to other parts of the skin, thus spreading the infection.

  • Mental Stress And Cystic Acne

Mental stress has shown to exacerbate acne symptoms, but the exact biological mechanism by which stress induces acne is unclear.

Mental stress has no direct association with cystic acne; however, it can cause mild to moderate acne, which can lead to severe acne if other factors for cystic acne appears.

Some studies point towards an increased sebum production; other studies suggest that stress aggravates acne independent of sebum production. Other research has shown that hormone such as cortisol and glucagon, which are released in response to stress and low blood sugar levels, can cause acne symptoms to worsen. The National Institute of Health (NIH) already considers stress as a factor in acne formation.

  • Modulation Of Sebaceous Glands

A recent study carried out by Anita Rokowska-Waluch and co-workers on the modulation of sebaceous glands by certain mental stress levels published in Annals of Dermatology. According to the study, psychosocial modulation of systemic circulation levels of certain cytokines, hormones and peptides resulting in stress may have implications in terms of acne onset and severity. A detailed insight of how sebaceous glands act under the influence of neuromodulator altered by mental stress is discussed in the E-book based on acne.

  • Smoking Promotes Cystic Acne

Association between tobacco smoking and acne remains a mystery. The only thing a teenager could utilize to get away from the mental exasperation of acne is smoking.  But for cystic acne this is not a good escape, as smoking has an indirect association because of inflammation.

There is no direct association of cystic acne with smoking. However, smoking leads to mild to moderate acne, which can worsen, into cystic acne, if major factors behind cystic are prevalent in the user.

Past studies have shown no correlation or a weak association between the two. Many have stated that there is evidence to the contrary, as some studies have found a strong correlation between smoking and acne. A 2009 study has shown a strong correlation between tobacco smoking and non-inflammatory acne. By non-inflammatory acne, I mean comedones, more commonly known as whiteheads and blackheads, which develop because of hair follicles being filled with, dead skin cells, dirt, excess oil, or other impurities to develop into visible lesions.

Moreover, a 2012 study conducted on 17,345 Chinese adolescents and adults, found a significant association with adolescent acne and smoking. A recent study conducted by Dr. Bibeka Nand Jha, taking into account a Nepalese sample group, published in Advanced Research Journal of Life Sciences, highlighted the important finding that the severity of acne vulgaris was of greater grade as compared to the observed patients who were non-smokers.

Possible linkage Of Smoking-Related Carcinogens With Acne Outbreak

  • Accumulation of carcinogens and toxins.
  • Reduction of protective barriers of the body.
  • Unchecked production of sebum and bacteria.

It might be that smoking contains many carcinogens and other toxic chemicals such as tar and nicotine that can be suspended in blood especially in individuals who are smoking for several years. These chemical substances attack antioxidants and other protective molecules and cells in the body, thereby increasing chances of radical, sebum and bacteria accumulation in the capillaries providing nutrients to the skin, they not only cause the skin cells to die but also increase chances of acne.

Furthermore, these chemicals have been known to interfere with the body’s natural healing process, forcing cells to take a longer time to properly regenerate which can lead to scarring, delayed skin reformation, and a potent inflammatory reaction, all of which are signs of poor skin health.

Why Is It Necessary To Seek Help For Cystic Acne?

When cysts form deep in the layer, the accumulated oil does not drain away easily, because it has a lot of ground to cover in order to reach the surface, due to which dermis infections take place, which can further cause scars and boils. One should not try to deal with cysts on their own, as it can further aggravate the condition by spreading the infection and causing further inflammation, and should be left to the dermatologist. If the acne cysts are popped, they cause the pus to release and spread to deeper skin layers, causing inflammation as a result.

Since the scars formed due to acne cysts are usually deeper than other lesions, they can be quite painful and difficult to treat, as more layers are involved and collagen gets damaged at deeper depths, which makes recovery more problematic. Collagen is the main structural protein of connective tissue, and if collagen gets severely damaged it doesn’t get replaced, and usually require silicone injections or exogenous collagen supplements. The space left by collagen damage is filled up by scar tissue. Therefore, the more collagen gets damaged the bigger the resulting scar will be.

Acne cysts do change their shape and size with time and can disappear on their own. The exact cause of cysts is unknown but it has been thought that hormones play a major part in cyst formation. Therefore, cysts usually form during puberty. Evidence has shown that roughly washing your skin can break the skin causing acne. Therefore, one should be careful while washing hands, and use moisturizing soap when possible.

Importance Of Early Cystic Acne Diagnosis

If acne progress and symptoms become severe leading to cystic acne it is vital to seek immediate medical help. The simple reason behind is that cystic acne causes aggravated inflammation and usually leaves behind a lot of deep scars as nodulocystic acne affects deep skin layers.

Furthermore, the longer the treatment is delayed, the more difficult it will be to treat cystic acne. Since cystic acne is so deep that they can almost be felt beneath the skin, squeezing or triggering the lesions, or treating with creams or ointments is a fruitless task, and can further aggravate the condition, making the healing process longer to complete. Therefore, patients usually have to take antibiotics, or strong steroid medication to manage the symptoms. This can often be a challenging chore, as these medications often have side effects of their own. Also, resistant acne takes a lot of patience to completely heal, in which case doctors take a full history of patients with questions such as:

  • When did you first observe the symptoms?
  • What diet were you taking?
  • The current medication the patient is on?
  • Any particular side effects developed by the use of any medicine?

If treatment seeking individuals need to for some reason quit treatment beforehand, they need to inform their doctor beforehand, because in doing so, could cause some serious unwanted complications.

Diagnosing severe form of acne is also necessary to rule out other diseases, which may be present in the form of acneiform eruptions and may present what clinicians label as “non-responding acne.” According to a study conducted by Clio Dessinioti and Andreas Katsambas, published in Clinics in Dermatology, acne may present itself in rare forms (other than acne conglobata and acne fulminans) which can be because of other syndromes of human beings some of which are:

  • Congenital Adrenal Hyperplasia (CAH).
  • Pyogenic Arthritis, Pyoderma gangrenosum Acne syndrome (PAPA).
  • Synovitis.
  • Pustulosis etc.

Principles To Live By

There are numerous treatments and management options for the people suffering from severe acne but regardless of that, there are some simple principles to live by including simple day to day lifestyle options that will help you live with acne as it is being treated with one or other of the treatment options.

  • Don’t mess with the cysts nodules and do not attempt to pick them because what you see is just the tip of the iceberg and there is a lot of things going on down under which if disturbed can allow the infection to spread further and deeper leading to scars.
  • Acne feeds on stress as stress is related to the excessive release of hormones in the body which will allow the acne to thrive and become more severe.
  • Lifestyle should be healthy, active and nourishing for the mind, body, and especially skin. This can be obtained by keeping check of the sleep cycle and choosing a diet with low glycemic index.