It's easy to see how someone who develops cystic acne would think it's just plain unfair. Many of the people who develop unsightly, painful, red, infected cysts on their faces and necks in late adolescence or early adulthood started out with beautiful skin.
Richer, deeper, brown and black skin tones seem to act like some kind of cyst magnet. And just about everything you would naturally do to treat cysts at least temporarily makes them worse. Cystic acne is surprisingly common and surprisingly hard to treat.
What is a cyst, exactly?
A cyst isn't a collection of pus. Technically, that's an abscess. A cyst is an encapsulated collection of dead skin cells, dead white blood cells (the pus part), and (we hope) dead bacteria, all surrounded by a thick membrane.
Cysts can also contain fluid or even air. Acne cysts form as a result, usually, of infection with a kind of bacteria known as Proprionibacterium acnes.
This microbe grows on the skin of newborns, briefly, and then colonizes the skin of the face and neck again about 12 to 36 months before puberty. Most of the time there are just 100 or so of these bacteria on a square centimeter (or a mere 250 germs per square inch) on healthy skin.
When the skin makes extra oil, however, as it does to lubricate itself during the adolescent growth spurt, acne bacteria multiply. Teenagers start hosting about 1,000,000 acne bacteria per square centimeter of skin when acne starts to break out.
Just having acne bacteria on your skin, however, does not necessarily result in acne breaking out. The redness and inflammation you see when you break out in zits is really the result of your skin's immune system reacting to the bacteria, rather than the bacteria themselves.
White blood cells in the skin secrete inflammatory chemicals to kill the excessive numbers of acne bacteria, but the acne bacteria secrete their own chemicals that make the inflammatory agents aimed at them attack healthy skin, instead.
Usually this process occurs in a pore. If the pore can drain, eventually both the bacteria and the white blood cells and the inflammatory chemicals are flushed out.
The problem is that pores in the skin have a "neck," where bacteria can get trapped. If the healthy skin around the pore grows over it before it can drain, then a cyst can form.
Why do people who have beautiful skin tend to be the ones who get cystic acne? The problem comes when the growth of the bones and muscles underlying the face is complete, usually at ages 19 to 23 or so. At this point, the skin doesn't need to keep expanding. Pores that were kept open naturally by the slow expansion of the skin now don't have growing skin tugging at their edges to keep them open. And because people who get cystic acne often have small pores and basically healthy skin, the pores get sealed up and cysts ensue.
Prevention is always better than cure. If you are a teen and you have great skin, make sure you keep it that way. Gently cleanse and exfoliate your skin every day.
Don't use alcohol on your skin. That dries skin and locks pores tight. Don't rub your skin or use any kind of detergent soap (with big bubbles, you need cleansers that make small bubbles) on your skin, for the same reason.
Treat pimples just as soon as you see them. Products that have benzoyl peroxide usually are not optimal for your skin. Anything stronger than 2.5% benzoyl peroxide can irritate your skin--locking bacteria inside the pores you are trying to treat--and benzoyl peroxide can dry your skin out.
While natural isn't always better in skin care, in preventing cystic acne, natural products tend to work better. Tea tree oil, for instance, will both kill bacteria and relieve redness and inflammation. (Don't give tea tree oil to children who haven't reached puberty, though. It's only appropriate when the skin is stimulating by surging sex hormones.)
Calendula soaps will kill both acne bacteria and staph bacteria, the kind of infection that makes pimples with a "yellow head." Use a moisturizer if you spend a lot of time in the sun, especially on the sides of your face. Just be sure the product is mostly water, not mostly alcohol.
Also, it's important to avoid foods that you know can cause skin irritation. You may be sensitive to chocolate (especially the dark kind) and colas, or you may not. But if you know something makes you break out, don't eat or drink it!
What can you do after you already have cystic acne?
The most important thing to remember is not to pick at it or mash it. All you accomplish when try to mash pimples, usually, is irritating the skin around the pore even more. And if you do break a cyst open, it will hurt, and you will be spreading bacteria all over your face.
There is another way to go about treating cystic acne. It's slower, but you won't wind up making a bad problem worse. Make sure you get vitamin A in your diet. The tried and true vitamin A food is cod liver oil. Most teens (outside of Scandinavia) will turn up their noses and utter "Eww" (or something like that) when offered cod liver oil. But eating some carrots, sweet potatoes, squash, or pumpkin every week will help keep your body supplied.
It also helps not to take vitamin E, unless you have some other medical condition that requires it, and not to overdo your consumption of tomatoes. Especially if you have fair skin, two much vitamin E and too much lycopene increase the skin's production of sebaceous oils. This puts more junk in your pores.
Cystic acne sufferers may also want to consider Retin-A. There are lots and lots of side effects to the standard dosage of Retin-A. However, there is a kinder and gentler over-the-counter version of Retin-A out now known as tretinoin topical. It's not cheap, but it's a lot less expensive than the stronger, doctor-prescribed version of the skin treatment.
Tretinoin topical is strictly for external use. But if you use it as directed, you won't have the skin irritation and inflammation that the prescription version causes, and it may slowly help your skin open up over a cyst so that it drains naturally, no lancing required.
Since the treatment works by stimulating skin growth, you may temporarily wind up with blackheads or pimples popping out where you had a cyst. To stop this from happening, you need to use your alcohol-free moisturizer and you still need to treat infections (see the references to benzoyl peroxide, tea tree oil, and calendula above) as soon as you see them. But typically the treatment doesn't leave a scar, as poking cysts with a pin or trying to lance them at home almost certainly will.
Cystic acne is a major cosmetic issue, but it is possible to get past it. Prevention is preferable, but treatment is possible. Just remember that if it hurts, it doesn't work. Anything that draws blood or causes pain is a self-treatment for cystic acne you want to avoid.
Image credit: US Food and Drug Administration, via Wikimedia Commons.