Question 1: How do I get rid of cystic acne?
ANSWER: Cystic acne is usually a result of hormones, stress and diet. The cysts are deep, and often tender or even painful, and they tend to stick around for what feels like FOREVER! If you try to pop them, nothing comes out because they’re not connected to the surface. You usually end up making things worse. When the cysts resolve, they leave marks that can sometimes last for weeks or even months.
Ok, enough doom and gloom. What can we do to treat or prevent cystic acne? Although the typical acne creams with retinoids and benzoyl peroxide can’t hurt, they don’t do much in cases of cystic acne. To treat cystic acne, it’s best to use a multimodal approach. First, diet and stress are key factors in this kind of acne. More on how to make some dietary and lifestyle changes that will help prevent cystic acne below. Second, many of my patients with cystic acne benefit from prescription hormonal medications such as birth control pills or a medication called spironolactone. If you’re going the birth control route, you should make sure your pill contains BOTH estrogen and progesterone. Progesterone only forms of contraception (the “mini-pill,” implantable devices and even some IUDs can make cystic acne MUCH worse). Spironolactone has literally been a game changer in my practice. It’s a pill you take every day that blocks the effects of male hormones on the skin, and can dramatically clear up adult female acne. But I like to keep the doses low and to do that, I need to make sure my patients are following the right diet and reducing their stress levels as much as possible. That’s one of the reasons I wrote The Beauty of Dirty Skin (link below). It’s easy to write a prescription, but diet and stress management is complicated! You can write chapters on those topics… so I did! Last, I like to tackle cystic acne using minimally invasive procedures in my office like cortisone injections, chemical peels and light-based therapies.
Question 2: Is there anything other than Retin A, cortisone injections to treat cystic acne? What preventative steps can be taken in terms of diet and lifestyle?
ANSWER: Cortisone injections can be amazing if you can get in to see a derm, but that’s easier said than done for most people! When it comes to diet, it’s essential to avoid skim milk, as this has been shown in a number of studies to trigger acne. But also beware of milk proteins that might sneak their way into your diet: whey and casein can play a major role in acne for some people, and they are commonly found in protein powders and “healthy” bars that are high in protein. High cortisol levels can also make cystic acne lesions explode all over your chin. It’s essential to start making lifestyle changes that drop those cortisol levels and keep them in a healthy range. One tip for doing that is incorporate regular exercise. Regular exercise reduces stress levels very effectively and helps you sleep better (which in turn further reduces your stress hormone levels in your blood).
Question 3: Are regular treatments like peels or lasers something that should be considered to minimize future cystic acne breakouts and/or reduce residual scarring?
ANSWER: Absolutely! My patients who can afford to get regular peels and light-based therapies see a huge difference in their skin FAST. Salicylic acid chemical peels combined with Theraclear (also called Acleara) light treatments are incredibly effective and work FAST. In my practice, I use a number of lasers and devices to improve acne scarring and minimize pore size, including Fraxel, Endymed Intensif and Microneedling. However, these treatments can be costly and those costs can add up. Even without these therapies, if you use the right skincare products and make certain lifestyle changes (detailed in my book – The Beauty of Dirty Skin), you can achieve beautiful, radiant skin on any budget!